Pediatric Autoimmune Neuropsychiatric Disorders Research Articles

Streptococcal Serology in Children With Stuttering.

Introduction: Stuttering is a pronunciation disorder represented by repetitive perpetuations, duplications, or freezes of spoken words or syllables, as well as nervousness and cognitive shunning. Group A beta-hemolytic Streptococcus (GABHS) can lead to pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS). Many case reports have proposed that stuttering is the result of a PANDAS, and that it can be identified together with Tourette syndrome, which shares many clinical characteristics with stuttering. Aim: The purpose of this study was to examine the association between streptococcal serology and stuttering in children. Method: The participants in this study are 26 children who stutter (CWS; mean age = 8.3 + 3.1 years) and 25 children who do not stutter (CWNS; mean age = 9.2 + 2.9 years). Participants were matched in terms of age (±3 months) and gender. We analyzed serum antistreptococcal antibodies [antistreptolysin O (ASO), anti-deoxyribonuclease B (anti-DNase B), and antistreptokinase] in both groups. Results: In the CWS group, ASO, anti-DNase B, and antistreptokinase were significantly higher than in the CWNS group (P < .0001, P < .0001, P < .0001). Conclusion: The higher serum antistreptococcal antibody amounts in CWS suggest that an increased autoimmune response against GAHBS may be the etiology of childhood stuttering. It has been suggested that CWS should be examined for autoimmune reactions, especially to GAHBS.

PANDAS: Twenty-Five Years Later

Background:: It has been 25 years since the definition of the concept of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). The abrupt onset of neuropsychiatric symptoms requires a comprehensive differential diagnosis involving complementary tests and optimal treatment selection. Methods:: This paper describes aspects related to the diagnosis and clinical management of PANDAS. A clinical perspective is developed starting from an example that meets the Swedo's criteria. Discussion:: A comprehensive approach, including interdisciplinary management and urgent evaluation of potential organic causes, is crucial for effective treatment. Treatment decisions should consider severity, symptoms, and available evidence. Collaboration with neuropediatric or neurological services is needed. ASLO/anti-DNase B and 25-OH-Vitamin D tests are valuable for atypical OCD/Tic presentations, always maintaining a broader organic screening.

Folate Receptor Alpha Autoantibodies in the Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) Population.

The folate receptor alpha autoantibodies (FRAAs) are associated with cerebral folate deficiency (CFD) and autism spectrum disorder (ASD). Both of these syndromes have overlapping characteristics with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS). Thus, we propose that the FRAAs may contribute to the symptomatology of PANS/PANDAS. To test this hypothesis, 1 mL of serum from 47 patients (age range = 6-18 years old) clinically diagnosed with PANS/PANDAS was sent to Vascular Strategies (Plymouth Meeting, PA, USA) for analysis of FRAAs. Moreover, 63.8% of PANS/PANDAS patients (male = 15; female = 15) were found to have either the blocking and/or blinding FRAAs, with 25 (83.3%; male = 14; female = 11) having binding FRAAs, two (6.7%; all female = 2) having blocking FRAAs, and 3 (10%; male = 1; female = 2) having both binding and blocking. Furthermore, surprisingly, ASD was associated with a 0.76 lower binding titer (p = 0.02), and severe tics were associated with a 0.90 higher binding titer (p = 0.01). A case of a FRAA-positive patient is provided to illustrate that a treatment plan including leucovorin can result in symptom improvement in patients with PANS/PANDAS who are FRAA-positive. These data, for the first time, demonstrate that PANS/PANDAS is associated with FRAAs and suggest folate metabolism abnormalities may contribute to PANS/PANDAS symptomatology. Further studies investigating the therapeutic nature of leucovorin in the treatment of PANS/PANDAS are needed. Such studies may open up an alternative, safe, and well-tolerated treatment for those with the PANS/PANDAS diagnosis.

Immunological characterization of an Italian PANDAS cohort.

