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Question about strep carriers...


ajcire

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The dr. said he suspected my pandas ds is a carrier... he is on antibiotics right now and likely will stay on them for a bit... he suspects that my ds is the one giving my dd the strep that she keeps getting (with sore throat symptoms). My son tests positive for strep with minor tics and behaviorial/mood issues as his symptoms... he has tested negative at times as well..

 

My mother asked me... if he is a carrier than why is he not like Typhoid Mary infecting everyone around him? I was wondering the same thing.. I mean my dd does get it... by wouldn't he be infecting everyone? I mean, sometimes I don't even know he has the strep and get him cultured until after my dd has the sore throat symptoms. I'm sure he has it sometimes when I don't catch it.

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The dr. said he suspected my pandas ds is a carrier... he is on antibiotics right now and likely will stay on them for a bit... he suspects that my ds is the one giving my dd the strep that she keeps getting (with sore throat symptoms). My son tests positive for strep with minor tics and behaviorial/mood issues as his symptoms... he has tested negative at times as well..

 

My mother asked me... if he is a carrier than why is he not like Typhoid Mary infecting everyone around him? I was wondering the same thing.. I mean my dd does get it... by wouldn't he be infecting everyone? I mean, sometimes I don't even know he has the strep and get him cultured until after my dd has the sore throat symptoms. I'm sure he has it sometimes when I don't catch it.

 

Maybe your immune system is more mature and can meet the challenges more readily? Do you know for sure that you're NOT catching it? Do you get cultured quickly? What if you catch it but you're able to fight it off quickly and only the level of your ASO titers would really reflect a recent infection?

 

Is it possible for people to be periodically asymptomatic? My DS12 has always been entirely asymptomatic, so who knows how many times he's had strep and we just didn't know. But, initially, in the early school years, he would bring home a school memo about a case of strep having been identified in his class, and within 3 or 4 days, I would come down with a bad case of strep throat, while he remained -- to the untrained eye, anyway -- A-OK (never knew at that point to associate an uptick in his OCD with strep exposure). But in the last few years, even though there's been more exposures at school according to paperwork coming home, neither he nor I have actually come down with the classic symptoms of strep. Did my immune system finally identify it to the extent that it could fight it more pro-actively? Or maybe my system is coursing with ASO titers also, keeping the strep itself at bay, and I'm not predisposed in some way to OCD or TS so I'm not suffering from other ramifications of the immune system?

 

All very puzzling! Okay, so I just added to the questions, didn't I? Anybody have answers?

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The dr. said he suspected my pandas ds is a carrier... he is on antibiotics right now and likely will stay on them for a bit... he suspects that my ds is the one giving my dd the strep that she keeps getting (with sore throat symptoms). My son tests positive for strep with minor tics and behaviorial/mood issues as his symptoms... he has tested negative at times as well..

 

My mother asked me... if he is a carrier than why is he not like Typhoid Mary infecting everyone around him? I was wondering the same thing.. I mean my dd does get it... by wouldn't he be infecting everyone? I mean, sometimes I don't even know he has the strep and get him cultured until after my dd has the sore throat symptoms. I'm sure he has it sometimes when I don't catch it.

 

Maybe your immune system is more mature and can meet the challenges more readily? Do you know for sure that you're NOT catching it? Do you get cultured quickly? What if you catch it but you're able to fight it off quickly and only the level of your ASO titers would really reflect a recent infection?

 

Is it possible for people to be periodically asymptomatic? My DS12 has always been entirely asymptomatic, so who knows how many times he's had strep and we just didn't know. But, initially, in the early school years, he would bring home a school memo about a case of strep having been identified in his class, and within 3 or 4 days, I would come down with a bad case of strep throat, while he remained -- to the untrained eye, anyway -- A-OK (never knew at that point to associate an uptick in his OCD with strep exposure). But in the last few years, even though there's been more exposures at school according to paperwork coming home, neither he nor I have actually come down with the classic symptoms of strep. Did my immune system finally identify it to the extent that it could fight it more pro-actively? Or maybe my system is coursing with ASO titers also, keeping the strep itself at bay, and I'm not predisposed in some way to OCD or TS so I'm not suffering from other ramifications of the immune system?

