Strep can present in a variety of ways. Many associated strep with strep throat. They assume a person will have a fever, sore throat, and white spots on their tonsils. Even though this presentation can indicate strep, it is not the only way strep may present itself. Testing can also be difficult. Lab tests can be helpful, but are not always a true depiction of what is happening in the body. Understanding the complexity of strep is very important when evaluating tests and lab work.
WHERE STREP CAN OCCUR
Strep throat is very common in children. Typically, the symptoms are described as above. However, the red flag symptoms can also be an upset stomach, headache, and more.
For some people, they may not exhibit any symptoms. For PANDAS children, the behavior changes are their indicating symptoms of a possible infection.
Some people can appear symptomless, yet can test positive for strep throat.
According to presentations done by Dr. Susan Swedo, PANDAS children should not be classified as “strep carriers”. Their PANDAS symptoms is their immune reaction. A classic strep carrier body, would create absolutely no negative reaction at all to the bacteria.
STREP IN OTHER PLACES OF THE BODY
In addition to the throat, strep can occur in the sinuses, in the ears, in the gut, on the skin, in the vagina, and peri-anal strep. A throat swab will not give you positive result for strep that is occurring somewhere else in the body.
STREP SWAB RAPID TEST AND CULTURE
A throat swab is the easiest and least invasive way to test for strep throat. Even though people can receive false negative strep tests, one should not bypass this simple, in-office test. If the child tests positive, treatment can begin quickly and the correlation between strep and the onset of symptoms can begin to be investigated.
A good swab is needed. This will involved the doctor or nurse swabbing the tonsils and the back on the throat. A gag reflex is normal and expected. Some providers have learned having the child lay down when performing the swab helps.
It is “normal” for a PANDAS child to experience anxiety during the swab. A child may resist being tested. Do not let this dissuade you from having the swab performed.
If an in-office strep swab renders a negative test result make sure your office also CULTURES a swab. There are some offices that will only do this upon request. A strep culture is not expensive and there are a number of children that have gotten positive cultures, even when rapids have been negative.
If your child or a family member tests positive for strep, schedule a follow up strep test two weeks after finishing all antibiotics. This is not typically done in a physician office, but the again, PANDAS itself is not typical.
STREP TESTING VIA BLOOD WORK
Blood work that can test for strep, includes:
Anti-DNase B Titer
Ask the doctor/laboratory to give you a numeric result – not just positive or negative. Anything above the labs normal range should be quantified with a specific numerical value. An active strep infection can give you numbers in the 1,000’s or not.
NORMAL TITERS DOES NOT ALWAYS MEAN STREP IS NOT PRESENT
In all literature regarding Rheumatic Fever, it is commonly known that strep has the ability to create “molecular mimicry” of the child’s own autoimmune response, therefore stopping the titer-rising process.
A good study expressing the dilemma regarding lack of raised titers and typical strep infection presentation is discussed in a recent study (2002) by Drs. Marie Lynd Murphy and Michael E. Pinichero. Quote: ”A notable feature of the tonsillopharyngitis episodes was the lack of severity. Few children had fevers, and their sore throats were mild. The tonsillopharynx was moderately to intensely red, but exudate was scant or absent and cervical adenopathy was minimal. None of these children displayed the typical features of classical severe GABHS tonsillopharyngitis, although 1 patient had scarlet fever rash. Murphy & Pinichero (2002) Study.
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.
TESTING FAMILY MEMBERS
It is important to swab all family members to be sure no one is asymptomatic when infected or a possible strep carrier. Carriers will often not show any strep symptoms, but if tested, will be positive for strep. A carrier will need one or two doses of antibiotics to rid themselves of strep.
Testing family members will lower your child’s chances of being re-infected. Also, some PANDAS children even react to exposure to strep.