This cross-sectional study aimed to contribute to the definition of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) pathophysiology. An extensive immunological assessment has been conducted to investigate both immune defects, potentially leading to recurrent Group A β-hemolytic Streptococcus (GABHS) infections, and immune dysregulation responsible for a systemic inflammatory state. Twenty-six PANDAS patients with relapsing-remitting course of disease and 11 controls with recurrent pharyngotonsillitis were enrolled. Each subject underwent a detailed phenotypic and immunological assessment including cytokine profile. A possible correlation of immunological parameters with clinical-anamnestic data was analyzed. No inborn errors of immunity were detected in either group, using first level immunological assessments. However, a trend toward higher TNF-alpha and IL-17 levels, and lower C3 levels, was detected in the PANDAS patients compared to the control group. Maternal autoimmune diseases were described in 53.3% of PANDAS patients and neuropsychiatric symptoms other than OCD and tics were detected in 76.9% patients. ASO titer did not differ significantly between the two groups. A possible correlation between enduring inflammation (elevated serum TNF-α and IL-17) and the persistence of neuropsychiatric symptoms in PANDAS patients beyond infectious episodes needs to be addressed. Further studies with larger cohorts would be pivotal to better define the role of TNF-α and IL-17 in PANDAS pathophysiology.

Ocular tics in Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS)

Aims/Purpose: Little is known about ocular tics in Paediatric Autoimmune Neuropsychiatric Disorders associated with Streptococcal infections (PANDAS). The purpose of this retrospective study was to assess ocular symptoms in 40 children with PANDAS.Methods: The clinical records of children with PANDAS referred to the Ophthalmology Unit, Azienda Ospedaliero‐Universitaria di Sassari, Sassari, Italy, between 2010 and 2019 were examined. The detection of ocular tics was investigated. Data about plasma antistreptolysin O (ASO) and anti‐DNAse b titres, erythrocyte sedimentation rate (ESR), plasma C‐reactive protein (CRP), and antibiotic use were recorded and statistically analysed.Results: 40 children (34 boys, 6 girls; mean age: 7.6 ± 2.5 years) with PANDAS were identified; 33 (82.5%) showed ocular tics, whereas the remaining 7 (17.5%) had extraocular tics. Children with ocular tics had significantly higher plasma values of anti‐DNAse b antibodies (p = 0.04) and CRP (p = 0.016) than those with extraocular tics. A course of oral antibiotics was given to 25 (76%) out of 33 children with ocular tics. All the treated patients showed marked improvement/complete resolution of symptoms; conversely, no improvement was observed in those untreated. A post‐antibiotic recurrence occurred in 8 (32%) children.Conclusions: Results suggest that higher plasma values of anti‐DNAse b antibodies and CRP may play a role in the pathophysiological mechanisms underlying ocular tics in PANDAS. Oral antibiotics may be beneficial in improving ocular symptoms. Further research is necessary to confirm our findings.

Neurobehavioral Changes Associated with Rheumatic Fever and Rheumatic Heart Disease: A Narrative Review

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are autoimmune conditions triggered by Group A Streptococcus skin or throat infections. If ARF/RHD is undetected, misdiagnosed or antibiotic treatment is not provided early, patients may develop cardiac failure, leading to premature death. Although it is an easily preventable disease, ARF/RHD remains the most significant cause of heart disease-associated deaths in people under 25 years old, both in low- and middle-income countries and among First Nations in high-income countries. Up to 30% of the patients with ARF/RHD present with a neurobehavioral condition – Sydenham’s chorea (SC). The clinical course of SC is mostly self-limiting and is characterized by the onset of involuntary choreiform movements and neuropsychiatric features such as obsessive-compulsive disorder, tics, depression and anxiety, psychosis, and attention-deficit hyperactivity disorder. While the precise mechanism as to why only a proportion of patients with ARF/RHD develop SC remains unknown, an impaired blood–brain barrier is considered to play a central role in its development. The most well-characterized neurobehavioral outcome is stroke which may occur in isolation or as part of systemic thromboembolism. Both infective endocarditis and mitral valve disease with or without aortic valve disease increase the embolic and ischemic stroke risk. ARF/RHD is known to significantly impact the quality of life with neuropsychiatric consequences. Another neurobehavioral syndrome which occurs in the absence of ARF/RHD is “pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections” (PANDAS). PANDAS has been categorized as a subset of pediatric acute-onset neuropsychiatric syndromes. However, establishing a diagnosis of PANDAS has been challenging. In this review, we discuss the current status of our understanding regarding the different manifestations of poststreptococcal neurobehavioral changes. Particular attention is given to ARF/RHD-associated SC, and we highlight the areas for further research to understand the association between poststreptococcal sequelae and neurobehavioral abnormalities.