 

All very puzzling! Okay, so I just added to the questions, didn't I? Anybody have answers?

 

 

 

I never had my titers done. I had one case of strep that I was aware of with very much the classic symtpoms of an awfully sore throat and fever. That was the first year we had strep in our house that I was aware of.. my dd had it like I did... my son.. only cultured positive and was only cultured because I asked just since we had it.. I had no idea of pandas so I didn't know

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All very puzzling! Okay, so I just added to the questions, didn't I? Anybody have answers?

 

"Carriage is an enigma" -- so says Dr. Ed Kaplan in his paper 1980 paper http://www.sciencedirect.com/science?_ob=A...92d1da34fbe59d6

 

There are several odd things about the carriage state. The first is it seems that the M-protein is affected in patients with chronic GABHS colonization. When these cells are moved to non-carriage individuals, the M-protein re-emerges. So something weird is happening there. Also in carriage individuals there seems to be competition from other throat flora that seems to keep the GABHS in check. Finally, there seems to be some IgA problem that prevents the colonization from being easily cleared. Carriage seems to create a low-grade infection that doesn't cause a huge ASO or Anti-DNAse response because only a small amount of the GABHS ever invades the blood stream.

 

In PANDAS, a hyper sensitivity is thought to occur where that "small amount" is enough and so it isn't at all clear that carriage is benign. Although Swedo and others have primarily studied children who did not have carriage (i.e., those mounting a high ASO response).

 

Now with respect to the typhoid Mary comment -- those with Carriage are actually just a lot less contageous -- there seems to be a bunch of differnet reasons. They tend not to have a large amount of mucous build up, they don't tend to cough/sneeze out the bacteria, and the bacteria itself seems to have certain mutation that is suppressing several of the factors that cause improved binding/adhesion (namely the M protein).

 

So absolutely a carrier in the house can infect others, but it is not the same as having someone with full on strep (which tends to spread easily).

 

Buster

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[quote name='MomWithOCDSon' post='51997' date='Jan 14 2010, 10:10 PM'

All very puzzling! Okay, so I just added to the questions, didn't I? Anybody have answers?

So absolutely a carrier in the house can infect others, but it is not the same as having someone with full on strep (which tends to spread easily).

 

Buster

Well, at least that last sentence makes me feel a little better... I think figuring this out is going to be the key to my PANDAS ds holding his ground.

My dd7 had full blown strep in November, was treated. Tested + again in Dec, no symptoms, treated again. Early January, joint pains, stomach aches, and impetigo, but swab/culture were negative... it seems there is something mutating inside of her, scary... Still waiting for titers results...

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Thanks Buster. That makes sense... although my ds does also have the rise in aso too.

 

I don't know that this is relevant to anything.. so far no dr. has reacted but my ds has a normal temperature between 97.6-98.6... but very often and very randomly he runs 99-99.7 with no explanation... I only check him because his ears turn red when he his temp goes up a little. Would it be due to a low grade infection from strep possibly?

 

 

 

 

http://www.sciencedirect.com/science?_ob=A...92d1da34fbe59d6[/url]

 

There are several odd things about the carriage state. The first is it seems that the M-protein is affected in patients with chronic GABHS colonization. When these cells are moved to non-carriage individuals, the M-protein re-emerges. So something weird is happening there. Also in carriage individuals there seems to be competition from other throat flora that seems to keep the GABHS in check. Finally, there seems to be some IgA problem that prevents the colonization from being easily cleared. Carriage seems to create a low-grade infection that doesn't cause a huge ASO or Anti-DNAse response because only a small amount of the GABHS ever invades the blood stream.

 

In PANDAS, a hyper sensitivity is thought to occur where that "small amount" is enough and so it isn't at all clear that carriage is benign. Althought Swedo and others have primarily studied children who did not have carriage (i.e., those mounting a high ASO response).

