Carriers

[Joan Pandas Mom]

I'm confused, once again! My friend, whose son is a carrier told me that her pedi told her he wasn't contagious. She said even if carriers are put on ABX's for a month they won't get rid of strep. Is this true?

[peglem]

I'm confused, once again! My friend, whose son is a carrier told me that her pedi told her he wasn't contagious. She said even if carriers are put on ABX's for a month they won't get rid of strep. Is this true?

I don't really think anybody knows the answer to these questions. The non-contagious, benign state of strep carriage is an assumption doctors have made, based on experience, I suppose. It hasn't been studied much. But, it seems that many of our PANDAS kids react to strep carriers by demonstrating PANDAS symptoms. I think that sheds doubt on it being non-contagious.

[Buster]

I'm confused, once again! My friend, whose son is a carrier told me that her pedi told her he wasn't contagious. She said even if carriers are put on ABX's for a month they won't get rid of strep. Is this true?

 

While a simple question, the answer is a bit complicated.

1. Antibiotics don't kill strep. The immune system kills strep.
   
2. Antibiotics work by slowing the progression of the strep replication allowing the immune system to catch up. Penicillin works by eroding the cell wall. Azith and macrolides work by inhibiting an enzyme used in rapid replication.
   
3. Antibiotics are only really helpful in rapidly replicating bacterial infections. Antibiotics are not particularly helpful in slowly replicating infections.
   
4. The immune system has to recognize the GABHS bacteria and attack the bacteria with macrophages.
   
5. In some people, the immune system doesn't recognize GABHS or has trouble clearing it. It is not known why. Kaplan refers to the carrier state as "an enigma" because GABHS is generating exotoxins but the immune system seems not to respond in some people.
   
6. To test for clearance, you have to check 14-21 days post last treatment.
   
7. The dosage for antibiotics is set to treat 80+% of people effectively (i.e., lowest dose that will help 80+% of people clear an infection).
   

so, to answer your question, the term "carriers" usually is short hand for "asymptomatic carriers" and means that there is no apparent immune response to the presence of GABHS. For these asymptomatic carriers, the use of antibiotics does not help the immune system overcome the infection because for reasons not understood the infection is being held in check through some other mechanism -- lots here about other throat flora, but the short answer is they don't know why. So yes, for asymptomatic carriers, they would typically not clear strep on normal dosage of antibiotics.

 

I probably just caused you to have more questions, but hope this helped.

 

Buster

[CandKRich]

.

Edited August 12, 2013 by CandKRich

[alderliefest]

I have had PANDAS for 10 years now. I am known as a carrier. I have had strep throat once or twice in my life. We don't know where the infection is hiding in my body, but we know its there. My ASO titers are in the high 700's. My highest being in the 1400's (2006). I was on antibiotics from 2000-2002ish and on anti anxiety meds for 10 years as well. I just ended a 40 day regiment of clydamicin (150mgs 2 times a day). I got blood drawn and am waiting on results. I have never given anyone strep even though I'm a carrier and I can't get rid of the infection. I know I'm a carrier, I just wish we knew how to get rid of it!

 

.... i did feel better on the antibiotics, when I wasn't having G.I issues.

[ajcire]

alderliefest, how do you know you haven't given it to anyone else?

 

 

 

I have had PANDAS for 10 years now. I am known as a carrier. I have had strep throat once or twice in my life. We don't know where the infection is hiding in my body, but we know its there. My ASO titers are in the high 700's. My highest being in the 1400's (2006). I was on antibiotics from 2000-2002ish and on anti anxiety meds for 10 years as well. I just ended a 40 day regiment of clydamicin (150mgs 2 times a day). I got blood drawn and am waiting on results. I have never given anyone strep even though I'm a carrier and I can't get rid of the infection. I know I'm a carrier, I just wish we knew how to get rid of it!

 

.... i did feel better on the antibiotics, when I wasn't having G.I issues.

[thereishope]

I had a short conversation with a friend who is a pediatrician. I explained how my kids do not get symptoms of strep. This person quickly said that means they are carriers. But they are NOT carriers.

 

So, do most doctors think no symptoms means carrier, therefore, no need for treatment. Or do doctors just not realize there are non-carriers out there that do not get symptoms of strep?

[alderliefest]

no boyfriends have gotten strep from me, and my husband hasn't had strep in the past 4 years that we had been together. So I don't see how I could have given it to them.

 

 

 

 

 

alderliefest, how do you know you haven't given it to anyone else?

 

 

 

I have had PANDAS for 10 years now. I am known as a carrier. I have had strep throat once or twice in my life. We don't know where the infection is hiding in my body, but we know its there. My ASO titers are in the high 700's. My highest being in the 1400's (2006). I was on antibiotics from 2000-2002ish and on anti anxiety meds for 10 years as well. I just ended a 40 day regiment of clydamicin (150mgs 2 times a day). I got blood drawn and am waiting on results. I have never given anyone strep even though I'm a carrier and I can't get rid of the infection. I know I'm a carrier, I just wish we knew how to get rid of it!

 

.... i did feel better on the antibiotics, when I wasn't having G.I issues.

