Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (Review)

Dop,Dalia; Marcu,Iulia Rahela; Padureanu,Rodica; Niculescu,Carmen  Elena; Padureanu,Vlad

doi:10.3892/etm.2020.9526

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (Review)

Authors:
- Dalia Dop
- Iulia Rahela Marcu
- Rodica Padureanu
- Carmen Elena Niculescu
- Vlad Padureanu
View Affiliations

Affiliations: Department of Pediatrics, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania, Department of Physical and Rehabilitation Medicine, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania, Department of Biochemistry, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania, Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
Published online on: November 26, 2020 https://doi.org/10.3892/etm.2020.9526
Article Number: 94
Copyright: © Dop et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are clinically characterized by the sudden onset of obsessive‑compulsive manifestations, motor and verbal tics, as well as other behavioral symptoms in a group of children with B‑hemolytic streptococcal infection. PANDAS are considered autoimmune diseases because the streptococcal infection and response can be demonstrated. The most frequent physiopathological mechanism is molecular mimicry: A foreign antigen shares sequence or structural similarities with self‑antigens. A thorough review of the literature was carried out using the PubMed database and SCOPUS, searching for immunological, clinical and microbiological aspects, as well as the treatment of the PANDAS syndrome. The diagnosis is clinical and it requires a careful medical history and a thorough physical examination, while the treatment is complex. Untreated or unrecognized manifestations of PANDAS can increase the risk of obsessive‑compulsive manifestations and tics during adulthood. Taking this into consideration, further studies are required to establish the best method of therapy.