Neuropsychıatrıc dısorders assocıated wıth chıldhood ımmunologıc dysfunctıon

Introduction. These disease entities are known as pediatric neuropsychiatric syndromes because infectious pathogens other than streptococci have also been reported to be associated with neuropsychiatric symptoms. Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS).&#x0D; Aim. The aim of this study was to evaluate neuropsychiatric disorders associated with immunologic dysfunction in childhood.&#x0D; Overview. PANS/PANDAS refers to the acute and dramatic onset of a neuropsychiatric syndrome in children, including OCD and/or tics. It is believed to be the result of an autoimmune reaction to the basal ganglia nuclei, initiated by infection with group A streptococci. Studies indicate neuroinflammatory reactions in the basal ganglia and related networks.&#x0D; Conclusions. Evaluating treatment strategies for PANS/PANDAS remains a challenge because it is a rare disease with few published high-quality studies. Little is known about its etiology, diagnostic methods, treatments or long-term effects. However, as hundreds of children and families suffer from the debilitating effects of the disease, infectious diseases should be carefully evaluated for PANS/PANDAS, especially in the pediatric age group. Even in the absence of evidence on which to base interventions, it is within the scope of advanced nursing practice to provide psychotherapeutic care with an empathetic perspective to children and families struggling with the frustration, fear and anxiety caused by illness.

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) Syndrome: A 10-Year Retrospective Cohort Study in an Italian Centre of Pediatric Rheumatology.

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) syndrome is a rare pediatric disorder consisting of a sudden onset of obsessive-compulsive disorder (OCD) and/or tics after a group A Streptococcus (GAS) infection. In the period between 2013 and 2023, 61 children presented to our Pediatric Rheumatology unit with a suspicion of PANDAS syndrome. Among these, a retrospective analysis was conducted, and 19 fulfilled the current classification criteria and were included in this study. The male-to-female ratio was 14:5, the median age at onset was 7.0 (2.0-9.5) years, and the median age at diagnosis was 8.0 (3.0-10.4) years. The median follow-up period was 16.0 (6.0-72.0) months. Family and personal history were relevant in 7/19 and 6/19 patients. Tics were present in all patients. Details for motor tics were retrospectively available in 18/19 patients, with the eyes (11/18) and neck/head (10/18) being most often involved. Vocal tics were documented in 8/19, behavioral changes in 10/19, and OCD in 2/19. Regarding the therapeutic response, all patients responded to amoxicillin, 12/13 to benzathine benzylpenicillin, and 7/9 to azithromycin. Our findings partially overlap with previous reports. Larger prospective studies are needed to improve treatment strategies and classification criteria.

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS): Myth or Reality? The State of the Art on a Controversial Disease.

