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vermontmoms

Positive strep normal ASO?

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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.

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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 by Buster

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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 by EAMom

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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.

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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!

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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.

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