View Figures

View References

1	Swedo SE, Leonard HL, Garvey M, Mittleman B, Allen AJ, Perlmutter S, Lougee L, Dow S, Zamkoff J and Dubbert BK: Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: Clinical description of the first 50 cases. Am J Psychiatry. 155:264–271. 1998.PubMed/NCBI View Article : Google Scholar
2	Swedo SE, Leckman JF and Rose NR: From research subgroup to clinical syndrome: Modifying the PANDAS criteria to describe PANS (pediatric acute-onset neuropsychiatric syndrome). Pediatr Therapeut. 2:1–8. 2012.
3	Kirvan CA, Swedo SE, Kurahara D and Cunningham MW: Streptococcal mimicry and antibody-mediated cell signaling in the pathogenesis of Sydenham's chorea. Autoimmunity. 39:21–29. 2006.PubMed/NCBI View Article : Google Scholar
4	Siloşi CA, Siloşi I, Pădureanu V, Bogdan M, Mogoantă SŞ, Ciurea ME, Cojocaru M, Boldeanu L, Avrămescu CS, Boldeanu MV and Popa DG: Sepsis and identification of reliable biomarkers for postoperative period prognosis. Rom J Morphol Embryol. 59:77–91. 2018.PubMed/NCBI
5	Kirvan CA, Swedo SE, Snider LA and Cunningham MW: Antibody-mediated neuronal cell signaling in behavior and movement disorders. J Neuroimmunol. 179:173–179. 2006.PubMed/NCBI View Article : Google Scholar
6	Kirvan CA, Swedo SE, Heuser JS and Cunningham MW: Mimicry and autoantibody-mediated neuronal cell signaling in Sydenham chorea. Nat Med. 9:914–920. 2003.PubMed/NCBI View Article : Google Scholar
7	Cox CJ, Sharma M, Leckman JF, Zuccolo J, Zuccolo A, Kovoor A, Swedo SE and Cunningham MW: Brain human monoclonal autoantibody from Sydenham chorea targets dopaminergic neurons in transgenic mice and signals dopamine D2 receptor: Implications in human disease. J Immunol. 191:5524–5541. 2013.PubMed/NCBI View Article : Google Scholar
8	Kirvan CA, Cox CJ, Swedo SE and Cunningham MW: Tubulin is a neuronal target of autoantibodies in Sydenham's chorea. J Immunol. 178:7412–7421. 2007.PubMed/NCBI View Article : Google Scholar
9	Brimberg L, Benhar I, Mascaro-Blanco A, Alvarez K, Lotan D, Winter C, Klein J, Moses AE, Somnier FE, Leckman JF, et al: Behavioral, pharmacological, and immunological abnormalities after streptococcal exposure: A novel rat model of Sydenham chorea and related neuropsychiatric disorders. Neuropsychopharmacology. 37:2076–2087. 2012.PubMed/NCBI View Article : Google Scholar
10	Lotan D, Benhar I, Alvarez K, Mascaro-Blanco A, Brimberg L, Frenkel D, Cunningham MW and Joel D: Behavioral and neural effects of intra-striatal infusion of anti-streptococcal antibodies in rats. Brain Behav Immun. 38:249–262. 2014.PubMed/NCBI View Article : Google Scholar
11	Chang K, Frankovich J, Cooperstock M, Cunningham MW, Latimer ME, Murphy TK, Pasternack M, Thienemann M, Williams K, Walter J, et al: Clinical evaluation of youth with pediatric acute-onset neuropsychiatric syndrome (PANS): Recommendations from the 2013 PANS consensus conference. J Child Adolesc Psychopharmacol. 25:3–13. 2015.PubMed/NCBI View Article : Google Scholar
12	Singer HS, Mascaro-Blanco A, Alvarez K, Morris-Berry C, Kawikova I, Ben-Pazi H, Thompson CB, Ali SF, Kaplan EL and Cunningham MW: Neuronal antibody biomarkers for Sydenham's chorea identify a new group of children with chronic recurrent episodic acute exacerbations of tic and obsessive compulsive symptoms following a streptococcal infection. PLoS One. 10(e0120499)2015.PubMed/NCBI View Article : Google Scholar
13	Morris-Berry CM, Pollard M, Gao S and Thompson C: Tourette Syndrome Study Group and Singer HS. Anti-streptococcal, tubulin, and dopamine receptor 2 antibodies in children with PANDAS and Tourette syndrome: Single-point and longitudinal assessments. J Neuroimmunol. 264:106–113. 2013.PubMed/NCBI View Article : Google Scholar
14	Gilbert DL, Mink JW and Singer HS: A pediatric neurology perspective on pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection and pediatric acute-onset neuropsychiatric syndrome. J Pediatr. 199:243–251. 2018.PubMed/NCBI View Article : Google Scholar
15	Singer HS, Gause C, Morris C and 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. 121:1198–1205. 2008.PubMed/NCBI View Article : Google Scholar
16	Dale RC: Tics and tourette: A clinical, pathophysiological and etiological review. Curr Opin Pediatr. 29:665–673. 2017.PubMed/NCBI View Article : Google Scholar
17	Chain JL, Alvarez K, Mascaro-Blanco A, Reim S, Bentley R, Hommer R, Grant P, Leckman JF, Kawikova I, Williams K, et al: Autoantibody biomarkers for basal ganglia encephalitis in sydenham chorea and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections. Front Psychiatry. 11(564)2020.PubMed/NCBI View Article : Google Scholar
18	Hesselmark E and Bejerot S: Biomarkers for diagnosis of Pediatric Acute Neuropsychiatric Syndrome (PANS)-sensitivity and specificity of the Cunningham panel. J Neuroimmunol. 312:31–37. 2017.PubMed/NCBI View Article : Google Scholar
19	Frankovich J, Thienemann M, Pearlstein J, Crable A, Brown K and Chang K: Multidisciplinary clinic dedicated to treating youth with pediatric acute-onset neuropsychiatric syndrome: Presenting characteristics of the first 47 consecutive patients. J Child Adolesc Psychopharmacol. 25:38–47. 2015.PubMed/NCBI View Article : Google Scholar
20	Murphy TK, Snider LA, Mutch PJ, Harden E, Zaytoun A, Edge PJ, Storch EA, Yang MCK, Mann G, Goodman WK and Swedo SE: Relationship of movements and behaviors to group A streptococcus infections in elementary school children. Biol Psychiatry. 61:279–284. 2007.PubMed/NCBI View Article : Google Scholar
21	Giedd JN, Rapoport JL, Garvey MA, Perlmutter S and Swedo SE: MRI assessment of children with obsessive-compulsive disorder or tics associated with streptococcal infection. Am J Psychiatry. 157:281–283. 2000.PubMed/NCBI View Article : Google Scholar
22	Niculescu EC, Dop D, Diaconu R, Stepan AE, Gheonea C and Stănescu GL: Vertical transmission of HIV/TB in newborns: A case report. Rom J Morphol Embryol. 55:1473–1476. 2014.PubMed/NCBI
23	Snider LA, Lougee L, Slattery M, Grant and Swedo SE: Antibiotic prophylaxis with azithromycin or penicillin for childhood-onset neuropsychiatric disorders. Biol Psychiatry. 57:788–792. 2005.PubMed/NCBI View Article : Google Scholar
24	Mihailovici AR, Padureanu V, Albu CV, Dinescu VC, Pirlog MC, Dinescu SN, Malin RD and Calborean V: Myocardial noncompaction. Rev Chim (Bucharest). 69:2209–2212. 2018.
25	Murphy TK, Parker-Athill EC, Lewin AB, Storch EA and Mutch PJ: Cefdinir for recent-onset pediatric neuropsychiatric disorders: A pilot randomized trial. J Child Adolesc Psychopharmacol. 25:57–64. 2015.PubMed/NCBI View Article : Google Scholar
26	Albu CV, Padureanu V, Boldeanu MV, Bumbea AM, Enescu AS, Albulescu DM, Silosi CA and Enescu A: Vascular neurocognitive disorders and the vascular risk factors. J Mind Med Sci. 5:7–15. 2018.
27	Franklin ME, Sapyta J, Freeman JB, Khanna M, Compton S, Almirall D, Moore P, Choate-Summers M, Garcia A, Edson AL, et al: Cognitive behaviour therapy augmentation of pharmacotherapy in pediatric obsessive-compulsive disorder: The pediatric OCD treatment study II (POTS II) randomized controlled trial. JAMA. 306:1224–1232. 2011.PubMed/NCBI View Article : Google Scholar
28	Swedo SE, Frankovich J and Murphy TK: Overview of treatment of pediatric acute-onset neuropsychiatric syndrome. J Child Adolesc Psychopharmacol. 27:562–565. 2017.PubMed/NCBI View Article : Google Scholar
29	Sigra S, Hesselmark E and Bejerot S: Treatment of PANDAS and PANS: A systematic review. Neurosci Biobehav Rev. 86:51–65. 2018.PubMed/NCBI View Article : Google Scholar
30	Frankovich J, Swedo S, Murphy T, Dale RC, Agalliu D, Williams K, Daines M, Mady Hornig M, Chugani H, Sanger T, et al: Clinical management of pediatric acute-onset neuropsychiatric syndrome: Part II-use of immunomodulatory therapies. J Child Adolesc Psychopharmacol. 27:574–593. 2017.PubMed/NCBI View Article : Google Scholar