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) syndrome is one of the most controversial diseases in pediatric rheumatology. Despite first being described more than 25 years ago as the sudden and rapid onset of obsessive-compulsive disorder (OCD) and/or tic disorder symptoms as complications of a Group A beta-hemolytic Streptococcus (GAS) infection, precise epidemiological data are still lacking, and there are no strong recommendations for its treatment. Recent advances in the comprehension of PANDAS pathophysiology are largely attributable to animal model studies and the understanding of the roles of Ca++/calmodulin-dependent protein kinase (CaM kinase) II, disrupted dopamine release in the basal ganglia, and striatal cholinergic interneurons. The diagnosis of PANDAS should be made after an exclusion process and should include prepubescent children with a sudden onset of OCD and/or a tic disorder, with a relapsing/remitting disease course, a clear temporal association between GAS infection and onset or exacerbation of symptoms, and the association with other neurological abnormalities such as motoric hyperactivity and choreiform movements. Antibiotic medications are the primary therapeutic modality. Nonetheless, there is a paucity of randomized studies and validated data, resulting in a scarcity of solid recommendations.

Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections Manifestations in a Teenager.

Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections Manifestations in a Teenager.

A Bibliometric Analysis of Global Research on Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are a clinical syndrome characterized by the abrupt onset of major personality, movement, and behavioral changes in a patient with a history of streptococcal infection. We aimed to do a bibliometric analysis of the published research on PANDAS. All the published articles available on the PubMed database from the time of inception till August 2022 were included in the study. All the PubMed IDs (PMID) of the articles were entered in Harvard Catalyst, a free online software, for bibliometric analysis, and data were extracted and verified. A total of 289 relevant published articles were identified. The average number of authors per article was 4.89 and the average number of times an article was cited was 11.19 (excluding self-citation). The H-index of the published articles was 31. The Journal of Child and Adolescent Psychopharmacology published the maximum number of articles ( n = 36). The highest number of average citations (39.50 citations/articles) was for the articles published in the American Journal of Psychiatry. The most common type of articles were journal articles ( n = 259) and of which 27 were original research articles. Most of the original research discusses the effectiveness of various interventions (penicillin and other antibiotic prophylaxis, role of immunoglobulin), neuropsychiatric symptoms, and outcomes in the longitudinal course. Though PANDAS is a well-researched entity, more clinical trials, and large-scale studies will help provide better insight on this subject.

Cerebrospinal fluid findings in patients with obsessive–compulsive disorder, Tourette syndrome, and PANDAS: A systematic literature review

BackgroundObsessive-compulsive disorder (OCD) and Tourette syndrome (TS) are related mental disorders that share genetic, neurobiological, and phenomenological features. Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) is a neuropsychiatric autoimmune disorder with symptoms of OCD and/or TS associated with streptococcal infections. Therefore, PANDAS represents a strong link between OCD, TS, and autoimmunity. Notably, cerebrospinal fluid (CSF) analyses can provide insight into the central nervous processes in OCD, TS, and PANDAS. MethodsA systematic literature search according to the PRISMA criteria was conducted to collect all CSF studies in patients with OCD, TS, and PANDAS. The total number of cases and the heterogeneity of the low number of studies were not sufficient for a meta-analysis to provide a high level of evidence. Nevertheless, meta-analytical statistics could be performed for glutamate, 5-hydroxyindoleacetic acid (degradation product of serotonin), homovanillic acid (degradation product of dopamine), 3-methoxy-4-hydroxyphenylglycol (major metabolite of noradrenaline), and corticotropin-releasing hormone (CRH) in OCD. A risk-of-bias assessment was implemented using the Cochrane ROBINS-E tool. ResultsMeta-analytical testing identified elevated glutamate levels in the CSF of OCD patients compared with healthy controls, while no significant differences were found in other neurotransmitters or CRH. Single studies detected novel neuronal antibodies in OCD patients and elevated oligoclonal bands in TS patients. For TS and PANDAS groups, there was a dearth of data. Risk of bias assessment indicated a substantial risk of bias in most of the included studies. ConclusionsThis systematic review of available CSF data shows that too few studies are currently available for conclusions with good evidence. The existing data indicates glutamate alterations in OCD and possible immunological abnormalities in OCD and TS. More CSF studies avoiding sources of bias are needed.

