High level of ASO titer. Tonsillectomy is the only option?

[jimbean72]

Hi!

I'm 33 and I discovered 2 years ago that I have a high levels of Antistreptolysin O titer. The progressions of ASO values were like this:

sept 2003 - 599
mar 2004 - 637
treatment with penicilin (one shot every week for 4 weeks) during april, may
june 2004 - 508
december 2004 - 444
march 2005 - 422
july 2005 - 448
treatment with penicilin again
oct 2005 - 440

Several throat cultures have been made and all were negative.
I get occasional (1-3 times a year) sore throat, but nothing that doesn't go away in 2-3 days. The right hand side tonsil is usually a little bigger than the left.

The doctor says that this must be a chronic strep infection and recommended to have tonsillectomy to avoid complications such as rheumatic fever, heart disease.

I want to know if there si something else I can do to avoid tonsillectomy. Any other tests that may be done to pinpoint the cause for high levels of ASO?

Thank you in advance
Jim

[National Jewish]

The upper limit of normal for antistreptolysin O (ASO) levels is 200 to 300, depending on age.  So the levels given are high.  This suggests recent strep infections.  It is possible that the strep may not be in the throat.  It could be in the nose or even another part of the body.  Tonsillectomy is not necessarily a minor procedure or without complications.  Before agreeing to tonsillectomy, you should seek a second opinion from an infectious disease specialist.

[bactitech]

http://www.drkoop.com/ency/93/003522.html

According to the above website,

"ASO testing demonstrates the presence of antibodies generated by the body against the enzyme streptolysin O, which is produced by the bacteria and which causes destruction of red blood cells. The ASO antibody may be detected in the blood for weeks or months after the primary infection has been eradicated."

In other words, your ASO level is going to stay elevated for quite some time, even if your cultures are negative.

http://tinyurl.com/exam3  Check out this website also.

Are you being seen by an ENT? If not, you should be.

Infections from Streptococcus pyogenes (Group A Beta Hemolytic Strep) are fairly uncommon in your age group. There are other beta hemolytic streps that can cause sore throats. If your throat cultures are negative, however, there may be another cause of your throat problems. I'm just going by anecdotal impressions from cultures that I've read out over the years. Don't get me wrong - adults can and do get strep throats caused by Group A strep. If your family practice doc is urging you to get tonsils taken out at your age, I would definitely seek a second opinion with an ENT. This surgery is not a walk in the park at age 33 by any means.

[jimbean72]

I've been seen by an ENT. He says that the streptococus can be deep inside the tonsils and does not respond to antibiotic treatment. That's why he reccomends tonsillectomy.

I have read that ASO titer levels cand remain high for several months after infection. The thing is I had treatment 18 months ago. The level decreased from 600+ and stabilised around 440 but still high.

[jimbean72]

I've been seen by an ENT. He says that the streptococus can be deep inside the tonsils and does not respond to antibiotic treatment. That's why he reccomends tonsillectomy.

I have read that ASO titer levels cand remain high for several months after infection. The thing is I had treatment 18 months ago. The level decreased from 600+ and stabilised around 440 but still high. Any other tests I can do to pinpoint the cause?

[bactitech]

I would defer to your ENT. If a throat culture is not detecting this, the better specimen would be a tissue obtained during surgery or a biopsy of some sort. Tonsils have deep crypts. The normal gag reflex you have when someone tries to shove a swab down your throat makes it nearly impossible to get down into those crypts. Also, there are tons of other bacteria that normally live in your mouth and pharynx.

When we read out throat cultures, a bundle of other bacteria usually grow which we bundle into a statement of "oral pharyngeal flora" or "normal pharyngeal flora."

Has your doc mentioned anything about peritonsillar abscesses?

http://www.aafp.org/afp/20020101/93.html

I would suspect he wants to haul out your tonsils before you end up with something like this. Group A beta strep and an anaerobic bacteria, Fusobacterium sp. are likely causes of this. Anaerobic bacteria live without oxygen. Our mouths and guts are full of these bacteria. Crypts of a tonsil are great places for them to grow. Group A (Strep. pyogenes) can grow anaerobically also but is considered an aerobe. After reading over the above page, I wouldn't mess with possibly getting this condition. Make sure you read the last paragraph on this page.

A second opinion is never a bad thing to get. I am not a doc, I only do the cultures they send me. Good luck with your decision. Hopefully the RN that posts on this page can help you out with the ENT side of things.

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