Eftimiadi Costantino, Eftimiadi Gemma, Vinai Piergiuseppe
Medicina Generale Convenzionata - ASL CN1, Carrù, Italy; GNOSIS Research Group NPO, Magliano Alpi, Italy.
GNOSIS Research Group NPO , Magliano Alpi , Italy.
Front Psychiatry. 2016 Mar 14;7:31. doi: 10.3389/fpsyt.2016.00031. eCollection 2016.
A 9-year-old girl with Tourette syndrome (TS) and increased antibody levels against Streptococcus pyogenes was monitored longitudinally for the presence of nasopharyngeal bacteria, specific antibody titers, and autoimmunity directed against brain antigens. Microbiological monitoring indicated that the child was an intermittent Staphylococcus aureus nasopharyngeal carrier. Clinical improvements in motor tic frequency and severity were observed during the S. aureus colonization phase and were temporally correlated with the downregulation of anti-streptococcal and anti-D1/D2 dopamine receptor antibody production. After decolonization, clinical conditions reverted to the poor scores previously observed, suggesting a possible role of the immune response in bacterial clearance as a trigger of symptom recrudescence. These findings imply that a cause-effect relationship exists between S. aureus colonization and tic improvement, as well as between bacterial decolonization and tic exacerbation. Understanding the impact of S. aureus on the host adaptive immune response and the function of autoantibodies in the pathogenesis of TS may alter approaches for managing autoimmune neuropsychiatric and tic disorders.
一名患有抽动秽语综合征（TS）且抗化脓性链球菌抗体水平升高的9岁女孩，被纵向监测鼻咽部细菌的存在情况、特异性抗体滴度以及针对脑抗原的自身免疫情况。微生物学监测表明，该儿童是金黄色葡萄球菌间歇性鼻咽部携带者。在金黄色葡萄球菌定植阶段，观察到运动性抽动的频率和严重程度有临床改善，且在时间上与抗链球菌和抗D1/D2多巴胺受体抗体产生的下调相关。去定植后，临床状况恢复到先前观察到的较差评分，这表明免疫反应在细菌清除中作为症状复发触发因素可能发挥了作用。这些发现意味着金黄色葡萄球菌定植与抽动改善之间以及细菌去定植与抽动加重之间存在因果关系。了解金黄色葡萄球菌对宿主适应性免疫反应的影响以及自身抗体在抽动秽语综合征发病机制中的作用，可能会改变自身免疫性神经精神和抽动障碍的管理方法。
