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What Do My Lab Test Results Indicate?
Question: My 17 year old son has been diagnosed with Crohn's disease (mild at this point). Testing done through Genova Diagnostics showed levels of gamma haemolytic streptococcus, alpha haemolytic streptococcus and haemolytic Escherichia coli at levels of 4+, which is apparently high. Do these results mean that he should be treated for these infections? Could these bacteria be the cause of his Crohn's?
I believe in the body's ability to heal itself if given the proper raw materials. I am not a proponent of using pharmaceutical drugs to treat all conditions, however they do have merit when necessary. If this is the case with my son, then by all means I would like him to be treated with medication. He is heading off to college in August, and I am concerned that because he gets sick quite easily, he is at a higher risk for bacterial meningitis.
I believe in the body's ability to heal itself if given the proper raw materials. I am not a proponent of using pharmaceutical drugs to treat all conditions, however they do have merit when necessary. If this is the case with my son, then by all means I would like him to be treated with medication. He is heading off to college in August, and I am concerned that because he gets sick quite easily, he is at a higher risk for bacterial meningitis.
Brief Answer:
Yes he needs to be treated for the infections right away!!!
Detailed Answer:
I welcome you with thanks for this consultation here at HCM.
Thoroughly going through your Son's case, I feel appropriate for him to be started with management right away. Yes-he needs to be treated for these infections. And these infections are secondary to Crohn disease. Crohn disease is caused by many other factors and doesn't look apparently to be caused by these infections.
Some diseases may have to left for healing itself e.g Viral infection of throat. In that case we may leave upto nature and body's immune system to heal it up as we know it is mostly self limiting. But when secondarily infected by bacteria then sore throat needs antibiotics for sure to kill the germs otherwise systemic complication may arise that may decrease quality of life.
In your Son's case we can't go conservatively until the Crohn disease gets into complete remission. We usually suggest two types of therapies in Crohn in adults. Step-Up and Step-Down therapy (less aggressive and more aggressive respectively). Once Crohn's go into remission we may leave the patient off of medications. But supervision is still needed.
If He was my patient , I must have started him with:
5ASAs like PENTASA or ASACOL. If these doesn't work, may be gone to SULFASALAZINE or MESALAMINE.
Sometimes we need to add start Corticosteroids and I prefer BUDESONIDE especially in patients like your Son.
CIPROFLOXACIN plus METRONIDAZOLE is needed right away. His Gastroentrologist may guide you better and may provide scripts for these Prescription drugs.
May he get very well soon and far before he is heading to classes again. Feel free to ask for anything else if further assistance is needed. I will be happy to assist.
Regards!
Yes he needs to be treated for the infections right away!!!
Detailed Answer:
I welcome you with thanks for this consultation here at HCM.
Thoroughly going through your Son's case, I feel appropriate for him to be started with management right away. Yes-he needs to be treated for these infections. And these infections are secondary to Crohn disease. Crohn disease is caused by many other factors and doesn't look apparently to be caused by these infections.
Some diseases may have to left for healing itself e.g Viral infection of throat. In that case we may leave upto nature and body's immune system to heal it up as we know it is mostly self limiting. But when secondarily infected by bacteria then sore throat needs antibiotics for sure to kill the germs otherwise systemic complication may arise that may decrease quality of life.
In your Son's case we can't go conservatively until the Crohn disease gets into complete remission. We usually suggest two types of therapies in Crohn in adults. Step-Up and Step-Down therapy (less aggressive and more aggressive respectively). Once Crohn's go into remission we may leave the patient off of medications. But supervision is still needed.
If He was my patient , I must have started him with:
5ASAs like PENTASA or ASACOL. If these doesn't work, may be gone to SULFASALAZINE or MESALAMINE.
Sometimes we need to add start Corticosteroids and I prefer BUDESONIDE especially in patients like your Son.
CIPROFLOXACIN plus METRONIDAZOLE is needed right away. His Gastroentrologist may guide you better and may provide scripts for these Prescription drugs.
May he get very well soon and far before he is heading to classes again. Feel free to ask for anything else if further assistance is needed. I will be happy to assist.
Regards!
Above answer was peer-reviewed by :
Dr. Prasad
Thank you for your prompt response. My son's diagnosis of Crohn's came two years ago, and since that time, his symptoms have been fairly steady. I declined to put him on Asacol, which was initially recommended by the gastroenterologist. My son's symptoms are not severe and not limiting him in any way, so I did not see the necessity of starting him on any type of drug protocol. He does not have stomach cramping, bloody stools, loss of appetite or weight loss (he has actually gained weight since his diagnosis). He does have loose stools (although not consistently diarrhea), and the number of his bowel movements range from 1 to 3 daily (3 is on the high side for him, which does not happen all that often) and on some days he doesn't have any bowel movements at all. All of this put together is why I even questioned the diagnosis of Crohn's, even though bloodwork appears to indicate that.
Given all of this, is it possible for him to just be treated with the antibiotics at this time? I am assuming the two that you suggest will take care of all 3 infections I mentioned in my original letter, correct? Lastly, once he has been treated, what effect will this have on his Crohn's?
