Psychiatry & Immunology: The Evolving PANS/PANDAS Profile
[Pages:60]
Psychiatry & Immunology: The Evolving PANS/PANDAS Profile
USF
Rothman Center
Tanya Murphy, MD, MS Professor, Pediatrics & Psychiatry Director, Rothman Center University of South Florida
DISCLOSURES
Research support from National Institute of Mental Health, Shire Pharmaceuticals, Pfizer, Inc, F. Hoffmann-La Roche Ltd., Neurocrine Biosciences, Psyadon Pharmaceuticals, Teva Pharmaceuticals and PANDAS Network.
!2
3/4/2018
THE INCREASING INCIDENCE OF IMMUNE DISORDERS
!3 T Murphy; University of South Florida
PANS/PANDAS ONSET
3/4/2018
Infection Symptoms
Possible Infectious Triggers
Pharyngitis Sinusitis Cough/pneumonia Dermatitis (impetigo,
perianal, vulvovaginitis)
Group A streptococcus (PANDAS)
Mycoplasma pneumonia (PANS)
Viruses: less reports but influenza A esp. H1N1, maybe EBV (PANS)
Lyme disease (PANS)
!4
T Murphy; University of South Florida
EVIDENCE FOR AN ASSOCIATION BETWEEN GAS AND PANDAS
Clinical association Epidemiologic studies Prospective study Molecular mimicry between GAS and neural antigens Animal models
!5
ASSOCIATION OF STREPTOCOCCAL THROAT INFECTION WITH MENTAL DISORDERS: TESTING KEY ASPECTS OF THE PANDAS HYPOTHESIS IN A NATIONWIDE STUDY ORLOVSKA ET AL. 2017
Data from over 1 million youth
GAS associated with especially OCD and tics but other mental disorders as well
Some increase with nonstrep pharyngitis ? supports PANS or possibly missed GAS on testing
!6
T Murphy; University of South Florida
PANS SURVEY PAPERS
CALAPRICE ET AL. 2017
698 patients represented 2/3rd M, 1/3rd F 12% ASD pre-existing 73% reported frequent infections
51% reported frequent sore throats 44% reported frequent ear infections 39% reported chronic sinusitis
!7
5-YEAR-OLD BOY AWOKE
Day 1
"A CHANGED CHILD"
frequent urination was noted the preceding day
fears that he was "dirty" & washing excessively
separation anxiety, frequent meltdowns
2 weeks later
he developed tics
handwriting deterioration
difficulties with concentration
4 weeks later
motor clumsiness that remitted within a week
5 weeks later
episode of spasmodic torticollis that remitted within 1 day (treated in the ER)
6 weeks later
!8
ASO was 680 and anti-DNase B >1360
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