The study of Streptococci is a field of study unto itself and there are well over 100 serotypes (M1, M3, M18) and within that there are different STRAINS – some strains are virulent and others are not. Below are some of the problems with strep.
THE COMPLEXITY OF STREP
The bacteria can adhere to the epithileal cells of the throat or nasal passages. Important to PANDAS cases: because at ONSET often the strep is reported as persistent and resistant to eradication. One child required nasal surgery. Strep was found in the biopsy.
SOME SEROTYPES CAN BECOME MUCOID
The big culprit for Rheumatic Fevers is M18. If it develops a “mucoid shield” – typical antibiotics like penicillin or Augmentin cannot pierce the cell wall. Doctors must experiment with stronger antibiotics to rid the body of these.
This is a natural process by where the human body is attempting to rid itself of the strep bacteria. It is the causative factor for Rheumatic Fever and other virulent strep illnesses, and, probably – initially with PANDAS. Below are two studies attempting to explain this phenomena in PANDAS.
Below are two studies attempting to explain this phenomena in PANDAS.
Only 54% of children with strep showed a significant increase in ASO,
Only 45% showed an increase in anti–DNase B.
Only 63% showed an increase in either ASO and/or anti–DNase B.
In short, this means, not all children who have strep will have a rise in titers.
OTHER BACTERIA AND VIRUSES
Even with strep triggered PANDAS, after several months, the autoimmune process is in full swing and the child may negatively react to many viruses, bacteria, URI’s and even chemical compounds like paint or chlorinated pools.
And, herein, lays the confusion with researchers attempting to understand the illness post-PANDAS onset. Many (but not all) of the parents have discussed the fact that after a period of weeks or months of cessation with antibiotic treatment – the child continues to have minor episodes. The baseline personality (OCD) and/or physical well being (Tic) of the child has altered and is constantly excited by activations to the immune system.
With the case of PANS, some providers and researchers believe some of the children whose onset cannot be correlated to strep actually experienced a more mild initial onset years prior that went undiagnosed. The more minor, undiagnosed exacerbation was likely triggered by undiagnosed strep that eventually resolved on its own or became “hidden” and rather undetectable.