vermontmoms Posted February 16, 2012 Report Share Posted February 16, 2012 Has anyone's PANDAS kids had positive strep rapid tests but ASO titers stay low? Link to comment Share on other sites More sharing options...
Buster Posted February 16, 2012 Report Share Posted February 16, 2012 Has anyone's PANDAS kids had positive strep rapid tests but ASO titers stay low? Yes. Take a look at this thread: http://www.latitudes.org/forums/index.php?showtopic=3756&st=0#entry29305 In 2003 by Shet and Kaplan found that ASO rises in 53% of patients with culturable strep (i.e., about the same as a coin flip). Buster Link to comment Share on other sites More sharing options...
vermontmoms Posted February 16, 2012 Author Report Share Posted February 16, 2012 Thanks! Have any changes happened since Jan 2011? Link to comment Share on other sites More sharing options...
airial95 Posted February 16, 2012 Report Share Posted February 16, 2012 Yes! My son has had over a dozen or so positive cultures over the last 2 years during our journey and NONE of his titers have been elevated at any time. He also has maddeningly normal immune workups - showing no deficiencies or ANYTHING out of the normal range. Yet he is a severe, and textbook, case of PANDAS. Link to comment Share on other sites More sharing options...
Buster Posted February 16, 2012 Report Share Posted February 16, 2012 (edited) Thanks! Have any changes happened since Jan 2011? There was a paper Feb 2010 by Leckman and Kaplan titled "The Human Immune Response to Streptococcal Extracellular Antigens: Clinical, Diagnostic, and Potential Pathogenetic Implications." (see http://cid.oxfordjournals.org/content/50/4/481.full) that also found a considerable failure of ASO to rise in documented and controlled experiments. The big statement is: "Of the previously mentioned 58 new GAS acquisitions, 36 (62.1%) were associated with a significant increase in ASO and/or ADB titer. However, only 28 of these acquisitions were associated with an increase in ASO and 28 with an increase in ADB." This means ASO rose in only 48% of cases. So a rise in ASO is confirmatory of a prior strep infection. A failure to rise doesn't seem to be meaningful (i.e., it doesn't happen in 52% of the time in the above cases of confirmed infections). Is that recent enough? This is remarkably similar to Shet's numbers -- so really a rediscovery but very recent. Buster Edited February 16, 2012 by Buster Link to comment Share on other sites More sharing options...
EAMom Posted February 16, 2012 Report Share Posted February 16, 2012 (edited) Thanks! Have any changes happened since Jan 2011? There was a paper Feb 2010 by Leckman and Kaplan titled "The Human Immune Response to Streptococcal Extracellular Antigens: Clinical, Diagnostic, and Potential Pathogenetic Implications." (see http://cid.oxfordjournals.org/content/50/4/481.full) that also found a considerable failure of ASO to rise in documented and controlled experiments. The big statement is: "Of the previously mentioned 58 new GAS acquisitions, 36 (62.1%) were associated with a significant increase in ASO and/or ADB titer. However, only 28 of these acquisitions were associated with an increase in ASO and 28 with an increase in ADB." This means ASO rose in only 48% of cases. So a rise in ASO is confirmatory of a prior strep infection. A failure to rise doesn't seem to be meaningful (i.e., it doesn't happen in 52% of the time in the above cases of confirmed infections). Is that recent enough? This is remarkably similar to Shet's numbers -- so really a rediscovery but very recent. Buster Another important thing to point out, is even if a child's titer rises, it may not necessarily rise enought to exceed a lab's normal values. (I added the bold.) One risk is illustrated in Figures 1A (subject 790), 2A (subject N012), and 2B (subject 784); all illustrate instances in which a confirmed GAS acquisition resulted in a significant antibody response, but the peak titers never exceeded ULN values. In these studies, of 54 serum samples with significant ASO titer increases, 59% peaked below the ULN. Similarly, of 51 serum samples with significant ADB titer increases, 61% had titers below the ULN. If only ULN values were used to evaluate single serum sample titers, these indisputable GAS infections would have been incorrectly characterized. Edited February 16, 2012 by EAMom Link to comment Share on other sites More sharing options...
Mayzoo Posted February 16, 2012 Report Share Posted February 16, 2012 My daughter was unexpectedly rapid test positive on 1-5-12 (so I have no idea how long she was strep +). I took her in to get the blood work ordered and found out her throat was red, so they tested her. Her ASO was very low when tested on 1-5-12 (I believe 6 but I do not have it in front of me) and her Dnase-B was I think 65 or 95.) She was placed on amox for 10 days, and was positive again on the 16th, the 26th and still positive on 2-1-12. We have changed antibiotics numerous times, and are now just staying on Zithromax 250 per day for 4 weeks before we retest on 2-29-12. We have not retested the ASO or D-nase-B. Link to comment Share on other sites More sharing options...
Kiera Posted February 16, 2012 Report Share Posted February 16, 2012 My ds has the opposite problem- persistently elevated titers (just recently came WNL) with neg throat swabs and cultures?? How does one explain this? Streptozyme just came back elevated so strep is hiding out somewhere I guess. Just had T&A so we'll see what culture of tonsils shows! Link to comment Share on other sites More sharing options...
AmySLP Posted February 16, 2012 Report Share Posted February 16, 2012 6 months of constant strep confirmed with rapids and cultures ---no rise in aso. Link to comment Share on other sites More sharing options...
EAMom Posted February 17, 2012 Report Share Posted February 17, 2012 (edited) Quad post! Edited February 17, 2012 by EAMom Link to comment Share on other sites More sharing options...
EAMom Posted February 17, 2012 Report Share Posted February 17, 2012 My ds has the opposite problem- persistently elevated titers (just recently came WNL) with neg throat swabs and cultures?? How does one explain this? Streptozyme just came back elevated so strep is hiding out somewhere I guess. Just had T&A so we'll see what culture of tonsils shows! One answer could be that the strep is hiding out in a non-throat location like the sinuses. It'll be interesting to see if the culture of the tonsils shows anything. Link to comment Share on other sites More sharing options...
EAMom Posted February 17, 2012 Report Share Posted February 17, 2012 (edited) Quad post! Edited February 17, 2012 by EAMom Link to comment Share on other sites More sharing options...
EAMom Posted February 17, 2012 Report Share Posted February 17, 2012 (edited) Quad post! Edited February 17, 2012 by EAMom Link to comment Share on other sites More sharing options...
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