High Aso Titer strep levels above 1,600_9 yr-old

[El111]

looking for advise,
my son is 9+yrs and has had a stiff neck since oct/nov last year. suddenly 2mo's ago he got really swollen glands with sore throat and bad chest infection with wheezing asthma, followed by high fever ard 5days later. it affected his liver too for e next 2months_swollen and palpable, with upset stomach and pain below the ribs. the doc suspected EBV, so he was told no sports for 2mo's.  a test showed that it was an old ebv infection, but not active. after 2+months of pain meds for his neck, and 2x 1-week courses of antibiotics, he had a week of 24hr neck pain, until he cdn't function anymore. the lymph nodes on his neck were swollen all around, and he had lost his apetite for quite a while and cd no longer sleep at night because of the painful lymph nodes in his neck. i asked for stronger pain meds and a solution... so they admitted him to run more tests. after a lot of tests, what's come back positive so far is the aso titer 'above 1,600' e doc says... very high' she added, saying it's scarlet fever. he has no other scarlet fever symptoms except the swollen painful lymph nodes... now she says just to call it 'strep infection'. he has not had sore throat for 2mo's and seems fine other than the lymph problem. (his liver has been back to normal since he was admitted.) in hospital he is on intravenous penicillin and tablet erythromycin for the last 3days. the pain in his neck has improved a lot since the intravenous meds were started. some of the neck swelling isalso reduced. i'm just wondering now if this really is strep, and if it is, at the numbers given (1,600+) then how long will it be before his levels are back to normal? how long before  he starts to feel completely back to normal? will he need antibiotics for many months after? if he returns to school, will he be susceptible to re-infection? (at least half the kids r sick with sore throat/ cough/ sneeze at any one time... and most wd be in school with those symptoms...some with fever too...) just wondering how i can help my son to recover and be strong after this? (he's asthmatic too, and has had particulalry low immunity since end last year...falling sick at least 2-3times with sore throat each month before the swollen lymph episode.) any advise wd be most appreciated,
El
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[mkh9]

Hi again,
I wanted to add that the fact that the ASO titer was positive means he did have invasive strep. But whether or what type of complications he may or may not have depends on the doctor to let you know via tests etc.
mkh9

[mkh9]

Hi and very sorry your son has been so ill. I can give you some information and advice.
Since he was ASO positive it means they were looking for invasive Streptococcus pyogenes (group A strep). Did he have a rash on his truck at any point? The doctor is saying possible scarlet fever. But, Strep Group A can cause a variety of invasive types of illnessness secondary to the original strep throat. these are rheumatic fever, scarlet fever, endocarditis, glomerulonephritis. They need to determine if he got any of these complications (which are rare) .By doing more tests. Did they ever culture Group A strep from his throat? It takes a few months for the ASO titer to go down and also for the lymph nodes to go down. It depends on their diagnosis if he has any complications and if so to then instruct you how to deal with them or if he will have any long term problems. Most sore throats are caused by viruses so he may not get exposed to this same strep throat if the kids have a sore throat at school. Strep throat is contagious and so he and the other kids should not share utinsils, and you should throw away his tooth brush after the antibiotics are finished as he can reinfect himself. You and other family members and friends could have been exposed before he was put on antibiotics but he would be ok now since he is on antibiotics. You should find out from the doctor if they did a sensitivity test on the culture of the Strep group A if that is what they found to find out if they think the antibiotics are working. As for your question as to whether he will need antibiotics in the future depends on whether mothers let their kids go to school when they have strep throat. He can be exposed again if they don't keep their kids home for 24-48 hours after being treated with an antibiotic. Obviously, if these kids have a virus they don't need antibiotics. You really need to ask the doctor if they think he had scarlet fever or could have rheumatic fever from it and so forth. If he didn't acquire any of these complications he should be fine after the lymph nodes go back down.  Hope this helps. Let me know if you have more questions.
mkh9