Streptokok Enfeksiyonu İle İlişkili Pediatrik Otoimmün Nöropsikiyatrik Hastalıklar: Kulak Burun Boğaz Hekiminin Yeri

Streptokok enfeksiyonu ile ilişkili pediatrik otoimmün nöropsikiyatrik hastalıklar, akut alevlenmelerle seyreden ve etkilenen çocuklarda obsesif kompulsif bozukluklar ve/veya tiklerle seyreden bir hastalıktır. Streptokok enfeksiyonu sonrası oluşan otoimmün yanıtın hastalıktan sorumlu olduğu düşünülse de, patofizyoloji ve tedavi üzerindeki tartışmalar halen devam etmektedir. Bu makalede, streptokok enfeksiyonu ile ilişkili pediatrik otoimmün nöropsikiyatrik hastalıkların tedavisi ve tedavide kulak burun boğaz hekiminin yeri tartışılacaktır.

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections: Role of Otolaryngologist

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, refers to a disorder in children who manifest symptoms of obsessive-compulsive disorder and/or tic disorders associated with acute exacerbations. Although autoimmune responses following infections with streptococcus have been hypothesized to be responsible, there is still controversies about the pathophysiology and treatment. In this article, the treatment methods of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and the role of otolaryngologist were discussed.

___

  • Swedo SE, Leonard HL, Garvey M, Mittleman B, Allen AJ, Perlmutter S et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: Clinical description of the first 50 cases. Am J Psychiatry. 1998;155:264–71.
  • Kondo K, Kabasawa T. Improvement in Gilles de la Tourette syndrome after corticosteroid therapy. Ann Neurol. 1978;4:387.
  • Darrow DH: Infectious and inflammatory illness of the oral cavity and pharynx. InTextbook Pediatric Otorhinolaryngology Head and Neck Surgery (Eds. CSouza, J Stankiewicz, PK Pellitteri):61-86. San Diego, Singular Pub, 1999.
  • Wiatrak BJ, Woolley AL. Pharyngitis and adenotonsillar disease. In Pediatric Otolaryngology 4th edition (Ed CW Cummings). Philadelphia, Elsevier, 2005.
  • Krober MS, Bass JW, Michels GN. Streptococcal pharyngitis: placebo-controlled double-blind evaluation of clinical response to penicillin therapy. JAMA. 1985;253:1271-74.
  • Marshall T. A review of tonsillectomy for recurrent throat infection. Br J Gen Pract. 1998;48:1331- 5.
  • Mouton Y. ,Senneville E. Broad-versus narrow-spectrum antibiotic use - the role in vitro testing and its correlation with clinical efficacy. Postgrad Med J. 1992;68: 68-72.
  • Peterson BS, Leckman JF, Tucker D, Scahill L, Staib L, Zhang H et al. Preliminary findings of antistreptococcal antibody titers and basal ganglia volumes in tic, obsessive-compulsive, and attention deficit/hyperactivity disorders. Arch Gen Psychiatry. 2000;57:364–72.
  • Dale RC, Heyman I, Giovannoni G, Church AW: Incidence of antibrain antibodies in children with obsessive-compulsive disorder. Br J Psychiatry. 2005;187:314–9.
  • Elia J, Dell ML, Friedman DF, Zimmerman RA, Balamuth N, Ahmed AA et al. PANDAS with catatonia: A case report. Therapeutic response to lorazepam and plasmapheresis. J Am Acad Child Adolesc Psychiatry. 2005;44:1145–50.
  • Yaddanapudi K, Hornig M, Serge R, De Miranda J, Baghban A, Villar G et al. Passive transfer of streptococcus-induced antibodies reproduces behavioral disturbances in a mouse model of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection. Mol Psychiatry. 2010;15:712–26.
  • Gause C, Morris C, Vernekar S, Pardo-Villamizar C, Grados MA, Singer HS. Antineuronal antibodies in OCD: comparisons in children with OCD-only, OCD+chronic tics and OCD+PANDAS. J Neuroimmunol. 2009;214:118–24.
  • Morris CM, Pardo-Villamizar C, Gause CD, Singer HS. Serum auto antibodies measured by immunofluorescence confirm a failure to differentiate PANDAS and Tourette syndrome from controls. J Neurol Sci. 2009;276:45–8.
  • Brilot F, Merheb V, Ding A, Murphy T, Dale RC. Antibody binding to neuronal surface in Sydenham chorea, but not in PANDAS or Tourette syndrome. Neurology. 2011;76:1508-13.
  • Swedo SE, Leonard HL, Mittleman BB, Allen AJ, Rapoport JL, Dow SP et al. Identification of children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections by a marker associated with rheumatic fever. Am J Psychiatry. 1997;154:110-2.
  • Murphy TK, Goodman WK, Fudge MW, Williams RC Jr, Ayoub EM, Dalal M et al. B lymphocyte antigen D8/17: a peripheral marker for childhood-onset obsessive compulsive disorder and Tourette's syndrome? Am J Psychiatry. 1997;154:402-7.
