Culture results - strep and H. Influenza

[Justinsmom]

Hi,
My recently diagnosed 7 year old had his first bronchoscopy after what we thought was two pneumonias (bacterial then 2 weeks later viral.) The CT scan showed an infiltrate which was why they thought he had pneumonia. The doctortook out a large amount of "stuff" including mucus plugs from his left lower lobe last Monday with the bronch. Luckily everything else looked great (other than the left lower lobe.) His CF doctor called on Friday and said that he cultured both strep and H. Incluenza. Heapparently has a very large amount of one of them. She put him on augmentin to clear this up. He had done two days of IV and 10 days on super high dose of antibotic over Valentine's day. Dr. explained that if not sucessfully treated, the strep (I think this is the one) can do permanent damage. We will have to CT again to make sure it is gone. She was pleased that he did not have any of the "really bad" CF related bugs. She said that it was hard to tell if what he has going on is directly related to the CF or not - because this could happen to kids with asthma or other issues - only time will tell.
Does anyone have experience with either of these? I am worried because other than a small amount of junky cough, he shows no symptoms other than a slight junky cough that could easily be mistaken for allergies. Even with the two exacerbations, he seemed fine up to when he spiked the fever and got a tummy ache. Because he has probably been growing this/these for several months (back to December and maybe even earlier - last pulmonologist keep saying it was just a bad year for kids and never checked anything) is he at higher risk for more infections? Any expereince would be greatly appreciated. This is so new to us.

 

[Justinsmom]

Hi,
My recently diagnosed 7 year old had his first bronchoscopy after what we thought was two pneumonias (bacterial then 2 weeks later viral.) The CT scan showed an infiltrate which was why they thought he had pneumonia. The doctortook out a large amount of "stuff" including mucus plugs from his left lower lobe last Monday with the bronch. Luckily everything else looked great (other than the left lower lobe.) His CF doctor called on Friday and said that he cultured both strep and H. Incluenza. Heapparently has a very large amount of one of them. She put him on augmentin to clear this up. He had done two days of IV and 10 days on super high dose of antibotic over Valentine's day. Dr. explained that if not sucessfully treated, the strep (I think this is the one) can do permanent damage. We will have to CT again to make sure it is gone. She was pleased that he did not have any of the "really bad" CF related bugs. She said that it was hard to tell if what he has going on is directly related to the CF or not - because this could happen to kids with asthma or other issues - only time will tell.
Does anyone have experience with either of these? I am worried because other than a small amount of junky cough, he shows no symptoms other than a slight junky cough that could easily be mistaken for allergies. Even with the two exacerbations, he seemed fine up to when he spiked the fever and got a tummy ache. Because he has probably been growing this/these for several months (back to December and maybe even earlier - last pulmonologist keep saying it was just a bad year for kids and never checked anything) is he at higher risk for more infections? Any expereince would be greatly appreciated. This is so new to us.

 

[Melissa75]

H. Influenza is considered an early CF bug, and like your doc said, it is also present in sick non-CF kids and people with COPD. Strep is not a common CF bug, according to this article, and seems to be more likely caused by immuno deficiency or the ubiquitous cause of pre-existing damage.

http://books.google.com/books?id=1z36JxZw5vEC&pg=PA32&lpg=PA32&dq=s.+maltophilia+bronchiectasis&source=bl&ots=MtT_lt8GOp&sig=lJ5TMG5x6ZPyJKpGCH_-1TRZHAs&hl=en&sa=X&ei=eSBuT6SnO4Lw0gGWupWiBg&ved=0CEIQ6AEwAg#v=onepage&q=s.%20maltophilia%20bronchiectasis&f=false

When I was first dx with bronchiectasis, I tended to culture h. influenza, moraxella catarrhalis, and once an NTM. I got recurrent pneumonia all the time during those years. I recovered quickly with tens days of Avelox, but was sick a few weeks after stopping it. I got a break for a few years, during which ironically I lost 15+ fev1 points but had few exacerbations. This past fall, with an FEV1 of still about 100, I started culturing on and off: pseudomonas, stenotrophomonas; and almost always strep.

I am pretty sure one of these has set up house in my lower left lobe, because it's what looks bad on x-ray and what feels soupy 80% of the day--like a harmonica if you touch the outside, and heavy and achy on the inside. Like your son though, I don't have an ongoing fever. (I'm getting full PFTs and a CTscan in April to figure out what new thing might be going on.) Does your son spit out his sputum and can you get a gauge on color vs symtoms? This is relevant to me still, though I know many on this board always have green sputum.

From what I've read, the lower left lobe is also a source of infection for people who aspirate food, so this might be worth looking in to. I wish I had concrete advice. Well, one thing, I would definitely focus manual PT on that lobe, look at immunodeficiency to strep if you haven't already, and ask about aspiration. (With the road to CF dx, I suspect you've explored these avenues.)

