PANDAS and Strep Infection: Are they Linked?

Sydenham氏舞蹈病是唯一公认的A组β溶血性链球菌（GABHS）感染的免疫介导的中枢神经系统表现。现在有几条证据表明，可能存在一系列gabhs后免疫介导的神经行为后遗症，称为“链球菌感染后儿童自身免疫性神经精神疾病（PANDAS）”。抽搐，包括图雷特综合症（TS）和强迫症（OCD）已被报道为PANDAS的特征。提出了一项多中心前瞻性病例对照队列研究，涉及40例PANDAS病例和40例匹配的TS和/或OCD对照，但没有PANDAS证据。所有受试者将接受为期24个月的强化临床和实验室前瞻性观察，以确定先前的GABHS感染是否：1)与PANDAS的加重有暂时性关联，2)与抽搐和强迫症的加重有特异性关联，以及3)是PANDAS加重的特异性触发因素。所有病例/对照状态、GABHS感染和临床恶化的确定都将通过盲法审查独立确定，以限制选择和临床偏倚。建立PANDAS的感染后病因学将极大地改变我们对TS和OCD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致命的风湿性心脏后遗症具有重要的公共卫生意义。反驳PANDAS假说将防止对PANDAS患者提出的昂贵和潜在危险的治疗方法（如血浆交换、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.