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

Fri Oct 20 11:09:33 EDT 2017

PFAPA is uncommon in adults but certainly occurs
https://www.ncbi.nlm.nih.gov/pubmed/18605359

I have often seen steroid responsive fevers characteristic of PFAPA in
children without pharyngitis, stomatitis or adenopathy but I have never
diagnosed PFAPA without the characteristic fevers.

As I previously noted and others have implied, the "recurrent strep" may be
failure to use the rapid strep test correctly.
Richard Wasserman
Dallas

On Fri, Oct 20, 2017 at 8:53 AM, CIS-PIDD <cis-pidd at lists.clinimmsoc.org>
wrote:

> I very much appreciate everyone’s comments/suggestions.
>
>
>
> Regarding PFAPA, I think it unlikely:
>
> -       She is older than the average PFAPA patient
>
> -       With the Strep throats, her fever is rarely over 100F
>
> -       These infections are not accompanied by enlarged lymph nodes
>
> -       She does not get oral ulcers.
>
>
>
> Joe Church
>
>
>
> *From:* cis-pidd at lyris.dundee.net [mailto:cis-pidd at lyris.dundee.net] *On
> Behalf Of *CIS-PIDD
> *Sent:* Friday, October 20, 2017 5:56 AM
>
> *To:* CIS-PIDD
> *Subject:* Re: [cis-pidd] Negative Strep Antibodies in a Patient with
> Recurrent Strep (EXTERNAL EMAIL)
>
>
>
> Ciao a tutti,
>
>
>
> I would also think on pfapa (recurrent inflammatory tonsillitis, enlarged
> lymph nodes, fever, mouth ulcer), negative strep test, elevated crp, esr
> and saa on a crisis that normalize between them. Usually the children or
> the adult patient is very well even on fever.
>
>
>
> Leo.
>
> Enviado do meu iPhone
>
>
> Em 20 de out de 2017, às 14:42, CIS-PIDD <cis-pidd at lists.clinimmsoc.org>
> escreveu:
>
> Couldn’t this be PFAPA (in combination with false positive rapid strep
> tests)?
>
> Esther de Vries
>
>
>
> Op 20 okt. 2017, om 13:56 heeft CIS-PIDD <cis-pidd at lists.clinimmsoc.org>
> het volgende geschreven:
>
>
>
> 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>
> 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
> <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
>
>
>
> *From:* cis-pidd at lyris.dundee.net [mailto:cis-pidd at lyris.dundee.net
> <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>
> 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
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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
Fax (972) 566-8837
Cell (214) 697-7211

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