Estimate of the incidence of PANDAS and PANS in 3 primary care populations.

Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infection (PANDAS) and Pediatric Acute-Onset Neuropsychiatric syndrome (PANS) are presumed autoimmune complications of infection or other instigating events. To determine the incidence of these disorders, we performed a retrospective review for the years 2017-2019 at three academic medical centers. We identified the population of children receiving well-child care at each institution. Potential cases of PANS and PANDAS were identified by including children age 3-12 years at the time they received one of five new diagnoses: avoidant/restrictive food intake disorder, other specified eating disorder, separation anxiety disorder of childhood, obsessive-compulsive disorder, or other specified disorders involving an immune mechanism, not elsewhere classified. Tic disorders was not used as a diagnostic code to identify cases. Data were abstracted; cases were classified as PANDAS or PANS if standard definitions were met. The combined study population consisted of 95,498 individuals. The majority were non-Hispanic Caucasian (85%), 48% were female and the mean age was 7.1 (SD 3.1) years. Of 357 potential cases, there were 13 actual cases [mean age was 6.0 (SD 1.8) years, 46% female and 100% non-Hispanic Caucasian]. The estimated annual incidence of PANDAS/PANS was 1/11,765 for children between 3 and 12 years with some variation between different geographic areas. Our results indicate that PANDAS/PANS is a rare disorder with substantial heterogeneity across geography and time. A prospective investigation of the same question is warranted.

Symptom flares after COVID-19 infection versus vaccination among youth with PANS/PANDAS.

Background: Flares of autoimmune conditions can happen after coronavirus disease 2019 (COVID-19) infection and after COVID-19 vaccines. Patients and clinicians confront difficult decisions about vaccine safety when considering efforts to balance the risks of disease exacerbation after vaccines versus the protection that vaccines offer to potential serious life-threatening complications of COVID-19 infection. Objective: To examine symptom flares after COVID-19 infection and vaccines in the case of a form of autoimmune encephalitis that primarily affects children and young adults (pediatric acute-onset neuropsychiatric syndrome [PANS] / pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections [PANDAS]). Method: A cross-sectional study that used a survey distributed through PANS/PANDAS groups, organizations, and clinics. Results: Surveys were completed by 496 parents and/or caregivers of children with PANS/PANDAS. Among the children reported to have had a COVID-19 infection (n = 178), 43% reported severe flares of PANS/PANDAS symptoms, 23% reported mild flares, and 30% reported no symptom flares. Among those who had received COVID-19 vaccines (n = 181), 65% observed no changes in PANS/PANDAS symptoms after the vaccine, 19% reported mild flares, and 15% reported severe flares. Paired sample t-tests showed that, after COVID-19 infections, children with PANS/PANDAS were significantly more likely to experience a severe symptom flare than a mild flare or no change in symptoms. In contrast, after receiving COVID-19 vaccines, children were significantly more likely to experience no change in PANS/PANDAS symptoms than to endure a mild or severe symptom flare. In addition, children who recovered from PANS/PANDAS were significantly more likely to have no symptom change versus children who were managing the condition, both after COVID-19 infection (92% versus 25%) and vaccine receipt (100% versus 66%). Conclusion: These results support COVID-19 vaccination for most individuals with PANS/PANDAS given that the frequencies of symptom flares and setbacks after COVID-19 infection were significantly higher than after the COVID-19 vaccine. Nonetheless, further studies are needed to fully assess the risk-benefit balance and to provide a more individualized approach to disease prevention in people with immune vulnerabilities.

