Symptomfreiheit nach oraler Penizillintherapie bei Waschzwang

Zusammenfassung

Wir berichten von einem sechsjährigen Patienten mit akut aufgetretenem Waschzwang, der nach oraler Penizillintherapie komplette Symptomfreiheit gezeigt hat. Auf Grund zahlreicher Infektionen mit β-hämolysierenden Strepto-kokken der Gruppe A (GABHS) in der Familie und erhöhtem Antistreptolysin O-Titer diagnostizierten wir PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections). Das schnelle und deutliche Verschwinden der Zwangssymptomatik nach oraler Penizillintherapie ist ein neuer Hinweis auf das immer wieder kontrovers diskutierte PANDAS.

Summary

We present the case of a six year old patient with sudden onset of obsessive compulsive disorder, whose symptoms disappeared completely after therapy with oral penicillin. We diagnosed PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) due to high antistrepolysin O titer and several streptococcal infections in the patient’s family. The fast and clear disappearance of obsessive-compulsive symptoms after oral penicillin irradiate new light on the often controversially discussed PANDAS.

Schlüsselwörter

PANDAS - Zwangserkrankung - Tic - β-hämolysierende Streptokokken der Gruppe A (GABHS)

Keywords

PANDAS - obsessive-compulsive disorder - tic - Group A betahemolyticstreptococcae (GABHS)

• Literatur

• 1 Arbeitsgruppe Deutsche Child Behavior Checklist. Elternfragebogen über das Verhalten von Kindern und Jugendlichen; deutsche Bearbeitung der Child Behavior Checklist (CBCL/4–18). Einführung und Anleitung zur Handauswertung. Auflage mit deutschen Normen, bearbeitet. von Döpfner M, Plück J, Bölte S, Melchers P, Heim K. Köln: Arbeitsgruppe Kinder-, Jugend-und Familiendiagnostik (KJFD); 1998
• 2 Allen AJ, Leonard HL, Swedo SE. Case study: a new infection-triggered, autoimmune subtype of pediatric OCD and Tourette’s syndrome. J Am Acad Child Adolesc Psychiatry 1995; 34: 307-11.
• 3 Cardona F, Orefici G. Group A streptococcal infections and tic disorders in an Italian pediatric population. J Pediatr 2001; 138: 71-5.
• 4 Dale RC, Heyman I, Giovannoni G, Church AW. Incidence of anti-brain antibodies in children with obsessive-compulsive disorder. Br J Psychiatry 2005; 187: 314-9.
• 5 Garvey MA. et al. A pilot study of penicillin prophylaxis for neuropsychiatric exacerbations triggered by streptococcal infections. Biol Psychiatry 1999; 45: 1564-71.
• 6 Giedd JN, Rapoprt JL, Garvey MA, Perlmutter S, Swedo SE. MRI assessment of children with obsessive-compulsive disorder or tics associated with streptococcal infection. Am J Psychiatry 2000; 157: 281-3.
• 7 Keitzer R. Infektionen mit ß-hämolysierenden Streptokokken der Gruppe A (GABS) und Streptokokkenfolgeerkrankungen. Monatsschr Kinderheilkd 2003; 151: 358-72.
• 8 Kurlan R, Kaplan EL. The pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) etiology for tics and obsessive-compulsive symptoms: hypothesis or entity? Practical considerations for the clinician. Pediatrics 2004; 113: 883-6.
• 9 Mell LK, Davis RL, Owens D. Association between streptococcal infection and obsessive-compulsive disorder, Tourette’s syndrome, and tic disorder. Pediatrics 2005; 116: 56-60.
• 10 Miller DL, Laxer RM. Review article Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) Pediatric Online Journal. 2003; 01: 140-61.
• 11 Murphy ML, Pichichero ME. Prospektive identification and treatment of children with pediatric autoimmune neuropsychiatric disorder associated with group A streptococcal infection (PANDAS). Arch Pediatr Adolesc Med 2002; 156: 356-61.
• 12 Pavone P, Bianchini R, Parano E, Incorpora G, Rizzo R, Mazzone L, Trifiletti RR. Anti-brain antibodies in PANDAS versus uncomplicated streptococcal infection. Pediatr Neurol 2004; 30: 107-10.
• 13 Perlmutter SJ. et al. Therapeutic plasma exchange and intravenous immunoglobulin for obsessivecompulsive disorder and tic disorders in childhood. Lancet 1999; 354: 1153-8.
• 14 Persönliche Besprechung mit Dr. Murphy.
• 15 Snider LA, Lougee L, Slattery M, Grant P, Swedo SE. Antibiotic prophylaxis with azithromycin or penicillin for childhood-onset neuropsychiatric disorders. Biol Psychiatry 2005; 57: 788-92.
• 16 Snider LA, Swedo SE. PANDAS: current status and directions for research. Mol Psychiatry 2004; 09: 900-7.
• 17 Swedo SE. et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases. Am J Psychiatry 1989; 146: 246-9.
• 18 Swedo SE, Leonard HL, Rapoport JL. The pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) subgroup: separating fact from fiction. Pediatrics 2004; 113: 907-11.
• 19 http://www.clinicaltrials.gov/ct/show/NCT00001658