How will I know he has strep even on high dose Augmentin

[Buster]

It seems to be nearly universally assumed that carriage is benign, w/o any real evidence that this is so. But so many assumptions seem ultimately to trump the few that show a MAYBE its not as benign as we think.

 

Peglem, absolutely. I've got a growing stack of papers indicating asymptommatic carriage is not benign. I'll dig for the others and perhaps post a few.

 

There was a very nice little study done in 1988 by Gerber known as "The group A streptococcal carrier state. A reexamination" ( http://www.ncbi.nlm.nih.gov/pubmed/3128949 ). He split the groups into three groups:

1. those with negative throat cultures,
   
2. those with positive throat culture and postive rise in antibody titers,
   
3. and those with positive throat culture and no significant rise.
   

He showed that treating those patients in group 3 with antibiotics had comparable and dramatic clinical response to treating those in group 2 (i.e., the antibody titer rise was really not useful clinically).

 

 

There was also a very nice paper in 1997 by Rogers, "Strain prevalence, rather than innate virulence potential, is the major factor responsible for an increase in serious group A streptococcus infection" ( http://www.journals.uchicago.edu/doi/pdf/1...875?cookieSet=1 )

 

While this paper was about superantigens, there is some very interesting items towards the end of the paper where the author writes "Colonization may occur in individuals without M serotype-specific antibody and manifest as a benign infection or carriage. The course of infection and progress to severe infection may primarily depend on an individual's state of immunity and genetic constitution as well as on antibody levels to the numerous extracellular products secreated by GAS."

 

 

 

Buster

[peglem]

Thanks, Buster. I've been looking alot. This really helps.