Group A �-hemolytic streptococcal infection in children and the resultant neuro-psychiatric disorder; a cross sectional study; Tehran, Iran

Introduction: Group A Beta-Hemolytic Streptococcus (GABHS) can induce PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection). GABHS is the most important and common bacterial cause of acute pharyngitis in Iranian children. We studied the role of GABHS (anti-streptococcal antibodies) in suspected cases of PANDAS in a cross sectional studies. Methods: Across sectional study was done in 2 pediatric psychiatric/and neurologic clinics in Tehran (Rasul Akram and Aliasghar Hospital) during 2008-2010. We studied serum antistreptococcal antibodies (anti streptolysin O, anti Deoxyribonuclease B, and anti-streptokinase (ABcam-ELISA, USA) in 76 cases with psychiatric manifestation (OCD, ADHD) in compare with 39 healthy controls. These antibodies were studied in 53 cases with movement disorders (Tic/Tourette syndrome) in compare with 76 healthy controls. Sensitivity, specificity and positive predictive value of tests were calculated. Results: In movement disorders ASOT, Anti-DNase and Anti streptokinase was significantly higher than controls (p 200IU/ml) had 75 sensitivity; 84 specificity and 80 PPV; Antistreptokinase (cut off level> 332 IU/ml) had 34 sensitivity; 85 specificity, and 72 PPV; Anti-DNase (cut off level> 140IU/ml) had 70 sensitivity; 99 specificity and PPV 90 for differentiating the group. ASOT, Anti-DNase and Anti streptokinase titer was significantly higher than controls (p<0.0001, p=0.000, p<0.0001). ASOT had 90 sensitivity; 82 specificity, PPV 92; Anti streptokinase: 82 sensitivity; 82 specificity, PPV 95; Anti DNase: 92 sensitivity; 82 specificity, PPV 92 for differentiation the cases from normal controls. Discussion: These findings support that a post infectious immune mechanism to GABHS may play a role in the pathogenesis of PANDAS in our children. A combination of throat culture, rapid antigen detection test, and serologic testing for GABHS is required to achieve maximum sensitivity and specificity for diagnosis. We prefer to use antibiotic prophylaxis in PANDAS cases for preventing recurrent streptococcal infections. Ongoing research is needed for identifying optimum diagnostic, prevention and therapeutic approach especially, aggressive treatment (intravenous immunoglobulin, plasmaphresis)

Acute nonbacterial gastroenteritis in hospitalized children: A cross sectional study

Background: Viral acute gastroenteritis (AGE) is a major cause of morbidity in childhood and leads to hospitalization in developed countries, such as Iran. Objectives: The aim of this study was to determine the prevalence and viral types (rotavirus, adenovirus, human parechoviruses-1, and human bocavirus) of acute nonbacterial gastroenteritis in hospitalized children. Patients and Materials: This was a across-sectional prospective study performed at the Pediatric Department of Rasoul Hospital, Tehran, Iran (2009-2011) on 80 hospitalized children with viral AGE. All Stool samples were collected on viral transport media. Human bocavirus (HBoV) was detected using the Real-time PCR TaqMan method. Molecular detection of human parechovirus type 1 (HPeV-1) RNA in stool samples was done using a specific nested reverse transcription PCR (RT-PCR). Rota and adeno virus antigens were sought by rapid chromatographic tests. P values less than 0.05 were considered statistically significant. Results: Fever was determined in 47.5 of cases (38), nausea and vomiting in 42.5 (34), respiratory symptoms in 16.3 (13), abdominal pain in 76. Duration of diarrhea was 1-30 days (mean = 6.3 + 4.3 days). No dehydration was observed in 43.5 of subjects, mild dehydration in 33.8, moderate dehydration in 17.5 and severe dehydration in 5 of cases. Positive rotavirus was found in 48.8 of cases (39), adenovirus in 20 (16), HBoV in 8 (6) and HPeV-1 in 23.2 (19), and adeno and rotaviruses co-infection in 6 (4). The frequency of positive HBoV was significantly lower than adeno and rotaviruses infection (P value = 0.0001). Rotavirus was more frequent in males (P value = 0.003) and in young children (17.49 months vs. 21.44 months) P value = 0.03, CI = -13.4, 5.5. Rotavirus infection was related to the degree of dehydration (P value = 0.001) but was not related to the presence of vomiting or fever (P value > 0.5). Conclusions: This study indicates that viral agents, especially rotavirus (48.8%), HPeV-1 (23.2%) and adenovirus (20%) are the most important causes for viral AGE in children while HBoV (8%) is infrequent during childhood. Determination of various viral pathogens of AGE is very important in planning diarrhea disease control strategies in our country where rotavirus vaccination in not routinely used. © 2014, Ahvaz Jundishapur University of Medical Sciences