Question about being a carrier?

[mar]

I know I probably have read this before but just want to confirm. When you are a carrier you obviously show no symptoms right? . So if you get a rapid swab and it's negative are you not a carrier? Does a carrier show positive rapid swabs. So if my child shows negative rapid swabs and is negative after culture they are not carriers. The reason I ask this question I guess is for my knowledge and also wonder about neighbors children. We met new neighbors last spring and my kids where hit with strep hard in April/may. Over the past couple of years they did great with one getting it once in 7 months and the other not infected. So after there bad hit this past may with it going back and forth b/t them and them playing with neighbors kids I am starting to wonder. So then the neighbors son had stomach pain and ear infection and some throat which she saids he gets everytime he's sick but for the first time he got swabbed for strep and he was positive. He is 10 and I can't believe they never ever swabbed before. This was about a month ago if not more. Then three weeks after that I meet up with her and she saids her sons throat is bothering him again and mother in law is telling her to get strep tested and she is all flustered saying I don't think that strep test was right he might only be a carrier and there is nothing I could do if that is tnd case. My eyeballs nearly popped out. I was thinking holy crap could he be a carrier that could be causing my kids issues and if he is, is this mom thinking its no big deal!! Well let me give you a background. This child has some autism and add and has a real low immune system. They are real nice people but bc her son is always sick with colds sore throats and ear infections and is always on antibiotics for something she just doesn't see this as a big deal. But for me it is a real eye opener. If this child is a carrier it greatly affects my children when they are around him. So I am trying to figure out how I tell this mom that you need to treat the carrier! Am I crazy but just bc a child is a carrier do you just let him be bc he has no fever. I am wondering if this would help her child out with always being sick if she cleared the strep. He is sick a lot and i feel bad for him. I wonder how many people out their say oh well he is just a carrier and I can't do nothing about it. I now wonder and worry if the strep could be coming from them! I guess that was more then one question.

Mar

[EmilyK]

My younger son is a carrier and the doctors have wanted him free of strep for DS with PANDAS' sake. He's had a lot of antibiotics to that end. Let me tell you, I'm completely paranoid about the neighborhood kids and strep. I don't blame you for being worried!

[MomWithOCDSon]

I haven't been successful in finding a local doc who believes in a "carrier state" for strep in its technical sense (whatever that means). That being said, my DS has always been classically asymptomatic for strep himself, but he definitely brought it home from school at least a dozen times and passed it on to DH and me!

 

DS never tested positive for strep via rapid swab or overnight culture. He never had a sore throat or a fever. But within 10 days of a letter coming home from school announcing that another kid in his class had been identified as having strep, either DH or I would come down with a classic, painful case while DS appeared to "sail through" unscathed. Until a couple of weeks later, at which point his OCD and general anxiety would skyrocket.

 

It wasn't until we started testing and tracking the direction of titers (ASO and antidnase that we were able to convince a ped that DS actually "had" strep . . . he just wasn't responding to it the way most kids do. She still didn't buy him as a "carrier," though, even though DH and I could pretty much prove that he had to have been the source of our strep episodes.

 

I'm not sure what you would do in cases in which neither swabs, cultures or titer blood tests provide evidence of strep . . . I've seen some other folks talk about sinus cultures?! I do think that, in my DS's case, the sinuses were probably where the actual bacteria was hanging out, given his upper respiratory history.

[thenmama]

I understand how concerned you must be. We've had trouble with strep recurrences (despite dd being on a treatment dose of Augmentin) and in trying to figure out the source everyone becomes a suspect. Because of what strep means for us and our families it is a really big deal. And we naturally feel like everyone should get every sore throat swabbed and know exactly what bacteria they're harboring-- because that's our understood way of being now and because their sore throat has some potentially significant implications for our children. It is also important to remember, though, that other people's lives and kids aren't ours so they don't live in PANDAS mode. And to be objective, if the boy is a carrier they are under no obligation to treat him for the sake of your children. Of course that doesn't mean if the kids are really good friends and you would have to keep them apart that the parents may not decide to treat him. But, to be fair, it means their child would need to take some heavier-hitting antibiotics that aren't considered medically necessary for him. It's not standard medical practice to treat every strep carrier, so you'd be asking someone else to give their child medication for your kids' sake, not his own, while also exposing that child to any risks, like C diff, associated with the antibiotic treatment. We've experienced that exact scenario firsthand-- my dh was hospitalized within the past month for serious c diff with colitis that he got from the abx combo given to clear strep b/c our kids keep getting re-infected and they've all been passing it around.

