PANDAS and Strep Infection: Are they Linked?

PANDAS 和链球菌感染：它们有联系吗？

• 批准号: 6358584
• 负责人: ROGER M KURLAN
• 金额: $ 86.09万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-09-25 至 2005-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6358584
• 关键词: Streptococcus infection; Tourette's syndrome; adolescence (12-20); anxiety; attention deficit disorder; autoimmune disorder; behavior therapy; behavioral /social science research tag; child (0-11); child behavior disorders; comorbidity; depression; human subject; immunoglobulins; longitudinal human study; microorganism disease chemotherapy; nervous system disorder epidemiology; neuropsychological tests; neuropsychology; obsessive compulsive disorder; patient oriented research

Sydenham's chorea is the only accepted immune-mediated central nervous system manifestation of group A beta hemolytic streptococcal (GABHS) infection. Several lines of evidence now suggest that there may be a spectrum of post-GABHS immune- mediated neurobehavioral sequelae termed "Pediatric Autoimmune Neuropsychiatric Disorders after Streptococcal Infection (PANDAS)". Tics, including Tourette's syndrome (TS), and obsessive-compulsive disorder (OCD) have been reported as the characteristic features of PANDAS. Proposed is a multicenter prospective case control cohort study involving 40 cases of PANDAS and 40 matched controls with TS and/or OCD but without evidence of PANDAS. All subjects will undergo intensive clinical and laboratory prospective observation for 24 months to determine whether antecedent GABHS infection is: 1) temporally associated with exacerbations of PANDAS, 2) specifically associated with exacerbations of tics and OCD, and 3) a specific trigger for exacerbations of PANDAS. All determinations of case/control status, GABHS infection and clinical exacerbation will be determined independently by blinded review in order to limit selection and clinical biases. Establishing a post-infectious etiology for PANDAS would dramatically change our understanding of the causes of TS and OCD, alter our therapeutic approach and may have a critical public health implication of preventing potentially fatal rheumatic cardiac sequelae in affected children. Disproving the PANDAS hypothesis would prevent the use of expensive and potentially dangerous therapies (e.g., plasma exchange, immune globulin, antibiotics) that have been proposed for PANDAS patients.

Sydenham的唱片是A组β溶血性链球菌（GABHS）感染的唯一可接受的免疫介导的中枢神经系统表现。 现在有几条证据表明，链球菌感染后（pandas）后，可能有一系列GABHS免疫后介导的神经性后遗症，称为“小儿自身免疫性神经精神疾病”。 据报道，包括图雷特综合症（TS）和强迫症（OCD）在内的抽动作用已被报道为熊猫的特征。提出的是一项多中心前瞻性病例控制队列研究，涉及40例熊猫病例和40例带有TS和/或OCD的匹配对照，但没有熊猫的证据。 所有受试者将在24个月内接受密集的临床和实验室前瞻性观察，以确定是否具有前提GABHS感染是：1）在时间上与PANDAS的加剧相关，2）特别与TICS和OCD的加重特别相关，以及3）特定的PANDAS触发触发因素。 病例/控制状态，GABHS感染和临床加剧的所有确定将通过盲目审查独立确定，以限制选择和临床偏见。建立对大熊猫的感染后病因，将极大地改变我们对TS和强迫症原因的理解，改变我们的治疗方法，并可能对预防受影响儿童的潜在致命的风湿性心脏后遗症具有重要的公共卫生含义。 反驳熊猫假说将防止使用昂贵且潜在的危险疗法（例如血浆交换，免疫球蛋白，抗生素），该疗法已被提出针对大熊猫患者提出的。