Dog as a strep carrier?

[EAMom]

This article has some informative links on dogs and strep http://www.justanswer.com/questions/wojx-d...rs-strep-throat

 

The member (browneyesmom) who's dog had strep didn't turn out to have GABHS (but had another type of strep). Here's the post http://www.latitudes.org/forums/index.php?...art=#entry30514

 

I do know they cultured ours. I thought I had posted at some point about our dog. I called back and spoke with the vet's office directly myself (rather than the second hand message I initially received). The type of strep she has is a strep that normally lives in the lungs and does not cause disease; she tested negative for group A beta hemolytic strep. However, as an abundance of caution, we treated her anyway.

 

I would agree with what others have posted (although there is certainly no harm in getting your dog cultured!)...that either your kids are getting repeated re-exposure from another source (school is a biggie; Diana who posts on this forum recently found out that her son's best friend is a strep carrier; my younger dd is a strep carrier...) and/or the strep isn't really getting cleared in the first place (and you need a longer course of a stronger ab like Azith).

 

How long after the 10 days of abs are you doing the re-culture? Usually we wait at least 3 weeks (based on some article we read)...I know some parents re-test sooner (1 week). If it is positive then you can believe it, but if it is negative (after only 1 week) then it may still be a false positive (from the recent abs) and you should test again in a few weeks.

 

Prophylactic antibiotics might help...but IMO you need to really clear the intial infection first. It is possible that the strep is intracellular and prophylactic abs (with something like Amoxcillin) will cause symptoms to "smolder" (Worried dad's expression) but not truly clear the strep. I think your PANDAS dd should have 1-2 mo. (minimum) of Azith. full strength and only then consider a lower dose of prophylactic abs. (Note: Azith. is better than other abs at getting intracellular strep.) Continue to be vigalent about checking family members for strep.

 

Our younger dd (non-pandas, strep carrier, gets strep without symptoms) has cultured positive (so far this school year) in Oct. and late Dec. She was neg in Aug., Nov., Feb., and 2x in March. We didn't test her in Sept. and Jan. There is a lot of strep going around the kid's school this year so I assume that is the source. We are going to re-test her again next week as I (43 years old!) currently have strep (very symptomatic, positive on rapid) to make sure I haven't infected her. This is the first time I've had strep (that I know of) since being a kid and I've gotten tested a few times since last March 08. I actually think I got my strep from my younger dd's classroom (I volunteer in there 2x weekly).

 

We treat our younger (strep carrier) with Azith. when she is positive. The first time she was positive we tried to clear her with Augmentin and that didn't work. In your situation I would consider treating your non-pandas dd also with an extended (at least a double 10 day course) course of Azith, although our non-pandas has been able to clear with just the regular 5 days.

[nojo]

This article has some informative links on dogs and strep http://www.justanswer.com/questions/wojx-d...rs-strep-throat

 

The member (browneyesmom) who's dog had strep didn't turn out to have GABHS (but had another type of strep). Here's the post http://www.latitudes.org/forums/index.php?...art=#entry30514

 

I do know they cultured ours. I thought I had posted at some point about our dog. I called back and spoke with the vet's office directly myself (rather than the second hand message I initially received). The type of strep she has is a strep that normally lives in the lungs and does not cause disease; she tested negative for group A beta hemolytic strep. However, as an abundance of caution, we treated her anyway.

 

I would agree with what others have posted (although there is certainly no harm in getting your dog cultured!)...that either your kids are getting repeated re-exposure from another source (school is a biggie; Diana who posts on this forum recently found out that her son's best friend is a strep carrier; my younger dd is a strep carrier...) and/or the strep isn't really getting cleared in the first place (and you need a longer course of a stronger ab like Azith).

 

How long after the 10 days of abs are you doing the re-culture? Usually we wait at least 3 weeks (based on some article we read)...I know some parents re-test sooner (1 week). If it is positive then you can believe it, but if it is negative (after only 1 week) then it may still be a false positive (from the recent abs) and you should test again in a few weeks.