 

[Melissa75]

H. Influenza is considered an early CF bug, and like your doc said, it is also present in sick non-CF kids and people with COPD. Strep is not a common CF bug, according to this article, and seems to be more likely caused by immuno deficiency or the ubiquitous cause of pre-existing damage.

http://books.google.com/books?id=1z36JxZw5vEC&pg=PA32&lpg=PA32&dq=s.+maltophilia+bronchiectasis&source=bl&ots=MtT_lt8GOp&sig=lJ5TMG5x6ZPyJKpGCH_-1TRZHAs&hl=en&sa=X&ei=eSBuT6SnO4Lw0gGWupWiBg&ved=0CEIQ6AEwAg#v=onepage&q=s.%20maltophilia%20bronchiectasis&f=false

When I was first dx with bronchiectasis, I tended to culture h. influenza, moraxella catarrhalis, and once an NTM. I got recurrent pneumonia all the time during those years. I recovered quickly with tens days of Avelox, but was sick a few weeks after stopping it. I got a break for a few years, during which ironically I lost 15+ fev1 points but had few exacerbations. This past fall, with an FEV1 of still about 100, I started culturing on and off: pseudomonas, stenotrophomonas; and almost always strep.

I am pretty sure one of these has set up house in my lower left lobe, because it's what looks bad on x-ray and what feels soupy 80% of the day--like a harmonica if you touch the outside, and heavy and achy on the inside. Like your son though, I don't have an ongoing fever. (I'm getting full PFTs and a CTscan in April to figure out what new thing might be going on.) Does your son spit out his sputum and can you get a gauge on color vs symtoms? This is relevant to me still, though I know many on this board always have green sputum.

From what I've read, the lower left lobe is also a source of infection for people who aspirate food, so this might be worth looking in to. I wish I had concrete advice. Well, one thing, I would definitely focus manual PT on that lobe, look at immunodeficiency to strep if you haven't already, and ask about aspiration. (With the road to CF dx, I suspect you've explored these avenues.)

 

[Ratatosk]

DS cultured H. Flu as a baby -- usually no symptoms, though sometimes he'd also have a sinus or ear infection and was put on augmentin. When he was 2 1/2 azithromycin was added to his regular medications and his doctor mentioned that would probably take care of the h. flu, whichit did.

 

[Ratatosk]

DS cultured H. Flu as a baby -- usually no symptoms, though sometimes he'd also have a sinus or ear infection and was put on augmentin. When he was 2 1/2 azithromycin was added to his regular medications and his doctor mentioned that would probably take care of the h. flu, whichit did.

 

[Mistyjo]

Jasey has cultured H influenza the past two times and dr doesn't seem concerned about it. I guess because she's not having any symptoms with it?

 

[Mistyjo]

Jasey has cultured H influenza the past two times and dr doesn't seem concerned about it. I guess because she's not having any symptoms with it?

 

[JENNYC]

Abby cultures those 2 bugs together off and on quite a bit. She usually just coughs a little more and sometimes runs a VERY slight temperature (99.3). The docs usually put her on abx and then she's fine.

 

[JENNYC]

Abby cultures those 2 bugs together off and on quite a bit. She usually just coughs a little more and sometimes runs a VERY slight temperature (99.3). The docs usually put her on abx and then she's fine.

 

[Justinsmom]

Hi Jenny,

How do you know that it gone? Justin did much better after the bronchoscopy, and started the antibotoics a few days later. It will be 2 weeks on Friday. He still has a little fever on and off (99-100), a very slight cough without junk (not nearly as bad as before - and that wasn't horrible) but has a little pain when I do his chest percussion in the back and also if he has to take a deep breath (2-3 on 1-10). He was on a high does of antibotic when in the hospital (2 days IV and then high dose at home) that did not get rid of it. I am worried that I will not know when he is sick and when he is not. We see the CF clinic tomorrow, hope to have more answers then.

Thanks for sharing.

 

[Justinsmom]

Hi Jenny,

How do you know that it gone? Justin did much better after the bronchoscopy, and started the antibotoics a few days later. It will be 2 weeks on Friday. He still has a little fever on and off (99-100), a very slight cough without junk (not nearly as bad as before - and that wasn't horrible) but has a little pain when I do his chest percussion in the back and also if he has to take a deep breath (2-3 on 1-10). He was on a high does of antibotic when in the hospital (2 days IV and then high dose at home) that did not get rid of it. I am worried that I will not know when he is sick and when he is not. We see the CF clinic tomorrow, hope to have more answers then.

Thanks for sharing.

 

[Ratatosk]

I realized I never commented on the Strep culture. So far DS hasn't cultured this; however, I remember when he was first diagnosed as a baby, his doctor putting him on prophylactic antibiotics due to concerns with the possibility of getting strep and potential for lung damage. Hopefully at the clinic they can culture him and get this taken care of once and for all.