Clinicolaboratory characteristics of pediatric autoimmune neuropsychiatric disorders associated with Streptococcal infections: A cross-sectional study

Clinicolaboratory characteristics of pediatric autoimmune neuropsychiatric disorders associated with Streptococcal infections: A cross-sectional study

Bibliometric Analysis of Publications on Pandas Syndrome in Psychiatry Research Area

Aim: Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS Syndrome) is a neuropsychiatric disorder whose diagnosis and treatment are controversial. The goal of this study was to highlight trends and discuss problems in Pandas Syndrome research since 1998 and to assist researchers in identifying new avenues for this field of study.&#x0D; Material and Method: The Vosviewer program was used to conduct bibliometric analysis on the articles chosen from the Web of Science Core Collection.&#x0D; Results: The analysis included 361 publications. 2004 was the year with the highest number of publications. In the following years, the number of publications followed an irregular course. The most cited publications were published in 2021 and these publications received 881 citations. The United States (n=191,52.91%), Italy (n=43,11.91%), England (n=32,8.86%), Germany (n=18,4.98%), Sweden (n=13,3.60%), Turkey (n=13,3.60%) and Spain (n=10, 2.77%) were detected as the mostly publishing countries. The United States, the United Kingdom, Italy, and Germany were the countries with the largest number of countries and the most cooperation between countries. The National Institute of Mental Health, Yale University, and Johns Hopkins University were the most prolific institutions.&#x0D; Conclusion: With this study, we reviewed the global studies on PANDAS in the field of psychiatry and tried to highlight the issues that can be identified as emphasis. According to the study findings, the number of publications on PANDAS is still much lower than expected. Scientific productivity on PANDAS syndrome, which has many unknowns about diagnosis, treatment and etiology, needs to be increased globally.

Abnormal mTOR Signaling Pathway Activity in Autism Spectrum Disorders: Prospects of Mechanism-Based Therapy

Autism spectrum disorder (ASD) is a developmental disorder characterized by the early onset of problems with communication, learning, and behavior. The syndromic form of ASD is caused by monogenic mutations. When it is not possible to find genetic or other known mechanisms, the term "idiopathic autism" is used. A significant part of both syndromic and idiopathic autism is associated with translational deregulation dependent on the mechanistic target of rapamycin (mTOR). In this review, we present both bioinformatic and experimental data that link the mTOR signaling pathway to maternal autoantibody related autism and childhood autoimmune neuropsychiatric disorders such as Sydenham's chorea and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS). The need for ASD subtyping and the prospects of mechanism-based therapy with inhibitors of the mTOR signaling pathway are also discussed.

The Coexistence of Antibodies to Neuronal Cell and Synaptic Receptor Proteins, Gangliosides and Selected Neurotropic Pathogens in Neurologic Disorders in Children

Various primarily non-autoimmune neurological disorders occur synchronously with autoantibodies against tissues in the nervous system. We aimed to assess serum and cerebrospinal fluid (CSF) autoantibodies in children with neurologic disorders. To find new diagnostic tools, we compared the laboratory and clinical findings between the distinguished groups. Retrospectively, 508 patients were divided into six subgroups: neuroinfections, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, neurologic autoimmune and demyelinating diseases, epilepsy, pervasive developmental disorders and other patients. We analysed serum anti-aquaporin-4, antiganglioside, neuronal antinuclear and cytoplasmic antibodies, as well as antibodies against surface neuronal and synaptic antigens in the CSF and serum. We involved available demographic and clinical data. Autoantibodies appeared in 165 (32.3%) children, with 24 showing multiple types of them. The most common were anti-neuroendothelium (anti-NET), anti-N-Methyl-D-Aspartate receptor (anti-NMDAr), anti-glial fibrillary acidic protein and anti-myelin antibodies bothering 46/463 (9.9%), 32/343 (9.4%), 27/463 (5.8%) and 27/463 (5.8%), respectively. Anti-NET and anti-NMDAr antibodies appeared more frequently in children with autoimmunity (p = 0.017; p < 0.001, respectively), increasing the autoimmune disease risk (OR = 2.18, 95% CI 1.13-13.97; OR = 3.91, 95% CI 1.86-8.22, respectively). Similar pathomechanisms appeared in diseases of different aetiology with clinical spectrums mimicking each other, so we proposed the model helping to diagnose autoimmune disease. We proved the influence of age, living place and medical history on the final diagnosis.

