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

Sat Oct 21 14:36:45 EDT 2017

Again I thank all who have made comments and suggestions.

Joe Church

________________________________
From: cis-pidd at lyris.dundee.net [cis-pidd at lyris.dundee.net] on behalf of CIS-PIDD [cis-pidd at lists.clinimmsoc.org]
Sent: Saturday, October 21, 2017 1:56 AM
To: CIS-PIDD
Subject: Re: [cis-pidd] Negative Strep Antibodies in a Patient with Recurrent Strep (EXTERNAL EMAIL)

Hi,

I want to mention 3 things:

  1.  The contact between immune system and Streptococcus has to be longer in order to develop antibodies against Strep A. When the treatment against Strep is quick after Strep-identification, "the chance" do develop antibodies is low. You can wait 3 days  (for a longer contact) and then, just when there are symptoms,  you can treat.  The longer contact with Strep (I appreciate 3 days) is useful not only for developing antibodies against Strep but also for  better (not strong but anyway stronger) defense against it.
  2.  The recurrence of a Strep-infection in spite of frequent antibiotics-regimen could also means a Strep-carrier, and a treatment with Clindamycin should be useful.
  3.  About PFAPA, my experience hat shown that more than 70% of patients have no mouth-ulcers. But the most patients have white spots on tonsils. And, of course, Strep test is negative.

Maybe these thoughts are useful.

Best regards,
Sorin Iurian
Pediatrician
Kinder Permanence,
Spital Zollikerberg, Zurich

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From: cis-pidd at lyris.dundee.net <cis-pidd at lyris.dundee.net> on behalf of CIS-PIDD <cis-pidd at lists.clinimmsoc.org>
Sent: Thursday, October 19, 2017 9:11 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

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

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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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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