 

But, I don't think this boy would be considered a carrier if he was recently dx'd with a strep infection. I could be wrong and someone here with a strep carrier in the family will probably know better, but I thought strep carriers didn't get sick from it? The fact that he's had a recent infection, has a low immune system, and has the history of illness/infection (plus the stomach ache with it-- that can often be associated with strep infection) makes me think he's also vulnerable to strep. And naturally when you mention that he has "some autism" I start to wonder about the strep, illness pattern, etc.-- try as I might to not view everything through my PANDAS lens. So, maybe the first thing you could approach with the mom, depending on your relationship with her, is sharing info to help her make an informed choice about whether or not to have her son re-tested for strep. If someone confirms that carriers don't get acute infections, that info would be a good place to start.

 

It isn't easy to live and let live, but (in the absence of true negligence or endangerment that require reporting) it's important to try. We only parent our own children and we can only control the things that are ours to control. That just ain't easy to begin with and PANDAS parenting just ups the challenge level...

 

Anyway, maybe my rambling reply will hit on at least one or two of the answers or suggestions you were looking for:) Hope things work out well for all involved.

Edited October 24, 2012 by thenmama

[mar]

Thanks for the feedback! No I would never bring this up to the mother and I would never expect them treat their kids on my behalf. What you said is absolutely right. I am just trying to figure out what a carrier looks like and how it could affect the family. My kids seem to get fevers and throat pain but wonder about DH and me. What is interesting Is that a carrier could bring this home with no symptoms and get others infected. So DH has questioned himself but if a carrier does not get positive on strep rapid Nor on the culture how do you know they are a carrier? Obviously my kids show signs but could there be times they are not showing obvious signs of fever and sore throat and be carriers? I always assumed that carriers need to be treated but that does not seem to be the case. So what if DH or I are a carrier? Does being a carrier not affect the individual? I am just trying to get as much info as I can about strep and carriers. I just recall several years ago before vacation ds had strep and we all got tested and were fine. Could we be fine on strep tests and be carriers?

Mar

[mar]

Want to mention I will never forget that one time ds was about 5 and had a fever for one day low grade ( he always would get high grade with anything) and it went away and then a couple of days later congestion hit with a fever and bring him in and has strep and so does dd and I was mad that I blew it off a couple of days prior. Will never forget that now of maybe I messed him up when I was always at doctor prior right away.

Mar

[peglem]

Thanks for the feedback! No I would never bring this up to the mother and I would never expect them treat their kids on my behalf. What you said is absolutely right. I am just trying to figure out what a carrier looks like and how it could affect the family. My kids seem to get fevers and throat pain but wonder about DH and me. What is interesting Is that a carrier could bring this home with no symptoms and get others infected. So DH has questioned himself but if a carrier does not get positive on strep rapid Nor on the culture how do you know they are a carrier? Obviously my kids show signs but could there be times they are not showing obvious signs of fever and sore throat and be carriers? I always assumed that carriers need to be treated but that does not seem to be the case. So what if DH or I are a carrier? Does being a carrier not affect the individual? I am just trying to get as much info as I can about strep and carriers. I just recall several years ago before vacation ds had strep and we all got tested and were fine. Could we be fine on strep tests and be carriers?

Mar

I don't think strep carrier is well defined, but generally I think it would be someone who swabs positive but does not have symptoms. When doctors were trying to avoid treating my daughter they would bring up strep carrier and ask if she's ever had neg results. She has, and I could predict by her behavior whether she would test positive or not. It gets all confused when there are not typical symptoms, but only neuro-psychiatric ones. I mean they DO have symptoms w/ strep, but not a great immune response (immune response is what causes typical symptoms).

[EAMom]

Thanks for the feedback! No I would never bring this up to the mother and I would never expect them treat their kids on my behalf. What you said is absolutely right. I am just trying to figure out what a carrier looks like and how it could affect the family. My kids seem to get fevers and throat pain but wonder about DH and me. What is interesting Is that a carrier could bring this home with no symptoms and get others infected. So DH has questioned himself but if a carrier does not get positive on strep rapid Nor on the culture how do you know they are a carrier? Obviously my kids show signs but could there be times they are not showing obvious signs of fever and sore throat and be carriers? I always assumed that carriers need to be treated but that does not seem to be the case. So what if DH or I are a carrier? Does being a carrier not affect the individual? I am just trying to get as much info as I can about strep and carriers. I just recall several years ago before vacation ds had strep and we all got tested and were fine. Could we be fine on strep tests and be carriers?

Mar

I don't think strep carrier is well defined, but generally I think it would be someone who swabs positive but does not have symptoms. When doctors were trying to avoid treating my daughter they would bring up strep carrier and ask if she's ever had neg results. She has, and I could predict by her behavior whether she would test positive or not. It gets all confused when there are not typical symptoms, but only neuro-psychiatric ones. I mean they DO have symptoms w/ strep, but not a great immune response (immune response is what causes typical symptoms).

 

Agreed...I think docs have conflicting definitions of what a "carrier" is.

