husbands elevated DNASE

[Johnsmom]

My husbands DNASE titers came back elevated - 360. Mine are fine. Our sons DNASE have never been elevated that we know of, only his ASO's. Can my husbands DNASE be affecting my son's ASO's?

 

Thanks

ann

[peglem]

My husbands DNASE titers came back elevated - 360. Mine are fine. Our sons DNASE have never been elevated that we know of, only his ASO's. Can my husbands DNASE be affecting my son's ASO's?

 

Thanks

ann

No, antibody titers are not contagious. But, if your husband has strep (active or carrier state) that can affect your son's ASO titers, because exposure causes the immune system to create antibodies- BUT, ASO titers are not the antibodies that cross react with the basal ganglia to cause PANDAS.

[Johnsmom]

R u sure about that? We have had 6 titer tests run on our son and never had elevated DNase

I'm confused.

 

 

 

 

My husbands DNASE titers came back elevated - 360. Mine are fine. Our sons DNASE have never been elevated that we know of, only his ASO's. Can my husbands DNASE be affecting my son's ASO's?

 

Thanks

ann

No, antibody titers are not contagious. But, if your husband has strep (active or carrier state) that can affect your son's ASO titers, because exposure causes the immune system to create antibodies- BUT, ASO titers are not the antibodies that cross react with the basal ganglia to cause PANDAS.

[peglem]

R u sure about that? We have had 6 titer tests run on our son and never had elevated DNase

I'm confused.

 

 

 

 

My husbands DNASE titers came back elevated - 360. Mine are fine. Our sons DNASE have never been elevated that we know of, only his ASO's. Can my husbands DNASE be affecting my son's ASO's?

 

Thanks

ann

No, antibody titers are not contagious. But, if your husband has strep (active or carrier state) that can affect your son's ASO titers, because exposure causes the immune system to create antibodies- BUT, ASO titers are not the antibodies that cross react with the basal ganglia to cause PANDAS.

I'm sure that antibodies are not contagious. And I'm sure that ASO and antiDnase titers are not the cause of PANDAS. My daughter was (is?) a strep carrier and she never had either of those titers elevated. If your husband's Dnase is elevated, it indicates a past infection (or could be current, but you can"t tell current infections from titer levels). ASO and AntiDnase, IMHO, are the most misinterpreted, confusing tests in this whole PANDAS business.

[Johnsmom]

okay I know all that. Whenever my son started acting goofy we would get the titers checked

and his aso's would be elevated to sometimes 5 - 600. And dr k just told me today

that with those elevated titers and his positive response to the steroid burst prove the autoimmune issue. I guess we just want to know how or if we can treat dh.

 

R u sure about that? We have had 6 titer tests run on our son and never had elevated DNase

I'm confused.

 

 

 

 

My husbands DNASE titers came back elevated - 360. Mine are fine. Our sons DNASE have never been elevated that we know of, only his ASO's. Can my husbands DNASE be affecting my son's ASO's?

 

Thanks

ann

No, antibody titers are not contagious. But, if your husband has strep (active or carrier state) that can affect your son's ASO titers, because exposure causes the immune system to create antibodies- BUT, ASO titers are not the antibodies that cross react with the basal ganglia to cause PANDAS.

I'm sure that antibodies are not contagious. And I'm sure that ASO and antiDnase titers are not the cause of PANDAS. My daughter was (is?) a strep carrier and she never had either of those titers elevated. If your husband's Dnase is elevated, it indicates a past infection (or could be current, but you can"t tell current infections from titer levels). ASO and AntiDnase, IMHO, are the most misinterpreted, confusing tests in this whole PANDAS business.

[KeithandElizabeth]

Hi Ann:

 

I cannot get a good answer to this question. My husband also had elevated ANTI DNASE B titers and we were sent to an Infectious Disease Specialist who basically sat there with sunglasses on his head and lectured me for giving my husband antibiotics on my own and how he doesn't believe we had anything to worry about and then he went on to discuss the political mania over lyme disease and how he doesn't believe in lyme disease. Anyway, 5 days later both of our children came back with positive lyme tests.

