Pediatric autoimmune neuropsychiatric disorders associated with streptococcus: Comparison of diagnosis and treatment in the community and at a Specialty clinic
Pediatric autoimmune neuropsychiatric disorders associated with streptococcus: Comparison of diagnosis and treatment in the community and at a Specialty clinic
复制标题
DOI：
10.1542/peds.2007-1307
复制
发表时间：
2008-08-01
期刊：
影响因子：
8
通讯作者：
Rabinovitz, Beth
中科院分区：
文献类型：
--
作者：
Gabbay, Vilma;Coffey, Barbara J.;Rabinovitz, Beth
目标。本研究旨在检查社区中与链球菌相关的儿童自身免疫性神经精神疾病是否得到了适当的诊断，并确定在没有确定感染的情况下，对抽搐和强迫症状进行无根据的抗生素治疗的后续发生率。该设计是一项回顾性、横断面、观察性研究，对176名儿童和青少年进行了抽动、妥瑞氏症和相关问题的专业评估。先前发表的诊断标准被用于建立我们临床中与链球菌相关的儿童自身免疫性神经精神疾病的诊断。与社区相比，在专科诊所接受与链球菌相关的儿童自身免疫性神经精神疾病诊断的可能性显著降低。在社区中，如果被诊断为与链球菌相关的儿童自身免疫性神经精神疾病，受试者更有可能接受抗生素或免疫抑制药物治疗。在27名社区诊断为与链球菌相关的儿童自身免疫性神经精神疾病并接受抗生素治疗的受试者中，22名（82%）在没有实验室感染证据的情况下接受治疗；2例给予免疫调节药物治疗。我们的研究结果支持了我们的假设，即与链球菌相关的儿童自身免疫性神经精神疾病在社区中经常被诊断出来，而没有应用所有有效的诊断标准。这种现象导致在没有实验室感染证据的情况下，对抽搐/强迫症使用抗生素治疗。
OBJECTIVES. This study aimed to examine whether pediatric autoimmune neuropsychiatric disorders associated with streptococcus were appropriately diagnosed in the community and to determine subsequent rates of unwarranted use of antibiotic treatment for tics and obsessive-compulsive symptoms without the identification of an infection.METHODS. The design was a retrospective, cross-sectional, observational study of 176 children and adolescents who were evaluated in a specialty program for tics, Tourette's disorder, and related problems. Previously published diagnostic criteria were used to establish the diagnosis of pediatric autoimmune neuropsychiatric disorders associated with streptococcus in our clinic.RESULTS. Subjects were significantly less likely to receive a diagnosis of pediatric autoimmune neuropsychiatric disorders associated with streptococcus at the specialty clinic than in the community. In the community, subjects were significantly more likely to be treated with antibiotics or immunosuppressant medication if they received a diagnosis of pediatric autoimmune neuropsychiatric disorders associated with streptococcus. Of the 27 subjects with a community diagnosis of pediatric autoimmune neuropsychiatric disorders associated with streptococcus who were treated with antibiotics, 22 (82%) were treated without laboratory evidence of an infection; 2 were treated with immunomodulatory medications.CONCLUSIONS. Our results support our hypothesis that pediatric autoimmune neuropsychiatric disorders associated with streptococcus are frequently diagnosed in the community without the application of all working diagnostic criteria. This phenomenon has resulted in unwarranted use of antibiotic treatment for tics/obsessive-compulsive disorder without evidence of laboratory infection.