Physical and psychological study of different presentations of rheumatic fever and pediatric autoimmune neuropsychiatric disorders after streptococcal infection

ABSTRACT

A recent line of research has suggested that autoimmune-mediated central nervous system manifestations of Group A-beta hemolytic streptococcal [GABHS] infection may not be restricted to Sydenham chorea [SC] but may include a range of neurobehavioral disturbances that has been termed pediatric autoimmune neuropsychiatric disorder after streptococcal infection [PANDAS]. To clarify the clinical link between rheumatic fever and its variant rheumatic chorea and PANDAS. This study was done on 86 children. Their ages ranged from 5 to 15 years. They were among the patients admitted to the Pediatric Department, Tanta University Hospital. They were classified into 5 groups [A] Six patients with PANDAS, [B] Twenty rheumatic chorea patients, [C] Twenty children with non-choreic rheumatic fever, [D] Twenty patients with recent GABHS infection, and [E] Twenty healthy children as controls. They were subjected to history taking, clinical examination and psychiatric and psychometric assessment. Serum samples were taken for the following laboratory investigations CBC, ESR, ASOT and CRP. The children were also subjected to ECG and X-ray chest and heart in addition to colored echo-Doppler examination. A significant increase in psychiatric manifestations was found in rheumatic chorea. Great similarities between PANDAS and rheumatic chorea patients were found as regard physical, psychiatric and laboratory findings. Both PANDAS and SC had no significant differences as regards prevalence or the type of psychiatric manifestations. Psychiatric manifestations should be looked for in rheumatic patients. Assessment of psychiatric patients for possible early presentation of rheumatic fever should be done. PANDAS should be studied in further researches to detect epidemiology and relation to rheumatic fever and SC