Neuropsychiatric Disorder Associated with Group G Streptococcus Infection.

Rie Okumura,Hiroshi Sakuma,Jun Tohyama,Tsukasa Ohashi,Akihiko Saitoh,Masaharu Hayashi,Sawako Yamazaki,Shinichi Magara

doi:10.1155/2018/6047318

Abstract

Immune-mediated central nervous system manifestations of group A β-hemolytic Streptococcus (GABHS) infection include Sydenham's chorea, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS)—which includes tic and obsessive compulsive disorders—and a variety of neurobehavioral disorders. We report a case of Streptococcus dysgalactiae subspecies equisimilis (group G Streptococcus) (GGS) infection associated with involuntary movements, complex tics, and emotional lability in an 11-year-old Japanese girl. Serum IgM and IgG antibodies to lysoganglioside were positive, and she responded rapidly to intravenous immunoglobulin treatment. Neuropsychiatric disorder associated with GGS infection was ultimately diagnosed. The present findings suggest that neuropsychiatric disorders can result from GGS infection and that the pathogenic mechanism is similar to that of GABHS infection. Future large-scale studies should examine the relation between GGS infection and onset of neuropsychiatric disorder.

Highlights

Infection with group A β-hemolytic Streptococcus (GABHS) causes autoimmune disorders of the basal ganglia in children, such as Sydenham’s chorea (SC) and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) [1]
Because group G Streptococcus (GGS) is evolutionarily closely related to GABHS, GGS may be capable of causing rheumatic fever [4]; few reports have described neuropsychiatric disorders, including Sydenham’s chorea, caused by GGS
GGS was identi ed in a throat culture, and serial change in Antistreptolysin O titer (ASOT) level suggests she was infected with GGS before exacerbation of her involuntary movements, which were probably caused by a postinfectious immune-mediated process

Summary

Neuropsychiatric Disorder Associated with Group G Streptococcus Infection

Rie Okumura ,1,2 Sawako Yamazaki, Tsukasa Ohashi, Shinichi Magara, Jun Tohyama, Hiroshi Sakuma ,5 Masaharu Hayashi ,6 and Akihiko Saitoh. Immune-mediated central nervous system manifestations of group A β-hemolytic Streptococcus (GABHS) infection include Sydenham’s chorea, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS)—which includes tic and obsessive compulsive disorders—and a variety of neurobehavioral disorders. We report a case of Streptococcus dysgalactiae subspecies equisimilis (group G Streptococcus) (GGS) infection associated with involuntary movements, complex tics, and emotional lability in an 11-year-old Japanese girl. Neuropsychiatric disorder associated with GGS infection was diagnosed. E present findings suggest that neuropsychiatric disorders can result from GGS infection and that the pathogenic mechanism is similar to that of GABHS infection. Future large-scale studies should examine the relation between GGS infection and onset of neuropsychiatric disorder

Introduction

Emotional lability Involuntary movements

Discussion