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When to do bloodwork for strep?


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Dd was put on azithro fro 5 days last wednesday due to rapid strep test being positive. Went back today for recheck. Rapid is negative and is being sent for culture. I asked if I could do blood test for strep and she said that since he recently had it it's going to come up high so it won,t be a real indication. My question is do I need to wait to do this test? If yes then how long after strep? If I do it now how will I know if it's due to recent strep or due to pandas?

 

Thanks Mar

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Yes, the strep titers will probably still show up high even if the strep infection is gone. I asked that exact question at my last visit. Our pediatrician said Usually takes a couple of months for those numbers to get back to normal ranges for your child. The important thing to remember is that even if the infection is gone and the pandas symptoms remain you will need to treat the symptoms just as much as you did the original strep infection. I also want to find out what the baseline number is for my son so I will ask for another strep titer test in a couple of months.

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When it comes to strep titers, the trend is what's important more so than the actual nunber! Explain this to your ped. So I would get the ASO and DNase B titers done now, then recheck in a few months to see that they're returned to normal. ASO rises 2-4wks post infection, DNase B rises 6-8wks post infection. Also be aware, up to 50% of kids don't even mount a response to strep and therefore will not even have elevated titers so this does not rule out Pandas by any means.

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Oh and one more thing. I know each kid is different but with my ds, when his strep titers finally came down to WNL after 1 1/2 yrs his symptoms were at their worst! So for him, there was no correlation between symptoms and titers. I think if titers are high, it just gives extra evidence to doubting Drs that an infectious process is going on, but unfortunately if titers are low, same Drs can use the fact to blow off pandas diagnosis!

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So it seems that testing for titers is not accurate. Should I not waste my time and ds freaking out about needles for the test? Also wasting money that will not prove anything. Basically what will this test show me that j don't see already. You moms out there are so strong. All your kids are so lucky to have you. I pray for all these children that they can find relief. Also kind of crazy but as I am sitting in doctors office waiting for her to get called in I open up a parents magazine and of course I see an article about pandas. I think to myself is this a sigh???

Mar

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Well the testing is indeed accurate, it does measure the actual strep antibodies in the blood. But the damage is being caused by antineuronal antibodies, that's what the cunningham test looks for. The strep titers are just giving you proof of a recent strep infection (which you already know from pos rapid) I would still encourage you to do it (if it's not too traumatic for your kid)as doing serial titers will let you know that the strep infection itself has cleared. If they don't return to normal then then there may still be strep hiding out somewhere else like sinuses etc. I know it's confusing, but even though the strep infection may clear, the autoimmune reaction may continue until stronger immune modulating methods are used eg steroids, ivig etc. or even long term strong antibiotics. Hope I didn't confuse you more ;)

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