Strep "carrier"

[T_Mom]

Can anyone explain what it means to be a "strep carrier" and how do you test for it?

Thanks.

[matis_mom]

Can anyone explain what it means to be a "strep carrier" and how do you test for it?

Thanks.

My non-scientific reply...

A carrier is someone who harbors strep but does not become sick with it. It is not as contagious as someone with an active infection, but it's enough to set a PANDAS child off, or keep him/her from getting well. You can find a carrier by getting people checked when they are well. If someone comes back positive, that's your carrier. That was the case of our 14-yo, although I have "caught" other kids with strep and no symptoms.

Hopefully the more scientifically oriented will chime in...

[AmySLP]

My understanding is that carriers always test positive-is that right? Sometime ago and ENT had told us our daughter was not a carrier b/c she tested negative after ABX course.

[matis_mom]

My understanding is that carriers always test positive-is that right? Sometime ago and ENT had told us our daughter was not a carrier b/c she tested negative after ABX course.

Well, if treated successfully, they are no longer carriers. Ds14 is negative after being treated with Clindamycin. I have to get him checked again next week, just to be sure, but I think it worked at clearing him.

[matis_mom]

My understanding is that carriers always test positive-is that right? Sometime ago and ENT had told us our daughter was not a carrier b/c she tested negative after ABX course.

Also, how soon did you test? You need to give it a couple of weeks after finishing the antibiotic and then test again. I brought dd back after 10 days on abxs plus to weeks and sure enough, she came back positive. I don't think she was a carrier, as she had all the typical symptoms, but the antibiotic did not work for her.

[AmySLP]

My understanding is that carriers always test positive-is that right? Sometime ago and ENT had told us our daughter was not a carrier b/c she tested negative after ABX course.

Also, how soon did you test? You need to give it a couple of weeks after finishing the antibiotic and then test again. I brought dd back after 10 days on abxs plus to weeks and sure enough, she came back positive. I don't think she was a carrier, as she had all the typical symptoms, but the antibiotic did not work for her.

 

 

Well, she's been on clindamycin twice over a two year period. Maybe she was a carrier? I am starting to wonder if I am a carrier-everytime I ask for a test b/c I'm sick it's positive. Currently, I am being treated for strep-I think I should retest in a few weeks after ABX to see what happens.

[matis_mom]

Currently, I am being treated for strep-I think I should retest in a few weeks after ABX to see what happens.

We are on the same boat! I did get swabbed (negative) after 6 days on Augmentin plus 20 days on Biaxin. I am checking titers too to see if they are coming down (ASO was 250).

[Buster]

Usually carrier is a shorthand for "asymptomatic carrier". This means that someone is carrying the bacteria and can be cultured positive (colonization) but does not have immunologic signs of an infection (no classic sore throat, no rise in ASO, no rise in AntiDNAseB, etc).

 

Dr. Kaplan (world health organization) refers to carriage as an "enigma" because it isn't exactly known what is happening in those who only get colonization and don't progress to infection. Several theories have been presented that perhaps the GABHS is "starved" by other competing flora in the throat. Others think streptolysin gets neutralized in some people due to differences in pH (or cholesterol levels), and there's lots of other items.

 

There's actually very little study of carriage and while many doctors think it is benign, there really isn't any evidence that this is true. There is some evidence that those with chronic carriage do not progress to acute rheumatic fever, but that might just be that the strain being carried is not a rheumatic strain.

 

Asymptomatic carriers have been harder to clear than symptomatic carriers. One strong reason is that most of the common treatments (Pennicilin and derivatives) only work when the bacteria is growing quickly -- if the bacteria is slowly growing amoxicillin, penicillin, augmentin are less effective. So asymptomatic carriage may merely be an inability of the immune system to really take out the bacteria -- sort of a chronic light colonization.

 

Buster

Edited August 29, 2010 by Buster

[thereishope]

Then there's my kids, they do not get symptoms of strep but they will test +...and they are not carriers.

[T_Mom]

Thank you all for the replies. Buster, your explanation really helps to shed some light on this for me--So as you say, it is an, "asymptomatic carrier".

"This means that someone is carrying the bacteria and can be cultured positive (colonization) but does not have immunologic signs of an infection (no classic sore throat, no rise in ASO, no rise in AntiDNAseB, etc)."

