Murphy Marie Lynd, Pichichero Michael E
Elmwood Pediatric Group, University of Rochester Medical Center, 601 Elmwood Ave, Box 672, Rochester, NY 14642, USA.
Arch Pediatr Adolesc Med. 2002 Apr;156(4):356-61. doi: 10.1001/archpedi.156.4.356.
The current diagnostic criteria for pediatric autoimmune neuropsychiatric disorder associated with group A streptococcal infection (PANDAS) are pediatric onset, neuropsychiatric disorder (obsessive-compulsive disorder [OCD]) and/or tic disorder; abrupt onset and/or episodic course of symptoms; association with group A beta-hemolytic streptococcal (GABHS) infection; and association with neurological abnormalities (motoric hyperactivity or adventitious movements, including choreiform movements or tics).
To assess new-onset PANDAS cases in relation to acute GABHS tonsillopharyngitis.
Prospective PANDAS case identification and follow-up.
Over a 3-year period (1998-2000), we identified 12 school-aged children with new-onset PANDAS. Each patient had the abrupt appearance of severe OCD behaviors, accompanied by mild symptoms and signs of acute GABHS tonsillopharyngitis. Throat swabs tested positive for GABHS by rapid antigen detection and/or were culture positive. The GABHS serologic tests, when performed (n = 3), showed very high antideoxyribonuclease antibody titers. Mean age at presentation was 7 years (age range, 5-11 years). In children treated with antibiotics effective in eradicating GABHS infection at the sentinel episode, OCD symptoms promptly disappeared. Follow-up throat cultures negative for GABHS were obtained prospectively after the first PANDAS episode. Recurrence of OCD symptoms was seen in 6 patients; each recurrence was associated with evidence of acute GABHS infection and responded to antibiotic therapy, supporting the premise that these patients were not GABHS carriers. The OCD behaviors exhibited included hand washing and preoccupation with germs, but daytime urinary urgency and frequency without dysuria, fever, or incontinence were the most notable symptoms in our series (58% of patients). Symptoms disappeared at night, and urinalysis and urine cultures were negative.
To our knowledge, this is the first prospective study to confirm that PANDAS is associated with acute GABHS tonsillopharyngitis and responds to appropriate antibiotic therapy at the sentinel episode.
目前与A组链球菌感染相关的儿童自身免疫性神经精神障碍（PANDAS）的诊断标准为：起病于儿童期，患有神经精神障碍（强迫症[OCD]）和/或抽动障碍；症状突然发作和/或呈发作性病程；与A组β溶血性链球菌（GABHS）感染相关；以及与神经学异常（运动性多动或异常运动，包括舞蹈样动作或抽动）相关。
评估与急性GABHS扁桃体咽炎相关的新发PANDAS病例。
前瞻性PANDAS病例识别与随访。
在3年期间（1998 - 2000年），我们识别出12名患有新发PANDAS的学龄儿童。每位患者均突然出现严重的OCD行为，同时伴有急性GABHS扁桃体咽炎的轻微症状和体征。咽喉拭子通过快速抗原检测GABHS呈阳性和/或培养阳性。进行GABHS血清学检测时（n = 3），抗脱氧核糖核酸酶抗体滴度非常高。就诊时的平均年龄为7岁（年龄范围5 - 11岁）。在首发事件中接受有效根除GABHS感染抗生素治疗的儿童，OCD症状迅速消失。在首次PANDAS发作后前瞻性地获得GABHS咽喉培养阴性结果。6名患者出现OCD症状复发；每次复发均与急性GABHS感染证据相关且对抗生素治疗有反应，支持这些患者不是GABHS携带者这一前提。所表现出的OCD行为包括洗手和对细菌的过度关注，但白天尿急和尿频且无排尿困难、发热或尿失禁是我们系列中最显著的症状（58%的患者）。症状在夜间消失，尿液分析和尿培养均为阴性。
据我们所知，这是第一项前瞻性研究，证实PANDAS与急性GABHS扁桃体咽炎相关且在首发事件时对适当的抗生素治疗有反应。
