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Tijdschrift voor Psychiatrie 42 (2000) 3, 157 - 166

Review article

Streptococcal infections in psychiatry

S.W.H.M. van Bommel, H.J.G.M. van Megen, H.G.M. Westenberg

background Recently, the hypothesis has been postulated that certain psychiatric disorders in childhood are possibly the result of group-a-bèta-hemolytic streptococcal (gabhs) infections. Sydenham's chorea has been proposed as a model to explain the pathogenesis of this subgroup of childpsychiatric disorders called pediatric, auto-immune, neuropsychiatric disorders associated with streptococcal infections (pandas). Sydenham's chorea is a neurological disease caused by a cross-reaction of group-a-bèta-hemolytic streptococcal antibodies with certain epitopes in the basal ganglia. Antineural antibodies can be detected in the blood of these patients. There is also a marker (antigen d8/17 on the surface of the b-lymfocyte) which is present in patients with Sydenham's chorea, but not in the normal population.
aims Clustering and summarizing of the data, investigating the possible immunological genesis of obsessive compulsive disorder.
methods Literature search in period 1980 until 1999, by Medline.
results Case-reports and studies with small numbers of patients show that there is indeed a group of children with psychiatric disorders who have had a gabhs infection before the onset of their symptoms. In these children antineural antibodies as well as the expression of d8/17 antigen on b-lymfocytes have been detected.
conclusions In order to further elucidate the role of immunological processes and the possible genetic susceptibility future investigations with larger groups of patients are warranted. If immunologic processes play indeed a pivotal role in ocd and tic disorders, it will have a tremendous impact on the treatment and prevention of these disorders.

keywords autoimmunity, pandas, psychiatric symptoms