 

Essential then to get all in the family tested--with an exacerbation...as it may shed some light on the situation. Thanks--

[Buster]

Vickie's comment is also correct. There is asymptomatic carriage where there is only colonization, then there is low level invasion ( I.e where there is an immunologic response such as elevated ASO/AntiDNAseB) and then there is all out infection where the bacteria overwhelms the immune system.

 

Only the first one is referred to as asymptomatic carriage because in the second case there is an immunologic response. I asked Dr Kaplan why he think there isn't an immunologic response in the first (i.e., couldn't it just be ineffective IgA clearance of the colonization). He said they don't know. They just know that antibiotics such as penicillin don't work great if the bacteria is growing slowly.

 

So for those with colonization only and slow growth, they need a different type of antibiotic to clear that doesn't rely on rate of growth.

 

Buster

Edited August 30, 2010 by Buster

[nojo]

Vickie's comment is also correct. There is asymptomatic carriage where there is only colonization, then there is low level invasion ( I.e where there is an immunologic response such as elevated ASO/AntiDNAseB) and then there is all out infection where the bacteria overwhelms the immune system.

 

Only the first one is referred to as asymptomatic carriage because in the second case there is an immunologic response. I asked Dr Kaplan why he think there isn't an immunologic response in the first (i.e., couldn't it just be ineffective IgA clearance of the colonization). He said they don't know. They just know that antibiotics such as penicillin don't work great if the bacteria is growing slowly.

 

So for those with colonization only and slow growth, they need a different type of antibiotic to clear that doesn't rely on rate of growth.

 

Buster

 

What type of antibiotic seems to work best in this instance?

[Worried_Dad]

Our docs prescribed a month of clindamycin to try to clear our whole family, since all of us (besides our PANDAS son) had elevated / rising ASO titers. I remember reading some posts in the past where an infectious disease specialist had recommended a combination of clindamycin and rifampin for eradicating stubborn strep. Might be some other combinations that are prescribed by other docs?

 

 

Vickie's comment is also correct. There is asymptomatic carriage where there is only colonization, then there is low level invasion ( I.e where there is an immunologic response such as elevated ASO/AntiDNAseB) and then there is all out infection where the bacteria overwhelms the immune system.

 

Only the first one is referred to as asymptomatic carriage because in the second case there is an immunologic response. I asked Dr Kaplan why he think there isn't an immunologic response in the first (i.e., couldn't it just be ineffective IgA clearance of the colonization). He said they don't know. They just know that antibiotics such as penicillin don't work great if the bacteria is growing slowly.

 

So for those with colonization only and slow growth, they need a different type of antibiotic to clear that doesn't rely on rate of growth.

 

Buster

 

What type of antibiotic seems to work best in this instance?

[peglem]

Vickie's comment is also correct. There is asymptomatic carriage where there is only colonization, then there is low level invasion ( I.e where there is an immunologic response such as elevated ASO/AntiDNAseB) and then there is all out infection where the bacteria overwhelms the immune system.

 

Only the first one is referred to as asymptomatic carriage because in the second case there is an immunologic response. I asked Dr Kaplan why he think there isn't an immunologic response in the first (i.e., couldn't it just be ineffective IgA clearance of the colonization). He said they don't know. They just know that antibiotics such as penicillin don't work great if the bacteria is growing slowly.

 

So for those with colonization only and slow growth, they need a different type of antibiotic to clear that doesn't rely on rate of growth.

 

Buster

 

What type of antibiotic seems to work best in this instance?

We used rifampin/augmentin successfully.

[pixiesmommy]

Our whole family keeps coming up positive for strep with no symptoms other than Pixie's slight exacerbations and knee pain. We cannot get off of antibiotics long enough to get a test before she is already flaring again and we repeat the cycle. My family dr says it is rare that you can actually clear someone who is a carrier, but that it is probably me since I have a long history with strep. I'm not sure though because I am the one with the history, true, but I always (that I know of) had severe sore throat with strep and was able to tell when I had it.

 

DH, on the other hand, has NO history with strep and comes up more strongly positive than anyone else in the family. That makes me think HE is the carrier, not me.

 

It's confusing!