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Strep on the skin


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Am curious about strep on the skin being tested. How do they find it. Is the strep visible (such as a rash or sore) or do they just sort of do a random swab hoping they come up with something? We're not going thru this but have heard of it.

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Am curious about strep on the skin being tested. How do they find it. Is the strep visible (such as a rash or sore) or do they just sort of do a random swab hoping they come up with something? We're not going thru this but have heard of it.

 

 

good question, I wish someone would answer.

 

danddd

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I am no professional on this but I can explain my experience.

 

I had asked dd12's ped for all strep tests possible and was told she couldn't test for strep on the skin even when she diagnosed scarletina rash. I read an article posted on this forum that psoriasis can harbor strep so I called my dermatologist and got an appointment. I brought the article and verbalized my concerns about my own exczema (psoriasis and excezma look similar so I was taking no chances!) and the fact that dd's IVIg was pending and we did not know if insurance was covering any of it and the out of pocket was going to be enormous...really buttered up the derm, right?! He knew the article content, was a microbiologist working with cytokines and t-cells before med school so understood the IVIg, had no problem connecting the PANDAS dots (REALLY-this was a dermatologist's office not immunolgy, neurology, infectious disease--all of whom poo-poo the whole concept of PANDAS) SO-he swabbed my arms, legs, feets, nares and said you just need to know how to look for strep to do a skin strep test. He also biopsied my exczema. Everything came back negative...but I had to find someone who knew the skin (and I think it really helped that he was a microbiologist, too). He was so excited to go look at everything under the microscope. He did a variety of tests too. He was like a kid in a candy store. And he reassured me that IVIg made perfect sense based on what I explained about PANDAS. Who would have thought I would get support for this from a dermatologist?! So a skin test is possible with the right doctor...

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Both my PANDAS son and my daughter have both had strep of the skin. It presented as almost like a pimple at first, that forms a yellowish kind of crust. It typically happens on the face, around the nose and mouth (which is where my daughter had it.) My son's was on his arm, which is slightly more unusual.

 

Our Dr. didn't do any sort of skin tests, just treated with both oral and topical abx.

 

FYI - it was this skin infection that we believe was the trigger for my son's PANDAS.

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The strep rash is believed to be a reaction to the toxins that the strep bacteria give off--so swabbing a scalatina rash will will come up negative.

 

Drs. can take a swab of any part of the body and use the rapid strep and/or send out for culture. I've had a few cases of impetigo in my household, and that looks pimply, and seems to spread quickly...pretty contagious too. I was told it was probably strep, but at that time the dr only prescribed antibiotics, and didn't do a swab.

 

Two other times, my kid's ped squeezed some pus from infections (finger and knee) from my boys and tested it with the rapid...one was positive, one was negative. The negative one he sent out for culture to be sure it wasn't MERSA. Basically, he said with skin infections it is either strep or staph.

 

Although strep infections on the skin don't only look pimply...google it and you'll see all kinds of pictures....same thing about the strep rash....it takes all kinds of forms....spider webby, hives, sandpaper...

Edited by Kayanne
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Thank you guys. My 19 yr old son has and has had eczema since he was a baby. It didn't occur to me to have his skin tested until reading this. Would his ASO titer be elevated though. I had that tested in early May and it was normal.

Just as a matter of full disclosure, this is worriedmommy's dh. I don't have my own user name and have never posted as my dw will from time to time, but I saw this thread and thought it worth throwing in my two cents as I can't help but think my dd's PANDAS could have possibly been headed off or learned of much earlier. My dd had an undiagnosed perianal (i.e., anal and vaginal area) strep infection for nearly three months when she was 5. It was flaming red and she was extremely itchy for months before a nurse finally mentioned that it could be strep. After many trips to the doctors, including a vaginal dermatologist, her pediatrician went so far to tell us she was "exploring" herself. We don't see that pediatrician any longer. We were never aware of the possibility of skin strep infections until the nurse mentioned it, and our dd was finally swabbed with the culture coming back with heavy growth. It cleared up with antibiotic. Her anal and vaginal area was swabbed using the regular Q-tip type swabs used for the throat. We believe she had multiple perianal strep infections since she was a young child (and when looking back she had some serious behavioral issues for an 18 month old) and this possibility was even mentioned in her doctor notes at a very young age, but was never relayed to us and a test was never done nor recommended. We thought that we were always battling diaper rash, but none of the typical diaper rash remedies would work. Looking back, the only time it subsided or cleared up was when she was taking antibiotic for sinus or ear infections. We never put it together becuase we were always focused on the high fevers and pain associated with sinus/ear infections. FYI, I have read (can't remember where) that ASO titer will not be elevated with skin strep infections because the cholestorol in the skin absorbs it. I believe this is just one solid reason why the lack of high ASO titers can't rule out PANDAS, and our dd seems to be the poster child for such (she has also had positive throat cultures in the past, but again, without high ASO titer). This was one of the messages that we heard loud and clear at the Autismone conference in May from a few of the doctors, including Dr. Swedo. I think that more doctors who are learning about PANDAS for the first time from parents like us need to appreciate this during the diagnosis phase. Of course, we all have to keep in mind that high ASO titer does not definitely mean PANDAS.

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