 

Prophylactic antibiotics might help...but IMO you need to really clear the intial infection first. It is possible that the strep is intracellular and prophylactic abs (with something like Amoxcillin) will cause symptoms to "smolder" (Worried dad's expression) but not truly clear the strep. I think your PANDAS dd should have 1-2 mo. (minimum) of Azith. full strength and only then consider a lower dose of prophylactic abs. (Note: Azith. is better than other abs at getting intracellular strep.) Continue to be vigalent about checking family members for strep.

 

Our younger dd (non-pandas, strep carrier, gets strep without symptoms) has cultured positive (so far this school year) in Oct. and late Dec. She was neg in Aug., Nov., Feb., and 2x in March. We didn't test her in Sept. and Jan. There is a lot of strep going around the kid's school this year so I assume that is the source. We are going to re-test her again next week as I (43 years old!) currently have strep (very symptomatic, positive on rapid) to make sure I haven't infected her. This is the first time I've had strep (that I know of) since being a kid and I've gotten tested a few times since last March 08. I actually think I got my strep from my younger dd's classroom (I volunteer in there 2x weekly).

 

We treat our younger (strep carrier) with Azith. when she is positive. The first time she was positive we tried to clear her with Augmentin and that didn't work. In your situation I would consider treating your non-pandas dd also with an extended (at least a double 10 day course) course of Azith, although our non-pandas has been able to clear with just the regular 5 days.

 

Thank you so much for the thoughful and detailed post. I am in the so overwhelmed phase that I need to figure out how to deal with this. I can't keep going on like this. Our vet relented, and did a strep test on the dog ($96!!!!). We are awaiting the culture results. We are currently on augmentin for this last round of strep, and I really don't think it is working. My poor daughter isn't acting right, usually I can tell a big difference by now, and she still doesn't look right. She is very fair, and when she is sick, she gets a deep purple tint in her eyes and face. The ped we saw said to come and get swabbed after we finish antibiotics (10 days) after starting. They won't do a rapid test, but send out a culture. From what you are saying, this would be way too soon to determine. I am trying to get my ducks in a row when we go in, and I think this is so far what I need to discuss with our normal ped. Please (any or all of you) add to the list.

 

1. Whether or not we have PANDAS (and in my opinion we do) we have to get the strep under control. Is the strep hiding somewhere else in the body? Can we do the extended treatment with azith? Can we start on Prophylactic antibiotics after this course of treatment? Do we need to go to an infectious disease specialist? What is the downside to Prophylactic antibiotics at this point. We are on 2 weeks of every month anyway.

 

2. Do we need to do the blood test for strep titers? We know she is going to be positive, does it matter how high they are? Will that vary the course of treatment?

 

3. The thing I thought were just quirks, I realize are more OCD behaviors. The way I could tell we had strep this time was the obsessing over the order of the spoons and forks. (sobbing, couldn't sleep until rearranged). Are we damaging her brain with the repeated infections?

 

4. What about her little sister? If she is still repeatly infected, is it going negate anything we do for her PANDAS sister?

 

5. We had bloodwork a year ago showing some low immune levels. When I asked what to do last year (this is all for asthma) they talked about ivig. Should we be retested, is this definitely a benefit to PANDAS?

 

6. Because of the severe asthma, we have been on prednisone for extended periods of time over the past year. I hear steroid bursts are helpful. Could this be why she isn't very severe with her PANDAS symptoms? (Mostly rages, ocd)

 

7. I know school plays a role in our strep. We never make it through a whole summer without strep, but it is usually not monthly. How do we deal with school if that is our main source of infection?

 

8. Are there different strains of strep? Do we need to find out what type she has to figure out what antibiotics will work? What exactly is intracellular strep?

 

I think that is all I can think of for a Saturday night. Any and all responses are welcome. By the end, I may just be a strep expert!

[EAMom]

1. Whether or not we have PANDAS (and in my opinion we do) we have to get the strep under control. Is the strep hiding somewhere else in the body? Can we do the extended treatment with azith? Can we start on Prophylactic antibiotics after this course of treatment? Do we need to go to an infectious disease specialist? What is the downside to Prophylactic antibiotics at this point. We are on 2 weeks of every month anyway.

