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

Fri Oct 20 07:56:10 EDT 2017

We See an awful lot of false positive rapid strep tests. The first thing I do is insist that they confirm with a culture then I have them repeat the throat culture at the end of treatment when the patient is a asymptomatic
If they are a carrier we need to treat them with penicillin or amoxicillin plus rifampin
Lisa

Sent from my iPhone
Lisa Kobrynski

On Oct 19, 2017, at 2:12 PM, CIS-PIDD <cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>> wrote:

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

From: cis-pidd at lyris.dundee.net<mailto: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<mailto: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

From: cis-pidd at lyris.dundee.net<mailto: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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