 

[Ratatosk]

I realized I never commented on the Strep culture. So far DS hasn't cultured this; however, I remember when he was first diagnosed as a baby, his doctor putting him on prophylactic antibiotics due to concerns with the possibility of getting strep and potential for lung damage. Hopefully at the clinic they can culture him and get this taken care of once and for all.

 

[JENNYC]

They usually just do a throat culture to see if it is gone. But usually I can pretty much tell because she quits coughing. And we have always cultured those 2 together for some reason, never just one or the other. Abby is very very active and generally does not cough unless she is sick. I'm not gonna lie there was once that she had a hard time knocking it, she had her abx extended but finally did get rid of it. She's probably had it cultured 4 or 5 times in the last 2.5 years if I had to guess. She has really nasty sinus' that like to act up a lot, I don't know if that has anything to do with it or not. Her docs were not real concerned about it. They didn't seem to think it wasn't something that couldn't be taken care of in other words. Hope all goes well tomorrow!!! Nothing worse than when our little ones are sick!!! Hope he is feeling better soon!!! <img src="i/expressions/face-icon-small-sad.gif" border="0">

 

[JENNYC]

They usually just do a throat culture to see if it is gone. But usually I can pretty much tell because she quits coughing. And we have always cultured those 2 together for some reason, never just one or the other. Abby is very very active and generally does not cough unless she is sick. I'm not gonna lie there was once that she had a hard time knocking it, she had her abx extended but finally did get rid of it. She's probably had it cultured 4 or 5 times in the last 2.5 years if I had to guess. She has really nasty sinus' that like to act up a lot, I don't know if that has anything to do with it or not. Her docs were not real concerned about it. They didn't seem to think it wasn't something that couldn't be taken care of in other words. Hope all goes well tomorrow!!! Nothing worse than when our little ones are sick!!! Hope he is feeling better soon!!! <img src="i/expressions/face-icon-small-sad.gif" border="0">

 

[JENNYC]

They usually just do a throat culture to see if it is gone. But usually I can pretty much tell because she quits coughing. And we have always cultured those 2 together for some reason, never just one or the other. Abby is very very active and generally does not cough unless she is sick. I'm not gonna lie there was once that she had a hard time knocking it, she had her abx extended but finally did get rid of it. She's probably had it cultured 4 or 5 times in the last 2.5 years if I had to guess. She has really nasty sinus' that like to act up a lot, I don't know if that has anything to do with it or not. Her docs were not real concerned about it causing damage or not being able to get rid of it. Hope all goes well tomorrow!!! Nothing worse than when our little ones are sick!!! Hope he is feeling better soon!!! <img src="i/expressions/face-icon-small-sad.gif" border="0">

 

[JENNYC]

They usually just do a throat culture to see if it is gone. But usually I can pretty much tell because she quits coughing. And we have always cultured those 2 together for some reason, never just one or the other. Abby is very very active and generally does not cough unless she is sick. I'm not gonna lie there was once that she had a hard time knocking it, she had her abx extended but finally did get rid of it. She's probably had it cultured 4 or 5 times in the last 2.5 years if I had to guess. She has really nasty sinus' that like to act up a lot, I don't know if that has anything to do with it or not. Her docs were not real concerned about it causing damage or not being able to get rid of it. Hope all goes well tomorrow!!! Nothing worse than when our little ones are sick!!! Hope he is feeling better soon!!! <img src="i/expressions/face-icon-small-sad.gif" border="0">

 

[JENNYC]

They usually just do a throat culture to see if it is gone. But usually I can pretty much tell because she quits coughing. And we have always cultured those 2 together for some reason, never just one or the other. Abby is very very active and generally does not cough unless she is sick. I'm not gonna lie there was once that she had a hard time knocking it, she had her abx extended but finally did get rid of it. She's probably had it cultured 4 or 5 times in the last 2.5 years if I had to guess. She has really nasty sinus' that like to act up a lot, I don't know if that has anything to do with it or not. Her docs were not real concerned about it causing damage or not being able to get rid of it. Hope all goes well tomorrow!!! Nothing worse than when our little ones are sick!!! Hope he is feeling better soon!!! <img src="i/expressions/face-icon-small-sad.gif" border="0">

 

[JENNYC]

They usually just do a throat culture to see if it is gone. But usually I can pretty much tell because she quits coughing. And we have always cultured those 2 together for some reason, never just one or the other. Abby is very very active and generally does not cough unless she is sick. I'm not gonna lie there was once that she had a hard time knocking it, she had her abx extended but finally did get rid of it. She's probably had it cultured 4 or 5 times in the last 2.5 years if I had to guess. She has really nasty sinus' that like to act up a lot, I don't know if that has anything to do with it or not. Her docs were not real concerned about it causing damage or not being able to get rid of it. Hope all goes well tomorrow!!! Nothing worse than when our little ones are sick!!! Hope he is feeling better soon!!! <img src="i/expressions/face-icon-small-sad.gif" border="0">