THE PRESENCE OF THE ANTI-STREPTOCOCCUS ANTIBODIES IN THE BIPOLAR AFFECTIVE DISORDER.

Background: A beta hemolyticus infection can cause a number of infections by different kinds of pathogenic mechanisms in the general population. These can range from streptococcal skin infections to rheumatic valve and heart diseases, as well as brain damage like encephalitis and paediatric autoimmune neuropsychiatric disorders. Objectives: The objective of this study was to find out the presence of anti-streptococcus antibodies in bipolar affective disorder with respect to family history, educational background, and gender differences. Methodology: The sample was collected with patient consent during the past year from the Bolan Medical College Complex Hospital, the Quetta Department of Psychiatry’s out door and in-door patients and from private referrals. A cross-sectional study with a sample size of 100 patients with a history of elated mood and low-grade fever in the absence of obvious causes, or if any causes were discovered after treatment, was conducted after carrying out their general physical and systemic examinations in order to include them in this study. Results: The positive anti streptolysin-o (ASO-titer) meaning more than 200 IU, is set for a positive result for the presence of the streptococcal antibody levels. In this study, the authors found a 29% prevalence of positivity. The variables are positive psychiatric family history, no education or poor educational background, and the third variable is the way the gender-based differences are, in males, the results are 71.7% and in females, it is 70% negative. Conclusion: The female gender, poor educational background, and positive family history are the main outcomes of this study.

Infections and obsessive-compulsive disorder - results from a systematic review and meta-analysis

IntroductionObsessive-compulsive disorder (OCD) is a psychiatric disorder affecting 1.3% of the population worldwide where both genetic and environmental factors, such as perinatal events and neuroinflammation, are thought to contribute to the etiology of the disorder. In the past, the description of clinical entities such as Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS), in which an acute neuropsychiatric syndrome with prominent obsessive-compulsive features emerges in children infected with group-A beta-hemolytic streptococcus (GABHS), sparked the hypothesis that infections may be a risk-modifying factor for the development of OCD. Along with streptococcal infections, other pathogens such as Toxoplasma gondii have been implicated in the pathophysiological models of the disorder, although causal associations have not been established for any of beforementioned pathogens.ObjectivesTo perform a systematic review and meta-analysis about the presence of biological evidence of infection in patients diagnosed with OCD.MethodsWe conducted a systematic review and a meta-analysis (PROSPERO registration CRD42021223415) by performing a standardized electronic database search in MEDLINE/PubMed, Web of Science, Embase and Scopus. Search was conducted on 17/10/2022. Eligible papers included case-control and cohort studies using a comparator group, that tested for specific biomarkers providing evidence of infection in patients diagnosed with OCD; exclusion criteria included studies without quantitative or qualitative measures of infection, case reports, systematic or scope reviews, and animal studies. Selection process was conducted according to PRISMA 2020 statement guidelines. Study quality was assessed through Newcastle-Ottawa Quality Assessment Scale.ResultsWe identified 8911 records through the search after duplicate removal. A total of 22 studies met inclusion criteria after selection process, and 15 were eligible for meta-analysis. Most evidence concerned Toxoplasma gondii (10 studies), and patients with OCD appear to have higher odds of being infected compared to controls, with a meta-analytic odds ratio of 2.39 (95% IC 1.60-3.58), when comparing 467 patients with 5411 controls. However, most studies were methodologically heterogeneous, which compromises the interpretation of meta-analytic results. Information regarding other agents, including GABHS, Borna disease virus and Toxocara canis was gathered but due to an insufficient number of papers it was not possible to perform a meta-analysis for each of them.ConclusionsOur work suggests that albeit exhaustively reported in the literature, there is no strong evidence of the over-representation of biomarkers of infection in patients with OCD compared to control volunteers. Methodologically robust studies are needed to further test this hypothesis.Disclosure of InterestNone Declared