PANDAS and Strep Infection: Are they Linked?

Sydenham舞蹈症是A组β溶血性链球菌(GABHS)感染中唯一被接受的免疫介导的中枢神经系统症状。现在有几条证据表明，可能存在一系列GABHS免疫介导的神经行为后遗症，称为“链球菌感染后的儿童自身免疫性神经精神障碍(熊猫)”。抽搐，包括抽动症(TS)和强迫症(OCD)已被报道为大熊猫的特征特征。建议的是一项多中心前瞻性病例对照队列研究，涉及40例大熊猫病例和40例患有TS和/或强迫症但没有大熊猫证据的配对对照。所有受试者将接受为期24个月的密集临床和实验室前瞻性观察，以确定之前的GABHS感染是否：1)暂时与大熊猫的恶化有关，2)具体与抽搐和强迫症的恶化有关，以及3)大熊猫的特殊触发因素。病例/控制状态、GABHS感染和临床恶化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。建立大熊猫感染后病因学将极大地改变我们对TS和强迫症病因的理解，改变我们的治疗方法，并可能对预防受影响儿童潜在的致命风湿性心脏后遗症具有重要的公共卫生意义。反驳大熊猫假说将阻止针对大熊猫患者提出的昂贵且具有潜在危险的疗法(如血浆置换、免疫球蛋白、抗生素)的使用。

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.