when child exposed to strep

[amy s]

I'm just thinking ahead and wondering what to do when this happens. When I get information that my pandas (post ivig) child has been exposed to strep for a significant time period (all day or something like that) what is the suggestion? She's on prophylactic antibiotics now. Do I call the pediatrician and get her on a full course rather than the prophylactic dose? Do you wait and see if there will be any (pandas) symptoms before doing that? My gut instinct is to give the full course right away without waiting for the symptoms to show up if I know the contact was significant. I wonder if there is any evidence that would help make that determination. I have read somewhere before that it has been done but I can't remember where or by who and of course convincing the docs can be hard, as you know! Any thoughts on what is expected? What if a Rheumatic Heart patient was exposed to someone with strep while already on prophylactic antibiotics....do they give the full course to them? Anyone know?

Regards,

amy s

[Worried_Dad]

Hi, Amy:

 

I'd vote for "crank up the antibiotics." Our post-IVIG son was just exposed to something at school a week+ ago. Came home complaining of feeling hot, sweaty, nauseous. No obvious fever, but he continued to complain of feeling hot and nauseous. Two days later, he had his most severe emotional meltdown since before IVIG, and it happened again the next night as well. (On the positive side, these "symptom explosions" weren't as severe or long-lasting as before IVIG.) The school said no reported strep, so we don't know if it's that or just some other infection that triggered the autoimmune response.

 

Took him to the local doc in a bit of a panic. They said a strep culture would be useless because he's on the prophylactic augmentin, which would distort the results. They just put him on a 5-day course of zithromax to supplement the augmentin. That seems to have killed the infection (which had lodged in his sinuses), but he hasn't fully recovered. Sigh....

 

So for us, I think, as soon as we see any sign of infection in him, we're gonna beg for zithro. Don't want to take any chances!

[amy s]

Hi, Amy:

 

I'd vote for "crank up the antibiotics." Our post-IVIG son was just exposed to something at school a week+ ago. Came home complaining of feeling hot, sweaty, nauseous. No obvious fever, but he continued to complain of feeling hot and nauseous. Two days later, he had his most severe emotional meltdown since before IVIG, and it happened again the next night as well. (On the positive side, these "symptom explosions" weren't as severe or long-lasting as before IVIG.) The school said no reported strep, so we don't know if it's that or just some other infection that triggered the autoimmune response.

 

Took him to the local doc in a bit of a panic. They said a strep culture would be useless because he's on the prophylactic augmentin, which would distort the results. They just put him on a 5-day course of zithromax to supplement the augmentin. That seems to have killed the infection (which had lodged in his sinuses), but he hasn't fully recovered. Sigh....

 

So for us, I think, as soon as we see any sign of infection in him, we're gonna beg for zithro. Don't want to take any chances!

 

Thanks Worried Dad- this was just what I was worrying about. Today is my dd's 3rd day back to school for several months and since IVIg so I'm a little (well, a lot) nervous about exposure. It's good that the symptom explosion in your ds wasn't as severe but you wonder what might have happened if you didn't go to the doc in a panic. Good thinking, for sure.

regards,

amy s

[Dedee]

Hi Amy,

 

I can't say much about IVIG as I have no experience with that. I do have a PANDAS son on antibiotics who has twice been exposed to strep. This second time is a guess. Several weeks ago he started having severe tics after a year and a half of practically none at all. We think, but not sure, that he may have been around a kid at school at the same time this child had strep. I started him on 5-HTP, and my pediatrician agreed to increase (and change) his antibiotics for two weeks and see what happens (he cultured negative). I can't really say for sure which has helped but the tics are about 90% improved. When the two weeks are up we will go back to the regualr maintenance dose of amoxcillin 250mg twice daily. Seems like everything is trial and error with this illness. It is so frustrating. I hope things go well for your daughter!

 

Dedee