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

Abstract

Background: A B-hemolytic streptococcal infections (GABHS) have been linked to obsessive-compulsive disorder (OCD) and tic disorders, leading to pediatric autoimmune neuropsychiatric diseases associated with streptococcal infections (PANDAS). This study aims to characterize the clinical and laboratory profile of a group of PANDAS patients and to relate between GABHS infection and their neuropsychiatric manifestations. Methods: a cross-sectional study was conducted between January2022 and January2023. We included all pediatric patients who had PANDAS using the following criteria: tic disorder and/or OCD; Presence of relationship between GABHS infection and disease onset and/or exacerbations. Streptococcal diagnosis for all cases was conducted using throat swab culture and measuring serum anti-streptolysin O(ASO) antibody titer, antideoxyribonuclease B (Anti Dnase B). Results: We diagnosed PANDAS in 76 patients. The mean age of patients was 6.8 ± 1.90 years. Motor tics occurred in 37 patients (48.7%), verbal tics in 6 patients (7.9%) and combined tics in 33 patients (43.4%). Attention deficit hyperactivity (ADH), Tourette syndrome, and OCD were identified in 27.6%, 18.4% and 15.8% of patients, respectively. Of all patients, 31 (40.8%) had pathologic Anti Dnase B antibody titer, 27 (35.5%) had pathologic (ASO) antibody titer, and GABHS were isolated from throats in 14 patients (18.4%). There was moderate agreement between GABHS throat culture and both ASO antibody titer (Kappa=0.58; p<0.001) and Anti Dnase antibody titer (Kappa=0.49; p<0.001). Of note, there was substantial agreement between ASO and Anti Dnase antibody titers (Kappa=0.78; p<0.001). Conclusion: The diagnosis of PANDAS requires careful assessment, including documentation of neuropsychiatric symptoms associated with evidence of GABHS infection.