 

So, I do know that an elevated Anti DNASE B means exposure to strep in greater than 8 weeks ago. But than you can question what else does this mean? Can these people with elevated Anti Dnase B levels also have Rheumatic Heart issues? And why do these people not display symptoms of strep?

 

Just thinking out loud!!

 

Elizabeth

[Buster]

Johnsmom,

 

The current research indicates that it is not ASO or AntiDNAseB that cause the exacerbation/goofiness.

 

It's good that your son shows an ASO rise when exposed to strep.

 

Many people even with perfect timing of titers do not show a rise. A good paper by Kaplan shows that even with positive throat culture and perfect timing of blood draws,

• 46% of subjects presented no ASO rise,
  
• 55% presented no Anti-DNAseB rise,
  
• and 37% presented no rise of either ASO nor Anti-DNAseB
  

So don't worry if your son didn't have a rise in anti-DNAseB -- most don't.

 

You might be asking if it is that bad a test why do doctors trust it. Well actually they trust the combination (i.e., usually either ASO or AntiDNAse B rise in the majority of cases). However, not always.

 

Anti-DNAse B rises between 4-6 weeks post infection. The fall of antiDNAseB is not well studied and some patients have elevated anti-DNAseB for months/years (despite no culturable strep).

 

Please remember that it is not the absolute value that matters. It is the slope. You have to detect a rise in titers. A single value isn't really useful except to tell you to take another value in a week.

 

Bottom line, if you are worried about dh -- get another draw in a week and see if the titer is rising or falling. If it is falling -- then no worries. If it is rising, then he may have had an infection some 4-6 weeks ago.

 

Buster

 

 

okay I know all that. Whenever my son started acting goofy we would get the titers checked

and his aso's would be elevated to sometimes 5 - 600. And dr k just told me today

that with those elevated titers and his positive response to the steroid burst prove the autoimmune issue. I guess we just want to know how or if we can treat dh.

 

R u sure about that? We have had 6 titer tests run on our son and never had elevated DNase

I'm confused.

 

 

 

 

My husbands DNASE titers came back elevated - 360. Mine are fine. Our sons DNASE have never been elevated that we know of, only his ASO's. Can my husbands DNASE be affecting my son's ASO's?

 

Thanks

ann

No, antibody titers are not contagious. But, if your husband has strep (active or carrier state) that can affect your son's ASO titers, because exposure causes the immune system to create antibodies- BUT, ASO titers are not the antibodies that cross react with the basal ganglia to cause PANDAS.

I'm sure that antibodies are not contagious. And I'm sure that ASO and antiDnase titers are not the cause of PANDAS. My daughter was (is?) a strep carrier and she never had either of those titers elevated. If your husband's Dnase is elevated, it indicates a past infection (or could be current, but you can"t tell current infections from titer levels). ASO and AntiDnase, IMHO, are the most misinterpreted, confusing tests in this whole PANDAS business.

[Buster]

Hi Elizabeth,

 

I can try to answer the question for you based on the research I did on titers -- but I wasn't quite sure of your question.

 

Rheumatic Heart disease and acute rheumatic fever seem to have a genetic component. Multiple studies have shown that the incidence of ARF when there are rheumatic strains of GABHS is about 3-6%. This seems to be a constant regardless of geography or ethnicity. Most conclude from this that ARF is actually a genetic predisposition.

 

About 30% of those who get ARF get Sydenham's Chorea and about 70% of those get OCD.

 

ASO is affected by lots of different things but most notably cholesterol. There appears to be a binding that occurs between cholesterol and lipids that neutralizes the Streptolycin O toxin (see a 1976 paper by Kaplan : http://jem.rupress.org/content/144/3/754.full.pdf)

 

In addition, tubuculosis, liver disease and other diseases can create false positives in ASO.

 

Anti-DNAseB tends to avoid many of the false-postive issues, but has a pretty high false negative rate. In addition, recent work by Kaplan shows that Anti-DNAseB can fall even with active colonization. So the measurement is really just another indicator and not a perfect diagnostic tool.