Many on this forum have done a 1-2 mo. trial of Azith (full strength). My dd (currently 55 pounds) has been on 250mg Azith. daily since June. IMO any downside of more aggressive antibiotic therapy is warranted for a child suffering from PANDAS. The immunologist we are seeing is not concerned about our use of Azithromycin. Our ped was initially freaked about the prophylactic abs, but she was forced to get over it after the pediatric neurologist, pediatric rheumatologist (and now the pediatric immunologist) all agreed with our use of prophylactic antibiotics.

 

2. Do we need to do the blood test for strep titers? We know she is going to be positive, does it matter how high they are? Will that vary the course of treatment?

 

IMO titers (ASO, anti-dnase B ) are not needed if you already have positive cultures. They shouldn't vary the treatment (unless the doc is confused!). Also, be aware that some PANDAS kids will have low titers (mine did, even with full-blown psychotic pandas and positive cultures). Where titers are useful is if you don't have positive cultures and are looking for some "proof" or "evidence" of a past strep infection. Buster's Aug 24 2008 and Jan 11 2009 posts have some very informative and well-researched information on titers http://www.latitudes.org/forums/index.php?...art=#entry29305. One big caution...some docs are confused about titers and will interpret low ASO/anti-dnase B titers as "proof" that your child does not have PANDAS (because they haven't read Buster's post!)

 

3. The thing I thought were just quirks, I realize are more OCD behaviors. The way I could tell we had strep this time was the obsessing over the order of the spoons and forks. (sobbing, couldn't sleep until rearranged). Are we damaging her brain with the repeated infections?

I hope not...but there are no good studies out there on what happens to these kids with repeated exacerbations...do they have a propensity for OCD or anxiety as adults?

 

4. What about her little sister? If she is still repeatly infected, is it going negate anything we do for her PANDAS sister?

 

Our younger dd is a strep carrier. Treating her strep was really important in getting our PANDAS dd's symptoms under control.

 

5. We had bloodwork a year ago showing some low immune levels. When I asked what to do last year (this is all for asthma) they talked about ivig. Should we be retested, is this definitely a benefit to PANDAS?

If your dd could get IVIG covered by insurance (for her asthma) that would be great. I don't know if the asthma dose is the same as the dose used for PANDAS (usually 1.5-2.0 grams/kg over a 2 day period). Some conditions use a lower dose (400mg/kg) and I don't know if asthma would be one of them.

 

6. Because of the severe asthma, we have been on prednisone for extended periods of time over the past year. I hear steroid bursts are helpful. Could this be why she isn't very severe with her PANDAS symptoms? (Mostly rages, ocd)

 

IMO...Yes.

 

7. I know school plays a role in our strep. We never make it through a whole summer without strep, but it is usually not monthly. How do we deal with school if that is our main source of infection?

This is a tough one. Some folks home school. We test our strep carrier dd on a regular basis. Our PANDAS dd is on prophylactic abs. We are working on getting IVIG but will still continue with the abs after that.

 

8. Are there different strains of strep? Do we need to find out what type she has to figure out what antibiotics will work? What exactly is intracellular strep?

 

Yes, there are different strains of strep. I believe some are more likely to cause PANDAS and some are more likely to go intracellular. http://www.ncbi.nlm.nih.gov/pubmed/15293451 Basically that means the strep is "hiding" in epithelial cells (in the throat usually) thereby escaping antibiotics (except for Azith.)

I don't believe it is easy/available for a "regular" (non-research doc) to do strain analysis. I don't know about doing a culture and sensitivity (to see what anti-biotic would work) ...one problem with strep is what works in the "petri-dish" (in vitro) doesn't necessarily work in the child (in vivo.)

 

I should also add that (if I didn't mention it already) that Azith. is immune-modulating and anti-inflammatory. The immunologist agrees that this may be a big benefit for our PANDAS child (in addition to its action as an antibiotic). Might help your dd's asthma as well?

[nojo]

1. Whether or not we have PANDAS (and in my opinion we do) we have to get the strep under control. Is the strep hiding somewhere else in the body? Can we do the extended treatment with azith? Can we start on Prophylactic antibiotics after this course of treatment? Do we need to go to an infectious disease specialist? What is the downside to Prophylactic antibiotics at this point. We are on 2 weeks of every month anyway.