 

Now with respect to the typhoid Mary comment -- those with Carriage are actually just a lot less contageous -- there seems to be a bunch of differnet reasons. They tend not to have a large amount of mucous build up, they don't tend to cough/sneeze out the bacteria, and the bacteria itself seems to have certain mutation that is suppressing several of the factors that cause improved binding/adhesion (namely the M protein).

 

So absolutely a carrier in the house can infect others, but it is not the same as having someone with full on strep (which tends to spread easily).

 

Buster

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Wow - that's interesting. When our son first got sick (before PANDAS diagnosis), he was spiking fevers of 100-101 periodically throughout the day. All the local docs just ignored that.

 

Even now - while he's been improving steadily on the high-dose augmentin XR - our son often complains of feeling hot. Almost like hot flashes: he doesn't complain of feeling sick, just hot, and he'll turn the ceiling fans on (when it's below freezing outside and 68 degrees in the house)! I told Dr. K about this and he actually said he considers this a good sign; said he's seen this often when a PANDAS patient is approaching "full conversion" after IVIG.

 

Buster, any thoughts on why this happens? Residual strep occasionally rearing its ugly head, intracellular strep "busting out"?

 

 

Thanks Buster. That makes sense... although my ds does also have the rise in aso too.

 

I don't know that this is relevant to anything.. so far no dr. has reacted but my ds has a normal temperature between 97.6-98.6... but very often and very randomly he runs 99-99.7 with no explanation... I only check him because his ears turn red when he his temp goes up a little. Would it be due to a low grade infection from strep possibly?

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Wow - that's interesting. When our son first got sick (before PANDAS diagnosis), he was spiking fevers of 100-101 periodically throughout the day. All the local docs just ignored that.

 

Even now - while he's been improving steadily on the high-dose augmentin XR - our son often complains of feeling hot. Almost like hot flashes: he doesn't complain of feeling sick, just hot, and he'll turn the ceiling fans on (when it's below freezing outside and 68 degrees in the house)! I told Dr. K about this and he actually said he considers this a good sign; said he's seen this often when a PANDAS patient is approaching "full conversion" after IVIG.

 

Buster, any thoughts on why this happens? Residual strep occasionally rearing its ugly head, intracellular strep "busting out"?

 

No idea. I've wondered about this too. One of our children seems to get this hot flash episode -- practically melting in the middle of the floor complaining of being hot and only calming with a shower. It seemed so similar to an older person with a hot flash -- the sudden intense feeling of heat. Our pediatrician asked us to check heart rate when it happens and to see if it is in the middle of an anxiety attack. Neither seems to be the case. They indicated if it keeps up we might want to have thyroid/andrenal checked. It is curious. In our case, our dd is not having a mini-fever.

 

Buster

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This is interesting. Within the past 4 weeks or so, my dd9 has either woken up in the middle of the night all sweaty and she has on light cotton pjs and quilt and it is 68 in the house, or in the AM when it's time to get up her pillow is all moist and her hair looks like frankenstein from perspiration. This has happened about 4x so far and we have done 5 ivigs to date. It never occured to me that she was having a reaction...I thought each time she was perhaps on the verge of a cold, etc., but no.

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Buster you seem to understand the strep carrier so could you please answer something for me. If a person is a carrier of strep, can they be treated to rid them of being a carrier? We went back to the ears nose and throat doctor yesterday and he confirmed that my son did not show any sinus infections on his CT. He has referred us to an infectious disease doctor. Our appointment is Feb. 9th. The ENT doctor told me that he suspected that my son is a strep carrier and thats why he keeps testing positive for strep. I asked him, "if he is a carrier, can't we get rid of the strep?" He said, not necessarily. He told me that the infectious disease specialist would be able to go more in depth and test to see what might be causing the strep. I explained again that while on antibiotics my sons symptoms improved and within a couple days of going off antibiotics they get much worse. Especially his OCD. He again told me that the infectious disease specialist would be better qualified to help us. He wouldn't give him an antibiotic, said he would leave that to the infectious disease doctor. Again, we don't get to see that doctor until Feb. 9th. I want to try to prepare myself as best I can for this appointment. So that is why I would like to know more about carriers. They will still give him antibiotics even if he is a carrier, right? I'm so confused.

