Resistant Chorea Successfully Treated with Intravenous Immunoglobulin: A Case Report

Sydenham’s chorea (SC) is common cause of acquired chorea in childhood. SC occurs mainly in children with untreated streptococcal infections. An effective list of therapeutic options has been used to treat this disorder: antiepileptic drugs (valproic acid, carbamazepine etc.), haloperidol, chlorpromazine, amphetamines, steroids, plasma exchange and intravenous immunoglobulins (IVIG). We report a 12-year-old girl with carditis and severely generalized chorea and successfully treated with IVIG. This case report shows that IVIG is an effective treatment for the chorea cases resistant to anticonvulsants, dopamine antagonists and steroids, although larger studies are needed to confirm this conclusion.

Group B Streptococcal infections among nonpregnant adults: A cross sectional study from a Tertiary care teaching hospital in South India

To understand the epidemiology of Group B Streptococcal infections among nonpregnant adults and to study the antibiotic susceptibility profile of GBS isolates.: A cross sectional study conducted in the department of microbiology in a tertiary care teaching hospital during December 2018 to May 2020. Group B Streptococcal (GBS) isolates from clinical samples of nonpregnant adults were included in the study. Identification and antibiotic susceptibility testing of GBS isolates were performed according to standard microbiology techniques. Patient’s demographic features and clinical details were collected from medical records. : A total of 58 GBS isolates were obtained from nonpregnant adults during the study period. There was a female (60.3%) predominance among the study group. Mean age of the study subjects was 51.4 years. In our study GBS were commonly isolated from urine 50% (n=29) and wound swabs 46.6% (n=27). One isolate each (1.7%) was obtained from blood culture, urethral swab and high vaginal swab. Common GBS infections noted in this study were Urinary tract infections (50%) and skin and soft tissue infections (46.6%). Diabetes mellitus (58.6%) was the most common risk factor noted in our study. All the isolates were sensitive to Penicillin, Linezolid and Vancomycin. Erythromycin and clindamycin resistance of 13.8% and 6.9% respectively were noted. A shifting trend of GBS infections from pregnant women and neonates to non-pregnant adults was observed in the present study. In patients with diabetes mellitus GBS could be considered as causative agent of skin and soft tissue infections.

Plasmapheresis, Rituximab, and Ceftriaxone Provided Lasting Improvement for a 27-Year-Old Adult Male with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS)

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is a specific autoimmune response to group-A streptococcal (GAS) infections in children and adolescents with a sudden onset of neuropsychiatric disorders including obsessive-compulsive disorder (OCD) or tic-like symptoms. We present a case report of a 27-year-old male patient who had lasting improvement with plasmapheresis, rituximab, and ceftriaxone. Our patient first developed sudden psychosis and confusion after GAS infections at age 17. He had elevated anti-streptolysin O (ASO) titers, negative urine drug screen, no ETOH in blood, normal CBC, normal TSH, normal salicylate, normal acetaminophen, and a normal head CT. The tentative diagnosis of PANDAS was made, and the patient was thereafter treated with antipsychotics, antibiotics, tonsillectomy, and IVIG which resulted in remissions and relapses of his neuropsychiatric symptoms. Once he reached age 27, he received a trial of therapeutic plasma exchange (TPE), rituximab, and ceftriaxone. This eventually resulted in sustained benefit and minimal fluctuations of his clinical symptoms. Our report is noteworthy in three ways.One, he is a 27-year-old adult with PANDAS.Two, he improved after TPE, rituximab, and ceftriaxone. Our literature search yielded minimal data on the use of plasmapheresis for nonteenage adults with PANDAS. Three, he had unusual symptoms of PANDAS, as the typical OCD and/or tic-like symptoms were not observed.

PANDAS: behov for nasjonale retningslinjer

Background: Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) was introduced in 1998. The hypothesis that acute tics and/or symptoms of obsessive-compulsive disorder (OCD) might be triggered by streptococcal infection lacks scientific support. Patients are seen by several specialists, and treatment depends on knowledge and acceptance of the condition. This article provides an overview of literature investigating proposed treatments. Method: We performed a literature search in PubMed and Cochrane Library between 1 June 2019 and 17 July 2021. Results: 14 reviews were included. Suggested treatments comprised psychiatric treatment, antibiotics, tonsillectomy and immune modulating therapy. Recommendations were largely based on case reports and uncontrolled studies. Conclusion: Few studies have been conducted on PANDAS treatment, and none were evidence-based. Cooperation between different professions and establishment of national guidelines on how to approach these children are crucial. Keywords: PANDAS, post-infectious autoimmunity, neuropsychiatry, interdisciplinary

Diagnostic Approach to Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS): A Narrative Review of Literature Data

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are clinical conditions characterized by the sudden onset of obsessive–compulsive disorder and/or tics, often accompanied by other behavioral symptoms in a group of children with streptococcal infection. PANDAS-related disorders, including pediatric acute-onset neuropsychiatric syndrome (PANS), childhood acute neuropsychiatric symptoms (CANS), and pediatric infection triggered autoimmune neuropsychiatric disorders (PITANDs), have also been described. Since first defined in 1998, PANDAS has been considered a controversial diagnosis. A comprehensive review of the literature was performed on PubMed and Scopus databases, searching for diagnostic criteria and diagnostic procedures of PANDAS and related disorders. We propose a test panel to support clinicians in the workout of PANDAS/PANS patients establishing an appropriate treatment. However, further studies are needed to improve our knowledge on these acute-onset neuropsychiatric conditions.

Isolation and characterization of bacteriophages from wastewater sources on Enterococcus spp. isolated from clinical samples

Background and Objectives: In recent decades, enterococcal resistance to antimicrobials has greatly increased. Further- more, these chemicals include several side effects on the patients. Since no reports are available of the bacteriophages' effects on eukaryotic cells, they can be good solutions for multidrug-resistant bacterial problems. Therefore, the major aim of this study was to isolate bacteriophages from wastewaters on clinical antibiotic-resistant enterococci. Materials and Methods: Clinical bacteria were isolated, then enterococcal isolates were identified using different methods. The antibiotic resistance scheme of the enterococcal isolates was assessed. The bacterial isolates were exposed to wastewa- ter samples containing potential bacteriophages. Technically, isolated bacteriophages were studied by electron microscopy. Results: Isolated bacteria were verified as Enterococcus faecium. Results showed that bacteriophages could easily be isolat- ed from wastewater sources. The isolated bacteriophages were effective on E. faecium as well as Streptococcus dysgalactiae. Furthermore, these bacteriophages were challenged with five other bacteria (ATCC) with no visible effects. In general, the isolated bacteriophages belonged to the Myoviridae, Siphoviridae, and Inoviridae families. Conclusion: Further studies on bacteriophages and their efficacy on enterococcal strains could increase the treatment possi- bility of enterococcal infections. Due to these bacteriophages' effects on Streptococcus strains, bacteriophages may be used to treat streptococcal infections as well.

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is a rear disease in pediatric age group which constitute a unique manifestation associated with obsessive-compulsive disorder (OCD) and tic disorder in children. However, this diagnosis has carried a lot of controversies, related mainly to its management. Here we are presenting one case of PANDAS syndrome who was treated successfully with full coarse of antibiotic for 10 days, where all his symptoms disappeared completely in subsequent days including suicidal attempts. PANDAS should be considered in children with neuropsychiatric disorders (tics, obsessive behavior etc.) especially if symptoms associated within a period of infection such as febrile illness or sore throats.