Many on this forum have done a 1-2 mo. trial of Azith (full strength). My dd (currently 55 pounds) has been on 250mg Azith. daily since June. IMO any downside of more aggressive antibiotic therapy is warranted for a child suffering from PANDAS. The immunologist we are seeing is not concerned about our use of Azithromycin. Our ped was initially freaked about the prophylactic abs, but she was forced to get over it after the pediatric neurologist, pediatric rheumatologist (and now the pediatric immunologist) all agreed with our use of prophylactic antibiotics.

 

2. Do we need to do the blood test for strep titers? We know she is going to be positive, does it matter how high they are? Will that vary the course of treatment?

IMO titers (ASO, anti-dnase B ) are not needed if you already have positive cultures. They shouldn't vary the treatment (unless the doc is confused!). Also, be aware that some PANDAS kids will have low titers (mine did, even with full-blown psychotic pandas and positive cultures). Where titers are useful is if you don't have positive cultures and are looking for some "proof" or "evidence" of a past strep infection. Buster's Aug 24 2008 and Jan 11 2009 posts have some very informative and well-researched information on titers http://www.latitudes.org/forums/index.php?...art=#entry29305. One big caution...some docs are confused about titers and will interpret low ASO/anti-dnase B titers as "proof" that your child does not have PANDAS (because they haven't read Buster's post!)

 

3. The thing I thought were just quirks, I realize are more OCD behaviors. The way I could tell we had strep this time was the obsessing over the order of the spoons and forks. (sobbing, couldn't sleep until rearranged). Are we damaging her brain with the repeated infections?

I hope not...but there are no good studies out there on what happens to these kids with repeated exacerbations...do they have a propensity for OCD or anxiety as adults?

 

4. What about her little sister? If she is still repeatly infected, is it going negate anything we do for her PANDAS sister?

Our younger dd is a strep carrier. Treating her strep was really important in getting our PANDAS dd's symptoms under control.

 

5. We had bloodwork a year ago showing some low immune levels. When I asked what to do last year (this is all for asthma) they talked about ivig. Should we be retested, is this definitely a benefit to PANDAS?

If your dd could get IVIG covered by insurance (for her asthma) that would be great. I don't know if the asthma dose is the same as the dose used for PANDAS (usually 1.5-2.0 grams/kg over a 2 day period). Some conditions use a lower dose (400mg/kg) and I don't know if asthma would be one of them.

 

6. Because of the severe asthma, we have been on prednisone for extended periods of time over the past year. I hear steroid bursts are helpful. Could this be why she isn't very severe with her PANDAS symptoms? (Mostly rages, ocd)

IMO...Yes.

 

7. I know school plays a role in our strep. We never make it through a whole summer without strep, but it is usually not monthly. How do we deal with school if that is our main source of infection?

This is a tough one. Some folks home school. We test our strep carrier dd on a regular basis. Our PANDAS dd is on prophylactic abs. We are working on getting IVIG but will still continue with the abs after that.

 

8. Are there different strains of strep? Do we need to find out what type she has to figure out what antibiotics will work? What exactly is intracellular strep?

Yes, there are different strains of strep. I believe some are more likely to cause PANDAS and some are more likely to go intracellular. http://www.ncbi.nlm.nih.gov/pubmed/15293451 Basically that means the strep is "hiding" in epithelial cells (in the throat usually) thereby escaping antibiotics (except for Azith.)

I don't believe it is easy/available for a "regular" (non-research doc) to do strain analysis. I don't know about doing a culture and sensitivity (to see what anti-biotic would work) ...one problem with strep is what works in the "petri-dish" (in vitro) doesn't necessarily work in the child (in vivo.)

 

I should also add that (if I didn't mention it already) that Azith. is immune-modulating and anti-inflammatory. The immunologist agrees that this may be a big benefit for our PANDAS child (in addition to its action as an antibiotic). Might help your dd's asthma as well?

 

 

Wow, thanks for your input. This was a really long post, and I was more writing to sort out my thoughts about what to discuss with the dr. I was hoping for input on what else to ask. Your knowledge is really appreciated, it really helps me understand more. It shows how much longer you've had to fight the fight! I'll let everyone know what happens with the dog.

[thereishope]

My neurologist was the one who told me to get any pets tested for strep. He's seen it before. Luckily, I have no pets.

[EAMom]

Hi Nojo,

what happened with your dog's strep test?