Yet another curious observation

[Dr_Rosario_Trifiletti]

Dear Parents,

 

I know that some of you have opted for tonsillectomy. Although removed tonsils are routinely sent to pathology for examination, they are not routinely cultured.

 

What organism are left behind in children with PANDAS who have their tonsils removed?

 

So far 3/3 kids - Haemophilus influenzae, non-Type B (NTHI). No strep in a single case. This is NOT the organism that HiBVax protects against, not the Type B organism that causes neonatal meningitis.

 

Does anyone else have culture results on tonsils?

 

Perhaps NTHI is a benign squatter, merely occupying territory formerly occupied by strep. Or it may be of pathogenic significance.

 

Or perhaps yet another potential co-infection?

 

 

Dr. T

[sf_mom]

Dr. T,

 

It is my understanding that this particular organism loves to make love to strep. Please correct me if I am wrong.

 

-Wendy

 

Dear Parents,

 

I know that some of you have opted for tonsillectomy. Although removed tonsils are routinely sent to pathology for examination, they are not routinely cultured.

 

What organism are left behind in children with PANDAS who have their tonsils removed?

 

So far 3/3 kids - Haemophilus influenzae, non-Type B (NTHI). No strep in a single case. This is NOT the organism that HiBVax protects against, not the Type B organism that causes neonatal meningitis.

 

Does anyone else have culture results on tonsils?

 

Perhaps NTHI is a benign squatter, merely occupying territory formerly occupied by strep. Or it may be of pathogenic significance.

 

Or perhaps yet another potential co-infection?

 

 

Dr. T

[faith]

Just wanted to post some links here to help understand what h. influenzae is. This one is interesting in that it does talk about interaciton between s. pneumo and h. influenzae. is this what you are alluding to , Wendy?

 

 

From: http://en.wikipedia.org/wiki/Haemophilus_influenzae

 

Interaction with Streptococcus pneumoniae

Both H. influenzae and S. pneumoniae can be found in the upper respiratory system of humans. A study of competition in a laboratory revealed that, in a petri dish, S. pneumoniae always overpowered H. influenzae by attacking it with hydrogen peroxide and stripping off the surface molecules that H. influenzae needs for survival.

 

When both bacteria are placed together into a nasal cavity, within 2 weeks, only H. influenzae survives. When either is placed separately into a nasal cavity, each one survives. Upon examining the upper respiratory tissue from mice exposed to both bacteria species, an extraordinarily large number of neutrophils (immune cells) was found. In mice exposed to only one bacteria, the cells were not present.

 

Lab tests showed that neutrophils exposed to dead H. influenzae were more aggressive in attacking S. pneumoniae than unexposed neutrophils. Exposure to dead H. influenzae had no effect on live H. influenzae.

 

Two scenarios may be responsible for this response:

 

1. When H. influenzae is attacked by S. pneumoniae, it signals the immune system to attack the S. pneumoniae

2. The combination of the two species together triggers an immune system response that is not set off by either species individually.

It is unclear why H. influenzae is not affected by the immune response.[8]

[thereishope]

Sorry. My son had them out before everyone came up with the great idea of culturing them!

[Fixit]

Dear Parents,

 

I know that some of you have opted for tonsillectomy. Although removed tonsils are routinely sent to pathology for examination, they are not routinely cultured.

 

What organism are left behind in children with PANDAS who have their tonsils removed?

 

So far 3/3 kids - Haemophilus influenzae, non-Type B (NTHI). No strep in a single case. This is NOT the organism that HiBVax protects against, not the Type B organism that causes neonatal meningitis.

 

Does anyone else have culture results on tonsils?

 

Perhaps NTHI is a benign squatter, merely occupying territory formerly occupied by strep. Or it may be of pathogenic significance.

 

Or perhaps yet another potential co-infection?

 

 

Dr. T

 

 

So can someone put this in English....

 

if both are in the system influenza wins?

but the influenza keeps saying attach strep even though its not there?

and its the strep anti bodies that we think are attacking the basal right?

so should we check for Haemophilus influenzae?

will clarithomycine get that or azith, or something else?

 

we haven't had a positive strep in i guess 2 years now.. but if we actually have influenza, could it sending signals to attach strep

 

.the igg on myco was 631 on as scale that said anything above 320 was pos

again to repeat, maybe the last couple of epsiodes were actually myco p caught early with the right abx(docs concerned about his strep frequecy so gave me abx)....just curious if we could have both......

 

sorry if i sound like an idiot or perinoid but i'm probably both.....

[reactive]

Dear Parents,

 

I know that some of you have opted for tonsillectomy. Although removed tonsils are routinely sent to pathology for examination, they are not routinely cultured.

 

What organism are left behind in children with PANDAS who have their tonsils removed?

 

So far 3/3 kids - Haemophilus influenzae, non-Type B (NTHI). No strep in a single case. This is NOT the organism that HiBVax protects against, not the Type B organism that causes neonatal meningitis.

 

Does anyone else have culture results on tonsils?

 

Perhaps NTHI is a benign squatter, merely occupying territory formerly occupied by strep. Or it may be of pathogenic significance.

 

Or perhaps yet another potential co-infection?

 

 

Dr. T

I replied to faith's ENT post about this also. May not be related. My ds9 had his tonsillectomy in 2007. I was looking through old records, and my ds was seen in urgent care in 2008 for sore throat, high fever, ect with worsening symptoms. He was dx with pneumonia, and put on abx ( I forget which one). I asked the doc to do a throat culture due to increase sx of PANDAS and it was neg for strep but pos for the H flu no type specified as above.

[sf_mom]

Sorry, Faith I don't know much more than you do..... Again, I looked into it when researching Kawasaki's. I also know there was a PANDAS child and similar was found after T & A. The child had two larger does IVIG treatments about six months apart and is doing well. I think consulting with Dr. T about the results is a good way to go. Is it culprit, maybe? Hopefully, you'll see some improvement from the antibiotics.

 

When I get time, I'll recheck some of the studies I read.

 

-Wendy

[colleenrn]

My two oldest children had a T&A, but as far as I know, nothing was cultured. The ENT that removed them has retired, but I do have a copy of their medical records. I will try to find them and see if they may have been cultured.

 

I took my 3rd child to an ENT yesterday and she agrees he would benefit from a T&A. We will most likely schedule it is the next 2 months. She was not that knowledgable on PANDAS, but I don't really need her to be I guess. I will make sure his tonsils and adenoids are cultured.

 

My BIG question is do I need my son on 10 days of Clindamycin prior to surgery or is the 250mg of Zithromax daily sufficient?? If anyone has any information on that I would greatly appreciate it!

 

Colleen

[fuelforall]

Hi Colleen,

Dr T told us to do clindamycin at least 7 days before surgery. Should be sufficient. Zith should work ok, just not on my kid.

 

That said, you will probably have to give your child another antibiotic while she recovers. She won't be able to swallow the clindamycin and theliquid version is just too nasty.

 

Michael