Autoimmune neuropsychiatric disorders associated with streptococcal infection in the pediatric age
Keywords:
neuropsychiatric disorder, streptococcal infection, pediatrics, autoimmune disorder.Abstract
OBJECTIVE: To identify the clinical aspects of pediatric patients with autoimmune neuropsychiatric disorders associated with streptococcal infection.
METHODS: A descriptive study was carried out. Information was taken from the medical records of all Cuban pediatric patients with autoimmune neuropsychiatric disorders associated with streptococcal infection, treated at the International Neurological Restoration Center of Havana, from January 2001 to August 2018. Fifty-six (56) patients met the diagnostic criteria for this disorder, and all were included in this study. The most relevant variables analyzed were age of the onset of symptoms, history of recurrent infections and clinical symptoms. Descriptive statistics methods were used for data analysis, such as the arithmetic mean, mode, proportion and percentages.
RESULTS: The age average of the onset of symptoms was of 6, 7 ± 2,7 years (standard deviation). Thirty-six patients referred some repeated infection (64,29 %). The clinical most frequent symptoms were tics and behavior dysfunctions in 52 cases (92,86 %), followed by dysfunction of deficit of attention with hyperactivity in 41 (73,21 %) and poor school performance in 27 (48,21 %).
CONCLUSIONS: Autoimmune neuropsychiatric disorders associated with streptococcal infection in the pediatric age were more frequent in male patients. They are related to the presence of repeated infections, especially of the upper respiratory tract. Its hereditary character is not clear. The symptoms can be dissimilar and, in some cases, difficult to define. The most frequent reason for consultation of these patients was tics.
Downloads
References
1. Orefici G, Cardona F, Cox CJ, Cunningham MW. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). En: Ferretti JJ, Stevens DL, Fischetti VA, editors. Streptococcus pyogenes: Basic Biology to Clinical Manifestations. Oklahoma: The University of Oklahoma Health Sciences Center; 2016.
2. Swedo SE, Leonard HL, Garvey M, Mittleman B, Allen AJ, Perlmutter S, et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases. Am J Psychiatry. 1998 Feb;155(2):264-71.
3. Sørensen CB, Skov L, Lundby L, Grejsen, J, Aaslet L, Debes NM. PANDAS and PANS in children and adolescents are still controversial diagnoses. Ugeskr Laeger. 2018;180(48). pii:V01180045.
4. Chavez Herbas O, Crespo Vargas KP, de Acha Torrez R, Flores Mercado AN. Desorden Neuropsiquiátrico Pediátrico Asociado con Infecciones Estreptocócicas. Rev Cient Cienc Méd. 2010;13(2):86-9.
5. Rie O, Sawako Y, Tsukasa O, Shinichi M, Jun T, Hiroshi S, et al. Neuropsychiatric Disorder Associated with Group G Streptococcus Infection. Case Rep Pediatr. 2018;2018:6047318
6. Blackburn JS. Tic Disorders and PANDAS. Semin Pediatr Neurol. 2018;25:25-33.
7. Snider LA, Swedo SE. Post-streptococcal autoimmune disorders of the central nervous system. Curr Opin Neurol. 2003 Jun;16(3):359-65.
8. Tan J, Smith CH, Goldman RD. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. Can Fam Physician. 2012 Sep;58(9):957-9.
9. Brown K, Farmer C, Farhadian B, Hernandez J. Pediatric Acute-Onset Neuropsychiatric Syndrome Response to Oral Corticosteroid Bursts: An Observational