 

Swedo says a "carrier" is somebody that has no immune response to strep (so no sore throat, or fever). She says PANDAS kids can not be considered carriers b/c they do have an immune response (neuropsych. symptoms)to strep .

 

Not sure if a carrier would have elevated titers. 1 paper I read said they don't have elevated titers (immune response). Another paper said something like "carriers are known for protractedly elevated titers". Neither paper had a reference. When dh asked Kaplan about this, he said it wasn't studied. But, if you take Swedo's word, then carriers shouldn't have high titers (b/c that is a type of immune response, right?).

 

I think when certain docs are checking strep titers (eg in family members) to see if they are "carriers", perhaps what they are REALLY checking for are occult infections.

Edited October 25, 2012 by EAMom

[thenmama]

I think, or thought... a carrier may or may not have elevated titers, as EAMom points out, but would swab positive-- always, right? Because they carry the strep bacteria but are not acutely ill? That would be why the negative swabs in between positives are significant. So, Mar, to answer your question about the swabs, I'm pretty sure, and hope someone will correct me if I'm wrong, if someone swabs consistently positive in that absence of an immune response/active strep infection, they would be considered a carrier, but if the person tests negative by swab in between positives, that person would not be considered a carrier (to the extent that swabs are accurate).

[EAMom]

I think, or thought... a carrier may or may not have elevated titers, as EAMom points out, but would swab positive-- always, right? Because they carry the strep bacteria but are not acutely ill? That would be why the negative swabs in between positives are significant. So, Mar, to answer your question about the swabs, I'm pretty sure, and hope someone will correct me if I'm wrong, if someone swabs consistently positive in that absence of an immune response/active strep infection, they would be considered a carrier, but if the person tests negative by swab in between positives, that person would not be considered a carrier (to the extent that swabs are accurate).

 

I suppose a carrier could swab neg if they are carrying the strep in their sinuses, not their throat. Or if it is a bad swab.

 

But, in general a carrier should swab positive. They are contagious, but LESS contagious than someone who is actually ill/symptomatic with strep. And, it is possible to clear a carrier (usually Azith or Clindamycin is recommended). But once you clear that carrier, it is possible they might "carry" strep again in the future. if they get exposed to strep again.

[EAMom]

This child has some autism and add and has a real low immune system. They are real nice people but bc her son is always sick with colds sore throats and ear infections and is always on antibiotics for something she just doesn't see this as a big deal. But for me it is a real eye opener. If this child is a carrier it greatly affects my children when they are around him.

 

I wonder how much this child being sick all the time is contributing to his autistic symptoms?

[peglem]

This child has some autism and add and has a real low immune system. They are real nice people but bc her son is always sick with colds sore throats and ear infections and is always on antibiotics for something she just doesn't see this as a big deal. But for me it is a real eye opener. If this child is a carrier it greatly affects my children when they are around him.

 

I wonder how much this child being sick all the time is contributing to his autistic symptoms?

Yeah, wondering too, if autism symptoms may actually be a result of PANS/PANDAS.

[mar]

This is sk interesting and confusing at the same time! It's crazy how school starts and notice ds reacting more with some tics and what not but anyway we tested him for strep a couple weeks ago and was negative but shows mild signs of OCDand of tics. Anyway I remember years ago when they were younger and before I new all this I would take ds in because of fever and he had strep. I would have them test dd with no symptoms bc I was there and she would be positive. On many occasions ds would show symptoms and be positive but dd with no symptoms ( meaning fever) would be positive and treated. Now looking back these past couple of years dd is showing high fevers with strep. Both of them have had negative results so I am assuming that aren't carriers. There were times when dd was positive and ds was not. And when he had the test several weeks ago I was surprised he wasn't positive bc I have been seeing other symptoms other then sickness and sad to say ( not that I wish my child to have strep) he was negative. So from what you have posted if seems that they are not carriers. I am interested in step in the sinuse? Do doctors actually swab them in there nose for strep? When ds was so bad three years ago and was negative by throat but crazy allergies and congestion I wonder if he had it in sinuses? So I am assuming if DH and i don't swap positive at times we are not carriers. It's just crazy how one of my brothers kids never had strep and then the other brother had a daughter with eczema and food allergies and recall when she was 4 she had strep with no symptoms and she kept testing positive and they were thinking to get tonsils out but was given stronger antibiotic and she was negative and no surgery. Never had strep that they know of again.. They thought she might be a carrier. This is the freaky part dd sleeps over several years later and remember her coming home and crying that night saying she feels real sad and doesn't know why. It took her about a week to get back to normal. Her and her cousin are inseparable. Then on another sleepover I recall my sister in law calling at 8 in the morning saying that she wants to come home! This is so unlike her especially when she waits all day for this. She has been fine lately but always wonder with those couple of times where it was such a drastic change in her. Now my crazy thinking of maybe my niece was still a carrier? Who will ever know???

Mar