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)

Unusual infections in resected adenoid of children: PCR for C. pneumonia, M. pneumonia, H. pylori

Recurrent or chronic adenotonsillar infections mainly affect children. The possible role for infectious agents in adenoid hypertrophy have reported. Searching the DNAs (PCR) of M. pneumonia, C. pneumonia and H. pylori in resected adenoid of children with adenoid surgery. A cross-sectional study done in ENT and Pediatric Department of Rasul Akram Hospital during 2006-2008. 53 children with recurrent or chronic adenotonsillar infections candidate for adenoid surgery were selected. The resected adenoid tissues (1cm) during surgery removed by surgeon. The tissue samples were centrifuged and homogenized, DNAs were extracted and searched for DNAs of M. pneumonia, C. pneumonia and H. pylori by qualitative PCR. Mean age of cases was 8 ±1.9 years. 48 male; 51.9 female 23. Most cases aged between 6-9 years (71.5). Most adenoid surgery was done in winter (32). M. pneumonia- DNA detected in 28; C. pneumonia in 13.2; H. pylori in 15 of tissue samples with no relation to sex and age of cases. Most positive PCR results for C. pneumonia and H. pylori (p=0.05; 0.02) were seen in spring and summer but not for M. pneumonia (p=0.5) We could detect at least 1 of these 3 unusual infectious agents (M. pneumonia, C. pneumonia and H. Pylori) in adenoid tissues of 60 cases. These unusual infections may have a relative role in etiology of adenoid hypertrophy. Chronic sinusitis and ear infection might be added to infected adenoid tissue as a reservoir for these unusual bacteria. The search by more specific method such as Real time-PCR; or specific culture may elucidate better the role of these unusual infections in adenoid hypertrophy in future. The decision for use of antibiotics to eradicate these unusual infections in recurrent or chronic adenotonsillar infections before adenoid surgery (with or without rhinosinusitis or chronic ear infection) needs Randomized Controlled Trial studies