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

[CIS-PIDD]

Dr. Church:

I suggest that recurrent streptococcal infection -- even with the negative ASO -- is common enough that it need not necessarily be an (easily diagnosable) immunodeficiency.  The question is where does the patient keep getting (re-)infected from?   My usual practice would be to test and treat the entire family.  If they have a pet cat or dog, ask the family to bring their animal to the vet to check if the pet happens to be a carrier, as well.

The pet thing is not as well-supported in the literature -- but many an ID doc has had experience of a case where the infection cycle didn't stop until Fluffy got treated at the same time everyone else was.

      - K

Karl O. A. Yu, M.D., Ph.D., F.A.A.P.
Scientist II and Assistant Director, Center for Infectious Diseases and Immunology
RGH Research Institute | Rochester General Hospital | Rochester Regional Health
1425 Portland Ave., Room R-403, Rochester, NY   14621
Tel  585-922-3709  |  Fax  585-922-2415


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From: cis-pidd at lyris.dundee.net [mailto:cis-pidd at lyris.dundee.net] On Behalf Of CIS-PIDD
Sent: Thursday, October 19, 2017 2:12 PM
To: CIS-PIDD
Subject: RE: [cis-pidd] Negative Strep Antibodies in a Patient with Recurrent Strep

Joe

We occasionally see patients with invasive Strep (not just pharyngitis) and the only association I was able to find was with agammaglobulinemia.  I don’t ususally consider Strep infections as a sign of an immune deficiency.  Perhaps that’s just my perception

I agree with Amoxil prophylaxis…must cheaper than Ig…and if it doesn’t work then this isn’t a Strep issue

Best

James

James W. Verbsky M.D./Ph.D.
Associate Professor of Pediatrics and Microbiology
Medical Director, Clinical Immunology Research Laboratory
Medical Director, Clinical and Translational Research
Medical College of Wisconsin
Milwaukee, WI

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From: cis-pidd at lyris.dundee.net [mailto:cis-pidd at lyris.dundee.net] On Behalf Of CIS-PIDD
Sent: Thursday, October 19, 2017 9:32 AM
To: CIS-PIDD <cis-pidd at lyris.dundee.net>
Subject: RE: [cis-pidd] Negative Strep Antibodies in a Patient with Recurrent Strep

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

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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

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On Wed, Oct 18, 2017 at 8:19 PM, CIS-PIDD <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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