 

Buster

 

 

 

 

 

Hi Ann:

 

I cannot get a good answer to this question. My husband also had elevated ANTI DNASE B titers and we were sent to an Infectious Disease Specialist who basically sat there with sunglasses on his head and lectured me for giving my husband antibiotics on my own and how he doesn't believe we had anything to worry about and then he went on to discuss the political mania over lyme disease and how he doesn't believe in lyme disease. Anyway, 5 days later both of our children came back with positive lyme tests.

 

So, I do know that an elevated Anti DNASE B means exposure to strep in greater than 8 weeks ago. But than you can question what else does this mean? Can these people with elevated Anti Dnase B levels also have Rheumatic Heart issues? And why do these people not display symptoms of strep?

 

Just thinking out loud!!

 

Elizabeth

[Johnsmom]

Okay Buster now you really have my head spinning! High Cholesterol affects ASO's???? When my husband went to the doctor it was for a physical. Along with testing for strep, they tested his cholesterol. His bad cholesterol is off the charts. Family history for heart disease is horrible. But he only had the elevated DNASE. I guess we will go and get tested again for the DNASE. What happens if they are elevated again. Since its post infection, what do we do?

 

 

Hi Elizabeth,

 

I can try to answer the question for you based on the research I did on titers -- but I wasn't quite sure of your question.

 

Rheumatic Heart disease and acute rheumatic fever seem to have a genetic component. Multiple studies have shown that the incidence of ARF when there are rheumatic strains of GABHS is about 3-6%. This seems to be a constant regardless of geography or ethnicity. Most conclude from this that ARF is actually a genetic predisposition.

 

About 30% of those who get ARF get Sydenham's Chorea and about 70% of those get OCD.

 

ASO is affected by lots of different things but most notably cholesterol. There appears to be a binding that occurs between cholesterol and lipids that neutralizes the Streptolycin O toxin (see a 1976 paper by Kaplan : http://jem.rupress.org/content/144/3/754.full.pdf)

 

In addition, tubuculosis, liver disease and other diseases can create false positives in ASO.

 

Anti-DNAseB tends to avoid many of the false-postive issues, but has a pretty high false negative rate. In addition, recent work by Kaplan shows that Anti-DNAseB can fall even with active colonization. So the measurement is really just another indicator and not a perfect diagnostic tool.

 

Buster

 

 

 

 

 

Hi Ann:

 

I cannot get a good answer to this question. My husband also had elevated ANTI DNASE B titers and we were sent to an Infectious Disease Specialist who basically sat there with sunglasses on his head and lectured me for giving my husband antibiotics on my own and how he doesn't believe we had anything to worry about and then he went on to discuss the political mania over lyme disease and how he doesn't believe in lyme disease. Anyway, 5 days later both of our children came back with positive lyme tests.

 

So, I do know that an elevated Anti DNASE B means exposure to strep in greater than 8 weeks ago. But than you can question what else does this mean? Can these people with elevated Anti Dnase B levels also have Rheumatic Heart issues? And why do these people not display symptoms of strep?

 

Just thinking out loud!!

 

Elizabeth

[JAG10]

Buster,

 

Are you aware of any significance in these extremely high Anti-DNaseB titers on some in this community? I think it was Dawn's family where some had titers in the 3000-5000 range when measuresd at Mayo?

 

Also, do you know if Dr. Cummingham looked for incidence of correlation btn CamKII and ASO and/or Anti DNaseB? Could it be that some people have a high co-production rate of these antibodies and perhaps there is a common thread to their symptomology versus PANDAS w/o titer rise, but positive swab?

Are they looking at patterns/trends between what biomeasurements currently exist and symptoms, age of onset, response to treatment?

 

I realize there is a difference between statistical significance and "trends", just wondering if anyone is pooling all the available data and looking for patterns.

 

I know, lots and lots of questions, more research needed for answers.

[Buster]

Well, sort of. ASO is neutralized by certain lipids. GABHS on the skin does not tend to cause an ASO response as the Streptolycin O is neutralized by the skin.

 

There seems to be some concern in your post about the higher Anti-DNAseB levels. If they are rising then there was likely an infection in the prior 8 weeks. If they are falling then who knows. If they are constant -- no one knows. Only a rising titer is informative.

