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

[CIS-PIDD]

Thanks, Richard.  She has done better on amoxicillin, but could she do better on Ig?  I won’t get the chance to try since her labs would not pass insurance criteria.  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 8:09 PM
To: CIS-PIDD
Subject: Re: [cis-pidd] Negative Strep Antibodies in a Patient with Recurrent Strep (EXTERNAL EMAIL)

Joe,
It sounds like there is some uncertainty about the strep throats. Rapid strep tests that incubate for longer than the appropriate time will all be positive. You might just try penicillin (or amoxicillin) prophylaxis to see if it makes a difference with these recurrent symptoms.
Richard Wasserman
Dallas

On Wed, Oct 18, 2017 at 8:19 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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Richard L. Wasserman, MD, PhD
Allergy Partners of North Texas
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
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