Given all of this, is it possible for him to just be treated with the antibiotics at this time? I am assuming the two that you suggest will take care of all 3 infections I mentioned in my original letter, correct? Lastly, once he has been treated, what effect will this have on his Crohn's?
Brief Answer:
Yes He needs antibiotics right away !!!
Detailed Answer:
Welcome back with a follow-up query. I appreciate the genuine concerns you have about your Son's health.
Yes, he needs prompt medications as aforementioned for his bacterial infections. Yes, they will suffice the need for covering the infections he has.
These two medications will have no impact on his Crohn's as these are antibiotics and are needed for the Infectious bacterial that has caused secondary infection.
For Crohn's the medications his Gastroentrologist prescribed and you a ready rejected to start with. So it is subjective decision you made. But I will still suggest you to take him to his Gastroentrologist and get properly treated for Crohn's.
The symptoms though not much serious but it's possible that he may need a course of medications for Crohn's because benefits outweigh the risks in this case !!!
Let me help you more if you need further assistance.
Regards!
Yes He needs antibiotics right away !!!
Detailed Answer:
Welcome back with a follow-up query. I appreciate the genuine concerns you have about your Son's health.
Yes, he needs prompt medications as aforementioned for his bacterial infections. Yes, they will suffice the need for covering the infections he has.
These two medications will have no impact on his Crohn's as these are antibiotics and are needed for the Infectious bacterial that has caused secondary infection.
For Crohn's the medications his Gastroentrologist prescribed and you a ready rejected to start with. So it is subjective decision you made. But I will still suggest you to take him to his Gastroentrologist and get properly treated for Crohn's.
The symptoms though not much serious but it's possible that he may need a course of medications for Crohn's because benefits outweigh the risks in this case !!!
Let me help you more if you need further assistance.
Regards!
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Thank you for your prompt follow-up response. Through my own research, I have learned that the bacteria we are talking about are those that constitute normal, commensal flora and have not been recognized as etiological agents of disease. But- at what point do we decide that they need to be treated? I mentioned in my initial email that my son's levels of the 3 different bacteria strains were 4+...how "out of the normal range" is that? What are normal levels for these bacteria?
Brief Answer:
Clinical correlation (physical examination) plus lab results helps decide!
Detailed Answer:
Welcome back with the follow-up query. I appreciate your concerns and happy to assist you today.
Commensals are normal gut flora that are abundantly present in intestines and are useful for digestion. Normally they are not harmful. But if there is concomitant disease of gut they may get overgrown and cause harm alongwith other pathogens that were dormant normally. Those are called opportunistic pathogens. When body's immunity falls or there is a gut disease they get the opportunity and attack the body.
When we already have a gut disease as Crohn's then it is better to get Prophylactic as well as curative antibiotic therapy in case of inflammation and infection of the gut. To decide if there is a need for antibiotics, his Gastroentrologist needs to go for thorough in-person evaluation. Clinical correlation is the key to decide when to start medications. High levels of bacteria on lab tests are also a reason why to start antibiotics.
Normally these bacteria are present in gut but not the blood. If we find bacterial population in blood, then again we need curative antibiotics. Normally major part of fecal matter is also constituted by bacteria.
Once started on antibiotics, we need to keep an eye on other symptoms too so that we may find out when to stop taking medicine. They may be gastrointestinal symptoms, Systemic manifestations or fever etc just to state some of them.
For your Son it is better to get an advice and prescription from a Gastroentrologist as he has the advantage of physical examination and follow-ups so as to see how the medications are working.
Hope it helps today. Feel free to ask for any further questions.
Regards!
Clinical correlation (physical examination) plus lab results helps decide!
Detailed Answer:
Welcome back with the follow-up query. I appreciate your concerns and happy to assist you today.
Commensals are normal gut flora that are abundantly present in intestines and are useful for digestion. Normally they are not harmful. But if there is concomitant disease of gut they may get overgrown and cause harm alongwith other pathogens that were dormant normally. Those are called opportunistic pathogens. When body's immunity falls or there is a gut disease they get the opportunity and attack the body.
When we already have a gut disease as Crohn's then it is better to get Prophylactic as well as curative antibiotic therapy in case of inflammation and infection of the gut. To decide if there is a need for antibiotics, his Gastroentrologist needs to go for thorough in-person evaluation. Clinical correlation is the key to decide when to start medications. High levels of bacteria on lab tests are also a reason why to start antibiotics.
Normally these bacteria are present in gut but not the blood. If we find bacterial population in blood, then again we need curative antibiotics. Normally major part of fecal matter is also constituted by bacteria.
Once started on antibiotics, we need to keep an eye on other symptoms too so that we may find out when to stop taking medicine. They may be gastrointestinal symptoms, Systemic manifestations or fever etc just to state some of them.
For your Son it is better to get an advice and prescription from a Gastroentrologist as he has the advantage of physical examination and follow-ups so as to see how the medications are working.
Hope it helps today. Feel free to ask for any further questions.
Regards!
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Above answer was peer-reviewed by :
Dr. Arnab Banerjee
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