  • Hollander E, DelGiudice-Asch G, Simon L, Schmeidler J, Cartwright C, DeCaria CM et al. B lymphocyte antigen D8/17 and repetitive behaviors in autism. Am J Psychiatry. 1999;156:317-20.
  • Zohar AH. The epidemiology of obsessive-compulsive disorder in children and adolescents. Child Adolesc Psychiatr Clin N Am. 1999;8:445–60.
  • Mason A, Banerjee S, Eapen V, Zeitlin H, Robertson MM. The prevalence of Tourette syndrome in a main stream school population. Dev Med Child Neurol. 1998;40:292–6.
  • Fallon T Jr, Schwab-Stone M. Methodology of epidemiological studies of tic disorders and comorbid psychopathology. Adv Neurol. 1992;58:43–53.
  • Bernstein GA, Victor AM, Pipal AJ, Williams KA. Comparison of clinical characteristics of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and childhood obsessive-compulsive disorder. J Child Adolesc Psychopharmacol. 2010;20:333-40.
  • Singer HS. PANDAS and immunomodulatory therapy. Lancet. 1999;354:1137-8.
  • Singer HS, Gause C, Morris C, Lopez P; Tourette Syndrome Study Group. Serial immune markers do not correlate with clinical exacerbations in pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. Pediatrics. 2008;121:1198-205.
  • Singer HS, Loiselle CR, Lee O, Minzer K, Swedo S, Grus FH. Anti-basal ganglia antibodies in PANDAS. Mov Disord. 2004;19:406-15.
  • Gabbay V, Coffey BJ, Babb JS, Meyer L, Wachtel C, Anam S et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcus: comparison of diagnosis and treatment in the community and at a specialty clinic. Pediatrics. 2008;122:273-8.
  • Grados M, Scahill L, Riddle MA. Pharmacotherapy in children and adolescents with obsessive- compulsive disorder. Child Adolesc Psychiatr Clin N Am. 1999;8:617–34.
  • Horikawa H, Kato TA, Mizoguchi Y, Monji A, Seki Y, Ohkuri T et al. Inhibitory effects of SSRIs on IFN-γ induced microglial activation through the regulation of intracellular calcium. Prog Neuropsychopharmacol Biol Psychiatry. 2010;34:1306-16.
  • Murphy ML, Pichichero ME. Prospective identification and treatment of children with pediatric autoimmune neuropsychiatric disorder associated with group A streptococcal infection (PANDAS). Arch Pediatr Adolesc Med. 2002;156:356-61.
  • Garvey MA, Perlmutter SJ, Allen AJ, Hamburger S, Lougee L, Leonard HL et al. A pilot study of penicillin prophylaxis for neuropsychiatric exacerbations triggered by streptococcal infections. Biol Psychiatry. 1999;45:1564-71.
  • Snider LA, Lougee L, Slattery M, Grant P, Swedo SE. Antibiotic prophylaxis with azithromycin or penicillin for childhood-onset neuropsychiatric disorders. Biol Psychiatry. 2005;57:788-92.
  • Perlmutter SJ, Leitman SF, Garvey MA, Hamburger S, Feldman E, Leonard HL et al. Therapeutic plasma exchange and intravenous immunoglobulin for obsessive-compulsive disorder and tic disorders in childhood. Lancet.1999;354:1153–8.
  • Beşiroğlu L, Ağargün MY, Ozbebit O, Sözen M, Dilek I, Güleç M. Therapeutic response to plasmapheresis in four cases with obsessive-compulsive disorder and tic disorder triggered by streptococcal infections. Turk Psikiyatri Derg. 2007;18:270-6.
  • Storch EA, Murphy TK, Geffken GR, Mann G, Adkins J, Merlo LJ et al. Cognitive-behavioral therapy for PANDAS-related obsessive-compulsive disorder: findings from a preliminary wait list controlled open trial. J Am Acad Child Adolesc Psychiatry. 2006;45:1171–8.
  • Orvidas LJ, Slattery MJ. Pediatric autoimmune neuropsychiatric disorders and streptococcal infections: role of otolaryngologist. Laryngoscope. 2001;111:1515–9.
  • Heubi C, Shott SR. PANDAS: pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections—an uncommon, but important indication for tonsillectomy. Int J Pediatr Otorhinolaryngol. 2003;67:837–40.
  • Batuecas Calerio A, Sanchez Gonzalez F, Santa Cruz Ruiz S, Santos Gorjon P, Blanco Perez P. PANDAS Syndrome: a new tonsillectomy indication? Acta Otorrinolaringol Esp. 2008;59:362–3.
  • Fusco FR, Pompa A, Bernardi G, Ottaviani F, Giampà C, Laurenti D et al. A case of PANDAS treated with tetrabenazine and tonsillectomy. J Child Neurol. 2010;25:614-5.
  • Alexander AA, Patel NJ, Southammakosane CA, Mortensen MM. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): an indication for tonsillectomy. Int J Pediatr Otorhinolaryngol. 2011;75:872-3.
  • Murphy TK, Lewin AB, Parker-Athill EC, Storch EA, Mutch PJ. Tonsillectomies and adenoidectomies do not prevent the onset of pediatric autoimmune neuropsychiatric disorder associated with group A streptococcus. Pediatr Infect Dis J. 2013;32:834-8.
  • Correspondence Address / Yazışma Adresi