 

 

 

 

 

 

 

 

 

All very puzzling! Okay, so I just added to the questions, didn't I? Anybody have answers?

 

"Carriage is an enigma" -- so says Dr. Ed Kaplan in his paper 1980 paper http://www.sciencedirect.com/science?_ob=A...92d1da34fbe59d6

 

There are several odd things about the carriage state. The first is it seems that the M-protein is affected in patients with chronic GABHS colonization. When these cells are moved to non-carriage individuals, the M-protein re-emerges. So something weird is happening there. Also in carriage individuals there seems to be competition from other throat flora that seems to keep the GABHS in check. Finally, there seems to be some IgA problem that prevents the colonization from being easily cleared. Carriage seems to create a low-grade infection that doesn't cause a huge ASO or Anti-DNAse response because only a small amount of the GABHS ever invades the blood stream.

 

In PANDAS, a hyper sensitivity is thought to occur where that "small amount" is enough and so it isn't at all clear that carriage is benign. Although Swedo and others have primarily studied children who did not have carriage (i.e., those mounting a high ASO response).

 

Now with respect to the typhoid Mary comment -- those with Carriage are actually just a lot less contageous -- there seems to be a bunch of differnet reasons. They tend not to have a large amount of mucous build up, they don't tend to cough/sneeze out the bacteria, and the bacteria itself seems to have certain mutation that is suppressing several of the factors that cause improved binding/adhesion (namely the M protein).

 

So absolutely a carrier in the house can infect others, but it is not the same as having someone with full on strep (which tends to spread easily).

 

Buster

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Mrigsby,

 

Have you had him evaluated to see if his tonsils and adenoids are enlarged? Sometimes the tonsils and adenoids can be a source of reinfection. While on antibiotics the child improves, but deteriorates whenever off the antibiotics b/c there is still a little strep hiding in crypts (holes in tonsils) that recolonizes if not on antibiotics. This was occuring with my two oldest children until they had a T & A. I am taking my 3rd child in for an ENT evaluation in a few weeks b/c I think that may be happening with him right now. If your child is a carrier you can erradicate the strep with the correct antibiotics.

 

Colleen

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Strep carriers can be cleared, they just need the right antibiotic (and right dose, perhaps for a longer course). If they get re-exposed to strep, they can "carry" again (and can be cleared again.)

 

PANDAS kids can be "carriers". IMO this is all the more reason to do a 1-2 mo. trial of Azith (at treatment level doses), and then possibly switch to a lower dose if doing well. If Azith, doesn't work there are other drugs to try (clindamycin). But, Azith is one of the better ones for clearing carriage (and getting intracellular strep).

 

It would also be important to check other family members to make sure they are also carriers (re-infecting your pandas child).

 

Normally (in a non-PANDAS child), docs don't always treat carriers as the carrier state has (incorrectly IMO) traditionally been viewed by the medical community as an inconsequential and benign condition.

 

It sounds like your docs are giving you a big run-around. Perhaps it would be worth a trip up North to see Dr. T. or one of the other pandas experts.

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Harley had his adenoids and tonsils removed in 2004 by the same ENT doctor that we just went to, because of chronic sinus infections and strep throat.

 

 

Mrigsby,

 

Have you had him evaluated to see if his tonsils and adenoids are enlarged? Sometimes the tonsils and adenoids can be a source of reinfection. While on antibiotics the child improves, but deteriorates whenever off the antibiotics b/c there is still a little strep hiding in crypts (holes in tonsils) that recolonizes if not on antibiotics. This was occuring with my two oldest children until they had a T & A. I am taking my 3rd child in for an ENT evaluation in a few weeks b/c I think that may be happening with him right now. If your child is a carrier you can erradicate the strep with the correct antibiotics.

 

Colleen

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