[CIS PIDD] [cis-pidd] Negative Strep Antibodies in a Patient with Recurrent Strep

[CIS-PIDD]

Thanks, Arturo.  This is most helpful.  JC

From: cis-pidd at lyris.dundee.net [mailto:cis-pidd at lyris.dundee.net] On Behalf Of CIS-PIDD
Sent: Wednesday, October 18, 2017 6:39 PM
To: CIS-PIDD
Subject: Re: [cis-pidd] Negative Strep Antibodies in a Patient with Recurrent Strep (EXTERNAL EMAIL)

Dear Joe,

About half of children that get strep throat do not develop ASLO or antiDNAse-B antibodies (see ref at: https://academic.oup.com/jid/article/188/6/809/943043/Immune-Response-to-Group-A-Streptococcal-C5a)
Thus, I would not consider this as a sign of immune deficiency or favor IVIG in this setting.

Arturo



Dr. Arturo Borzutzky S.
Profesor Asociado
Inmunología, Alergia y Reumatología Pediátrica
Departamento de Enfermedades Infecciosas e Inmunología Pediátrica
Escuela de Medicina, Pontificia Universidad Católica de Chile
[https://docs.google.com/uc?id=0BwqpIi5-Fh6gUlFpNmZtRWxIQk0&export=download]
[https://docs.google.com/uc?id=0BwqpIi5-Fh6gRGlDcWVwMzlUUUU&export=download]

On Wed, Oct 18, 2017 at 10:19 PM, CIS-PIDD <cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>> wrote:
Colleagues:

I follow a 15yo girl who has experienced multiple “strep throats.”  Most of these have been identified at the primary physician’s office with a positive rapid strep antigen test.

However, anti-streptolysin O antibody and anti-DNase-B antibody have been negative.

The patient has normal IgG (817), IgA (74) and IgM (121) levels and persistently positive (>1.3) antibodies to 23 of 23 S. pneumoniae serotypes (20 of these antibodies are >3.0) 2+ years from Pneumovax.

Are the negative strep antibodies significant in this patient?

Would these results justify a trial of Ig despite the very normal pneumococcal antibody responses?

Thank you for your time.

Joe Church
Children’s Hospital Los Angeles





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