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Background: Recent
evidence suggest that group A ß-hemolytic streptococcal (GABHS)
infection may increase the risk of
pediatric autoimmune neuropsychiatric disorders (PANDAS) composed of the clinical signs of obsessive-compulsive and
attention deficit hyperactivity disorders. The objective of this study was to compare
the titer of antibodies against GABHS between children with PANDS and the controls.Methods : This cross-sectional, case-control study was done in Hazrat Rasoul Hospital, in Tehran, Iran
during 2008-2010. We compared serum antibodies
streptolysin O, deoxyribonuclease B, and streptokinase against GABHS
quantitatively in 79 cases with PANDAS and 39 age-matched controls. The
area under ROC curve, sensitivity, specificity and positive predictive value (PPV) of tests were calculated.Results : Most cases were studied in summer (57%) and spring (23%). The three aforesaid antibodies were higher in the cases (P=0.001). Antisterptolysin O (cut-off point 195) had a 90% sensitivity, 82% specificity and a 92% PPV, (CI=95%, 0.99-0.91). Anti streptokinase (cut-off
point 223)
had an 82% sensitivity, 82% specificity and a 95% PPV, (CI=95%, 0.934-0.735). Anti-DNase (cut-off point 140) had an 82% sensitivity, 82% specificity and a 95% PPV, (CI=95%, 0.99-0.91). Conclusion: The
study demonstrated a possible role for streptococcal infection in PANDAS.
We found a significantly higher antibody titer against GABHS in
OCD and ADHD cases in comparison with
healthy children. Treatment of streptococcal infection is achievable by the use
of long-acting penicillin. Use of aggressive treatment schedules like
plasmaphresis, IVIG, etc needs further RCT
studies