Wow,Wow,Wow!

[Kiera]

Hi everyone,

My ds just had T&As and sinus drained last week and the ENT just called with the culture results : Both tonsils and adenoids grew Pseudomonas (a bacteria, not good), and maxillary sinus grew gram neg bacillis - beta lactamase (even worse!). He himself was a bit shocked, he doesn't normally culture T&As but I asked him too, and he said he would be surprised to find this in any of his other patients, and the augmentin he's on does not cover it, he needs the big guns antibiotics! BTW, my ds still has some OCD and tics, however has not had a meltdown since surgery (touch wood). Hopefully now, ivig will just dilute the circulating antibodies to relieve the rest of the symptoms. I'm excited, in a perverse sort of way, to have found this hidden infection. From the outside, the ENT would not have recommended T&A, as tonsils were small and normal looking. The clogged sinus we found on MRI as part of work-up. I'll keep you all posted!

[JAG10]

Kiera,

 

Great catch!

 

Did your son have overt s/s of sinus issues? Was he hyponasal? Always sound congested? Or was the only way you knew about the sinus blockage through the MRI?

[Kiera]

Always nasal that were put down to allergies, he was on veramyst nasal spray and zyrtec to help!

[JAG10]

I see, that makes sense. I was curious if the sinuses were being explored randomly and this was found....with no indication there was any issue....similar to the small tonsils that don't look problematic upon office exam but then turn out to be a colossal mess when they are removed and examined.

 

So what are the big gun abx that were chosen?

[Kiera]

Working on that now, have to get the paper copy with the sensitivity list, there are many to choose from.

[eljomom]

Kiera--I think, if I remember correctly, mati's mom had her tonsils out (the mom) and she tested positive for pseudomonas too. You might want to touch base with her. She's not on here much anymore, but would still reply to a PM.

 

Also, what do you mean by hyponasal? My dd had her adenoids (only) out 2.5 years ago (before knowing about pandas) due to chronic URI's, snoring, etc. She STILL mouth breathes. Still mild snoring/breathing loudly through her mouth.

[Kiera]

eljomom, thanks for the info. Jag10 asked about "hyponasal", not quite sure what she meant there either. But my ds is always congested, but improved lately with nasal spray and zyrtec. Also has hepafilter in bedroom.

[JAG10]

Sorry for the jargon.

 

Hyponasal is how we sound when we are congested. The swelling of our sinuses changes the sound of our vocal resonance. Hypernasal is the opposite; think Fran from the Nanny.

 

Resonance, how our voice sounds in space changed after a T & A because tissue is removed; sort of like how the sound of your voice changes in a room full of furniture versus an empty room. That is completely normal. My dd8 sounded like Snow White after her surgery and gradually adjusted.

[kimballot]

Very interesting find! Does your ds have immune deficiency? My understanding is that Pseudomonas is generally not seen unless there is a compromised immune system. It is also very stinky. Did your son have "garbage" smelling breath?

 

I am so glad you had everything cultured. This will be very good information for you for the future.

[Kiera]

No, ds is not immune def. I've talked to another local Pandas mom who's dd's tonsils also showed pseudomonas (no immune def, either) so I don't know if it's just an oppertune infection or what?? And no also, on the smelly breath, thanks goodness! Perplexing!

[Kiera]

Started ds on cipro for 10 days, for the pseudomonas in T&As, it was the only antibiotic on the sensitivity list that can be taken orally (rest are iv). Also he's been tested for cystic fibrosis due to the pseudomonas as it's an oppertunistic infection frequently seen ib CF patients. DS also has GI issues and underweight, but I'm hopeful he doesn't have CF and it'll just be ruled out (PG)and also hopeful because many pandas kids have pseudo in tonsils and many have GI issues too from what I read here on the forum. I'll keep you posted. Remains on augmentin too for strep prophylaxis.