Confused...is this strep?

[Jv83]

What does it mean if you get a positive rapid strep but a negative nasal and throat culture? I'm confused synths and not sure if there is an infection or not. Thanks for help. Jv

[blakes_mom]

They usually use 2 swabs for these tests so it is possible that they did not get a good specimen for the throat culture. If the rapid is positive I would consider that strep.

[peglem]

What does it mean if you get a positive rapid strep but a negative nasal and throat culture? I'm confused synths and not sure if there is an infection or not. Thanks for help. Jv

The positive rapid means that whatever antigen the rapid test detects was present in the sample. This is supposed to be an antigen that is specific for GABHS. We've had this happen alot. In addition to what blake's mom mentioned (swab not done well enough), it could be recent abx has made it so the bacteria does not reproduce so it won't grow in the culture. Could be lab error...lots of theories about why this might happen. But, I'd err on the side of caution and treat for strep.

[colleenrn]

I would definitely treat for strep with a positive rapid test. Did they take two swabs and swab at the same time? If so, the swab sent for culture may not have "hit" the correct places in the throat- both tonsils and back of throat. The rapid would not be positive if it did not detect strep A. We have had this happen more than once. Some physicians will say a rapid positive with a negative culture means someone does not need to be treated for strep, or they are a "carrier"- not true. A child with PANDAS can't risk having any untreated strep. Will your dr treat?

Colleen

[Jv83]

Thank you for your responses. I should say that she was on zithromax when this happened and she was a bit emotional and then woke up the next morning with petechaie around her eyes so I took her in and that when we got the positive rapid. Since we have not had a positive rapid since she had Scarlett fever I brought her back they next day for a culture. The nasal culture was they same day as the rapid and the throat was the day after the rapid. Both came back negative. He will give me a new abx but this just upsets me so much. About two weeks ago for the first time in a year her ASO was back in range..139. He is suggesting duricef. We have not given her new abx and left her on the zithromax this week. She is already ok again. I am so confused about this. So what I am gathering from responses is I should start new abx. Does anyone think I should leave her on zithromax? Thanks everyone..you guys really are the best. Jv

[peglem]

The first time this happened to us, we were also on zith. But, we had never cultured after a positive rapid before, and most people do not culture if the rapid is positive. My guess is that if they confirmed every rapid w/ a culture, they'd find that it happens frequently. Anyway, we switched to 14 days of clindamycin, but had a +rst w/ neg culture 3 days after finishing that as well. We seldom do strep tests anymore (what good are they?) My daughter remains on zith with a switch to something stronger (clinda or rifampin) + prednisone when symptoms flare. I've tried quitting the zith and going abx-free, but we get a symptom flare w/in @ 3 days when I do that.

Edited March 18, 2012 by peglem

[Jv83]

The first time this happened to us, we were also on zith. But, we had never cultured after a positive rapid before, and most people do not culture if the rapid is positive. My guess is that if they confirmed every rapid w/ a culture, they'd find that it happens frequently. Anyway, we switched to 14 days of clindamycin, but had a +rst w/ neg culture 3 days after finishing that as well. We seldom do strep tests anymore (what good are they?) My daughter remains on zith with a switch to something stronger (clinda or rifampin) + prednisone when symptoms flare. I've tried quitting the zith and going abx-free, but we get a symptom flare w/in @ 3 days when I do that.

 

Peglem...thanks for your reply! I think this is what we are thinking about. I am going to bring to doc for another RST tomorrow and see what the result is. I feel like zith really helps, particularly with the behavior aspect of it..it was practically like nothing so it must n

Be helping. I really appreciate the input..jv