 

Generally a throat culture is preferable to taking blood titers. Use of blood titers is really to confirm a prior suspected strep infection in the prior 1-8 weeks.

 

Are you concerned that your dh is still positive? The odd are that his titers are falling from a prior infection.

 

Buster

 

Okay Buster now you really have my head spinning! High Cholesterol affects ASO's???? When my husband went to the doctor it was for a physical. Along with testing for strep, they tested his cholesterol. His bad cholesterol is off the charts. Family history for heart disease is horrible. But he only had the elevated DNASE. I guess we will go and get tested again for the DNASE. What happens if they are elevated again. Since its post infection, what do we do?

 

 

Hi Elizabeth,

 

I can try to answer the question for you based on the research I did on titers -- but I wasn't quite sure of your question.

 

Rheumatic Heart disease and acute rheumatic fever seem to have a genetic component. Multiple studies have shown that the incidence of ARF when there are rheumatic strains of GABHS is about 3-6%. This seems to be a constant regardless of geography or ethnicity. Most conclude from this that ARF is actually a genetic predisposition.

 

About 30% of those who get ARF get Sydenham's Chorea and about 70% of those get OCD.

 

ASO is affected by lots of different things but most notably cholesterol. There appears to be a binding that occurs between cholesterol and lipids that neutralizes the Streptolycin O toxin (see a 1976 paper by Kaplan : http://jem.rupress.org/content/144/3/754.full.pdf)

 

In addition, tubuculosis, liver disease and other diseases can create false positives in ASO.

 

Anti-DNAseB tends to avoid many of the false-postive issues, but has a pretty high false negative rate. In addition, recent work by Kaplan shows that Anti-DNAseB can fall even with active colonization. So the measurement is really just another indicator and not a perfect diagnostic tool.

 

Buster

 

 

 

 

 

Hi Ann:

 

I cannot get a good answer to this question. My husband also had elevated ANTI DNASE B titers and we were sent to an Infectious Disease Specialist who basically sat there with sunglasses on his head and lectured me for giving my husband antibiotics on my own and how he doesn't believe we had anything to worry about and then he went on to discuss the political mania over lyme disease and how he doesn't believe in lyme disease. Anyway, 5 days later both of our children came back with positive lyme tests.

 

So, I do know that an elevated Anti DNASE B means exposure to strep in greater than 8 weeks ago. But than you can question what else does this mean? Can these people with elevated Anti Dnase B levels also have Rheumatic Heart issues? And why do these people not display symptoms of strep?

 

Just thinking out loud!!

 

Elizabeth

[Buster]

Hi Jag10,

 

Well, yes, I do collect data and stare at it thinking it will tell me something -- most times it doesn't

 

Based on Shep and Kurlan, the absolute value of any of the titers is not as important as the direction. Since most people do not have an initial value to compare against, they use what is called the upper limit of normal as if that was one of your prior readings.

 

Let me try by analogy, have you known anyone who gets big welts to a mosquito bite whereas others have only a small bump? Well, that's sort of what is happening here. Some have huge reactions to the exotoxin DANse-B and others don't. Some people produce tons of antibodies (3000 IU per ml) while others don't.

 

This is why kurlan uses direction -- i.e., by analogy is there a bump. He doesn't look at the height, just that it got bigger or smaller.

 

Hope the analogy works.

 

Buster

 

Buster,

 

Are you aware of any significance in these extremely high Anti-DNaseB titers on some in this community? I think it was Dawn's family where some had titers in the 3000-5000 range when measuresd at Mayo?

 

Also, do you know if Dr. Cummingham looked for incidence of correlation btn CamKII and ASO and/or Anti DNaseB? Could it be that some people have a high co-production rate of these antibodies and perhaps there is a common thread to their symptomology versus PANDAS w/o titer rise, but positive swab?

Are they looking at patterns/trends between what biomeasurements currently exist and symptoms, age of onset, response to treatment?

 

I realize there is a difference between statistical significance and "trends", just wondering if anyone is pooling all the available data and looking for patterns.

 

I know, lots and lots of questions, more research needed for answers.