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What Does "positive ASO Titre Of 200" Indicate?

Posted on Fri, 28 Feb 2014

Question: Hi My 4 year old son has tested positive with ASO Titre of 200. His reactive protein is negative, A pre echo showed some flags on his left valve. He has suffered from urine infections in the past and blood count of 12.4. He also has a sedrate of 40. he looks perfectly healthy, does not have a fever and behaves like a normal 4 yr old. what could be his diagnosis?

Answered by Dr. Chobufo Ditah (3 hours later)

Brief Answer: ?????Could be sequellae rheumatic heart disease Detailed Answer: Hi and thank you so much for this query. I am so sorry to hear about these abnormal findings you have mentioned. Though the findings are not entirely conclusive of endocarditis, that is the most likely unifying diagnosis. Repeated urine infections, presence of a vegetation on the valves, anemia and positive ASO are suggestive. Also, the heart rate of 40 suggest a third degree heart block. All these are possible manifestations and complications of endocarditis. I will recommend that further investigation be pursued to either confirm this or rule it out. Following up with a cardiologist would be the best option. With a heart rate of 40, am surprised he goes about without any symptoms. Is he able to play for long like other kids or do some strenuous exercises like climbing up and down stairs at home? Also, what was the reason for doing all tests? How often did he get sore throat in the past? I hope this addresses your query fully. Thank you so much for patronizing our services and please do feel free to ask for follow up clarifications and information if need be. I wish him the best of health. Dr. Ditah, MD.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chobufo Ditah (14 minutes later)

Hi doctor. Thanks for your answer. his pediatriction recommended him for circumcision because of the infections. The surgeon investivsted it further. An Echo was done by a cardiologist whose report was all normal. I don't remember him complaining with any sore throat. He plays normal like other kids and I have not seen him struggling to breathe as a result. He recently complained of not being able to breathe properly at nights. That was ruled out as sinusitis and the area in his nose was swollen. We are looking for the answers to these questions. He has not been ill before except with the common cold. His doctor is referring him to a kidney specialist. Any opinions would be welcomed.

Answered by Dr. Chobufo Ditah (28 minutes later)

Brief Answer: Thanks for following up with me Detailed Answer: Hi and thank you so much for this follow up precision. With these investigations not bringing forth any abnormality, I would want all these abnormalities to be controlled again after a few months. If they remain same and the child has no concerning symptoms, then I would advice that you stop really stop pursuing aggressive measures. We may be able to gather more information in future to understand what the problem is. I will second that you consider circumcision. It has been documented that circumcision reduces the frequency of urine infection. Could this be the case with your child? Not a must but it would have taken it out of the way as a possible explanation for the repeated infections and open the doors to a broader thinking if it should persist. There are other possible reasons for repeated urine infection in children. if there is any malformations, back flow of urine from bladder towards the kidneys, urine flow obstructions, kidney stones etc. However, I very much doubt if this is the case because of the absence of symptoms. How often does he gets urine infections? And for sure is that heart rate 40 or something else? Well, I hope more investigations provide clues as to what the possible answers are but this information all by itself doesn't help so much. I wish you well as you get this looked into. Would be interested to know what the findings down the road are and the final conclusion.Keep me posted please and I would see whether with more information I can contribute new ideas towards the care. Thanks. Dr. Ditah, MD.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chobufo Ditah (9 minutes later)

Thanks doctor. He was ruled out for rhuematic fever based on the XXXXXXX factor. Correct me if I am wrong. I really just want him to be fine. The echo was done before the pre echo. So I am a bit confused my self. He is my only child and I just want to make sure that he is fine. Also when all those tests were conducted he was suffering with the flu. I will keep you informed. His last urine test done when he reported these abnomalities showed no infections

Answered by Dr. Chobufo Ditah (1 hour later)

Brief Answer: You are right about Jones' criteria! Detailed Answer: Hi and thanks for this information. You are very right. Based on Jone's criteria Rheumatic heart disease is very unlikely. He would be fine.Though I cannot tell why he has these abnormal readings, he is doing fairly healthy. At times we focus so much on laboratory data forgetting that how the person fees and acts is better than the numbers. I know what he means t you and I really pray nothing that cannot be easily managed come his way. All the best! Dr. Ditah, MD.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chobufo Ditah (21 hours later)

Hi doctor. After consultation with my sons doctor today he confirne what you said. That he should be left alone. That he is fine and there is nothing to indicate any diseases. Thanks for your input. It was very much appreciated.

Answered by Dr. Chobufo Ditah (3 hours later)

Brief Answer: Thanks so much! Detailed Answer: Thank you so much for these updates. Am happy to know your doctor thinks same and you are reassured and relieved of your fears. I wish your child well. I wish you well, too. Am greatly humbled to know we were of help to you. Thanks once more and do not hesitate to contact me in future if need be. Dr. Ditah, MD.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar