OpenHealth Q&A

Investigating Persistent Strep Pneumoniae

Hello all, this is my first time sharing on this platform! To provide some context, I am a PA student, and my husband is also a PA. During my current clinical year, I experienced severe nausea, abdominal cramps, and fatigue back in April. One day, as these symptoms persisted, I decided to check my throat, since I frequently deal with tonsil stones and wanted to see if any were present. To my surprise, I discovered what appeared to be white, round spots surrounding my uvula. I hesitate to label them as exudates because they didn’t resemble traditional exudates and were absent from my tonsils. Instead, they looked like small white mold spots, akin to those found on spoiled bread, almost resembling cocci in chains. These spots were located around my uvula but not on my tonsils; rather, they were visible on both the anterior tonsillar pillars. Notably, I didn’t have a sore throat. At that moment, my mind began to wander to the possibility of a yeast infection and worried whether I might be facing something more serious like cancer, which could compromise my immune system. Since my husband works in an urgent care facility, I went there for a swab test, and the rapid results were negative. However, the sample was sent for further analysis at Health Track RX, which came back positive, and I was prescribed amoxicillin, leading to symptom improvement. During this ordeal, I mentioned my experience to my mother, who reminded me that I often exhibited similar symptoms as a child whenever I had strep throat—never experiencing a sore throat but recurrent nausea, vomiting, and abdominal pain. In those instances, the rapid tests were frequently negative, yet the cultures confirmed strep infection, which she noted happened quite often throughout my childhood. Fast forward to this week, and I find myself again feeling exhausted and nauseous. One evening, unable to eat dinner, I checked my throat in the mirror once more and saw the same spore-like appearance around my uvula and on the anterior tonsillar pillars, again noting the absence of any tonsil involvement and no sore throat. Yesterday, I underwent another swab test, and once more, the rapid results were negative—though I expect the Health Track RX results will echo April’s findings. Out of curiosity, I revisited my previous results and noted that while strep pneumoniae was present, both strep A and B were negative. This is peculiar since strep pneumoniae is generally part of normal oral flora and is primarily associated with pneumonia or meningitis. I find it quite peculiar that I’m experiencing these recurring issues without any clear explanation. To share more about my medical background, I have prominently sized tonsils that frequently produce tonsil stones. In college, I suffered from tonsillitis often, where exudates would cover my tonsils, but I always had a sore throat accompanying it—my mother pointed out that this current form isn’t representative of my usual childhood strep presentations. Additionally, while I regularly deal with tonsil stones, a recent visit to an ENT revealed a mucocele on one of my tonsils. Besides that, I have asthma, eczema, and hearing impairment, with a diagnosed bilateral mild to moderate sensorineural hearing loss that one of my sisters also has. It was determined that this hearing loss resulted from a case of viral meningitis we contracted at ages five and three. Lastly, though it may not be related, I have been experiencing significantly low B12 levels, accompanied by episodes of vertigo. After a week of loading injections, my vertigo returned within two weeks, leading us to reevaluate; my B12 level was 400. Following this, we have decided to start bi-weekly injections and monitor the situation closely while checking for MMA, homocysteine, and MTHFR levels during the next lab draw. I find the recurring presence of strep pneumoniae to be quite perplexing, and I am eager to hear if anyone else has insights or thoughts on this matter. I want to ensure that I’m not overlooking anything crucial in this situation.

Answers (1)

7/26/2025, 1:40:48 PM

OpenHealth AI

It's understandable to feel concerned about your recurring symptoms and the presence of strep pneumoniae. Your experiences of nausea, abdominal cramps, and unusual spots in your throat warrant careful attention. Let's break this down and address your main concerns.

Main Points

1. Strep Pneumoniae Presence: The detection of strep pneumoniae can be puzzling, especially in the context of your symptoms. While it's part of normal oral flora, its recurrence alongside your symptoms needs careful evaluation.
2. Recurring Symptoms: Your symptoms of nausea and the appearance of spots without a sore throat, especially given your history, suggest a potential underlying issue that may require more investigation.
3. Low B12 Levels: Your low B12 levels and associated vertigo are relevant and could contribute to your overall well-being and symptomatology.

Explanation

Strep pneumoniae typically causes respiratory infections, but it can also be present asymptomatically in healthy individuals. Your history of recurrent symptoms in childhood, especially with negative rapid tests but positive cultures for strep, may indicate that you have a unique manifestation of infection where traditional symptoms do not always trigger.

The mucocele and tonsil stones suggest that your tonsils may be working differently, potentially harboring bacteria or other organisms that lead to your symptoms. This combination could affect your immune system, particularly if you have underlying health issues such as asthma and low B12.

Next Steps

1. Symptom Monitoring: Keep a detailed record of your symptoms, noting any patterns in nausea or the appearance of spots. This can help you and your healthcare provider understand the frequency and triggers of your symptoms better.

2. Follow-Up Testing: Since you’ve experienced recurring symptoms, it may be beneficial to pursue cultures specifically to identify germs, including strep pneumoniae, from your throat instead of solely relying on rapid tests. Discuss with your healthcare provider the possibility of seeing an ENT specialist for further evaluation of your tonsils and the mucocele.

3. Address B12 Levels: Continue with your bi-weekly B12 injections as planned. Discuss your symptoms of vertigo with your healthcare provider, and ensure regular monitoring of your B12, MMA, homocysteine, and MTHFR levels, as these can impact your energy and overall health.

4. Throat Hygiene: Keep your throat healthy by staying hydrated, practicing good oral hygiene, and potentially using a saline gargle or mouthwash to soothe any irritation and limit bacterial growth.

5. Health Review: Consider a comprehensive health review that addresses your asthma and hearing impairment. These conditions might contribute to your overall health and susceptibility to infections.

By approaching your symptoms holistically and methodically, you can gather more data to better inform your healthcare decisions. You're not overlooking anything crucial; being thorough in your investigation is a wise approach. Please stay connected with your healthcare team for ongoing guidance.