[EAMom]

But our "assymptomatic carrier" younger dd has cleared sucessfully several times on a 5 day course of Azith. The first time we tried to clear her (with Augmentin) it didn't work. Clindamycin might also be another ab to consider if clearing on Azith. doesn't work.

[peglem]

But our "assymptomatic carrier" younger dd has cleared sucessfully several times on a 5 day course of Azith. The first time we tried to clear her (with Augmentin) it didn't work. Clindamycin might also be another ab to consider if clearing on Azith. doesn't work.

So, you clear her, and then she resumes carriage at a later time?

[EAMom]

I did have a good paper (where is it? I need to dig it up) that talked about strep carriers. Basicailly, they found that strep carriers ARE contagious. The more hours you have of contact with the carrier, the more likely you are to get it. Thus, casual contact (spending a few hours with a carrier) isn't likely to give you strep, but sharing a household with one (or going to a sleepover!) is another matter.

 

Plus, we need to keep in mind that PANDAS kids are thought to be more suspectable to strep in the first place!

 

One of our family friends (she was 11 or so at the time) did get strep after a sleepover at our house. At the time we didn't know that both of our dd were "carrying strep".

 

On the other hand, (I've never figured this one out!) when I had full-blown strep (x 1 week), nobody in our family actually got strep (although our pandas dd on abs reacted, handwriting deterioration). Even our younger dd (the carrier who has picked up strep several times from school) stayed clear! And this is when we were on vacation, all crammed into 1 room!

[EAMom]

But our "assymptomatic carrier" younger dd has cleared sucessfully several times on a 5 day course of Azith. The first time we tried to clear her (with Augmentin) it didn't work. Clindamycin might also be another ab to consider if clearing on Azith. doesn't work.

So, you clear her, and then she resumes carriage at a later time?

 

She'll stay clear if there is no more exposure (like over the summer, or in the spring if there are no strep notices). Last school year she had a couple of positives...she was definitely clear in the fall/summer at the start of school, then we got a strep notice in Oct...positive, then she was clear after tx 2-3 weeks later, then another strep notice in Dec, positive again, then we cleared her and she stayed negative the rest of the year (even after I got strep in April!).

[colleenrn]

Alderliefest,

 

Have you ever added Rifampin to another antibiotic to attempt to clear carriage? The rifampin is sometimes needed if other antibiotics are not successful.

Colleen

[simplygina]

But our "assymptomatic carrier" younger dd has cleared sucessfully several times on a 5 day course of Azith. The first time we tried to clear her (with Augmentin) it didn't work. Clindamycin might also be another ab to consider if clearing on Azith. doesn't work.

So, you clear her, and then she resumes carriage at a later time?

 

She'll stay clear if there is no more exposure (like over the summer, or in the spring if there are no strep notices). Last school year she had a couple of positives...she was definitely clear in the fall/summer at the start of school, then we got a strep notice in Oct...positive, then she was clear after tx 2-3 weeks later, then another strep notice in Dec, positive again, then we cleared her and she stayed negative the rest of the year (even after I got strep in April!).

 

I know my nieces were having trouble with strep and they finally realized it was my nephew that was carrying it. From what I remember they just gave him abx and the whole issue seemed to clear up.

 

My youngest son is definitely asymptomatic but I don't know about a carrier. He has had several throat swabs and cultures in the last 2 months that have come back negative but sometimes he has that streppy smell. He's the one with major gut issues so I'm beginning to wonder if he isn't carrying it someplace else.

 

How can they tell if you are a carrier? Will most just have a positive throat culture? I've been wondering about myself as well, though I've had a negative culture in the last month too.

 

It's tempting to take everyone of us, including the dog to have every orafice swabbed and cultured. Sorry to be so graphic but I'm only half joking!!!

[EAMom]

no boyfriends have gotten strep from me, and my husband hasn't had strep in the past 4 years that we had been together. So I don't see how I could have given it to them.

 

 

 

 

 

alderliefest, how do you know you haven't given it to anyone else?

 

 

 

I have had PANDAS for 10 years now. I am known as a carrier. I have had strep throat once or twice in my life. We don't know where the infection is hiding in my body, but we know its there. My ASO titers are in the high 700's. My highest being in the 1400's (2006). I was on antibiotics from 2000-2002ish and on anti anxiety meds for 10 years as well. I just ended a 40 day regiment of clydamicin (150mgs 2 times a day). I got blood drawn and am waiting on results. I have never given anyone strep even though I'm a carrier and I can't get rid of the infection. I know I'm a carrier, I just wish we knew how to get rid of it!

 

.... i did feel better on the antibiotics, when I wasn't having G.I issues.

 

I ditto ajcire's question:

In general, adults/teens will be less susceptible to contracting strep than children. Just b/c your boyfriend is immune, doesn't meant you haven't infected someone with a less robust immune system (eg children ).

 

When both my kids were "carrying" strep, dh and I were not affected...however, an 11-year-old family friend who slept over 1 night did end up contracting it from them. And, I have no idea how many kids they might have infected in school!

Edited March 23, 2010 by EAMom