title: Autoimmune neurological disorders associated with group-A beta-hemolytic streptococcal infection.
abstract: Although central nervous system (CNS) disorders associated with group-A beta-hemolytic streptococcal (GABHS) infection occur only rarely, Sydenham's chorea is a well-recognized disease that can arise following infection. Children may develop a tic, obsessive compulsive disorder (OCD), and extrapyramidal movement subsequent to GABHS infection. These disorders have been termed pediatric autoimmune neuropsychiatric disorders associated with streptococci (PANDAS). Herein we report one case each of acute disseminated encephalomyelitis (ADEM), PANDAS and subacute encephalitis associated with GABHS infection. To evaluate the pathogenesis of the CNS disorders associated with GABHS infection, we measured levels of neurotransmitters, cytokines, anti-neuronal autoantibodies, and performed immunohistochemistry using patient sera to stain human brain sections. All three cases showed psychiatric behavioral disorders. Immunotherapy was effective, and homovanillic acid levels in the cerebrospinal fluid (CSF) were elevated at the acute stage in all three cases. In each case of ADEM and PANDAS, immunohistochemistry demonstrated neuronal impairment in the basal ganglia during the acute stage. Neuronal immunoreactivity was visualized in the cerebral cortex at the acute stage in the case of subacute encephalitis. There was no direct correlation between immunoreactivity of patient sera on the brain sections and positivity of anti-neuronal autoantibodies or CSF biomarkers. The results suggest that autoimmune responses may modulate neurotransmission, and the use of patient serum for immunohistochemistry is a sensitive screening method for the detection of anti-neuronal autoantibodies in CNS disorders associated with GABHS infection.
authors.affiliation: Department of Neuropediatrics, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan. yasuo_hachiya@tmhp.jp
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Hachiya
authors.forename: Rie
authors.initials: R
authors.lastname: Miyata
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Tanuma
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Hongou
authors.forename: Keiko
authors.initials: K
authors.lastname: Tanaka
authors.forename: Konomi
authors.initials: K
authors.lastname: Shimoda
authors.forename: Sachiko
authors.initials: S
authors.lastname: Kanda
authors.forename: Ai
authors.initials: A
authors.lastname: Hoshino
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Hanafusa
authors.forename: Satoko
authors.initials: S
authors.lastname: Kumada
authors.forename: Eiji
authors.initials: E
authors.lastname: Kurihara
authors.forename: Masaharu
authors.initials: M
authors.lastname: Hayashi
mesh_terms: D001327:Autoimmune Diseases / Q000209:etiology* / Q000276:immunology / Q000503:physiopathology; D002648:Child; D004673:Encephalomyelitis, Acute Disseminated / Q000209:etiology* / Q000276:immunology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D009422:Nervous System Diseases / Q000209:etiology / Q000276:immunology / Q000503:physiopathology; D013290:Streptococcal Infections / Q000150:complications*; D013297:Streptococcus pyogenes