Physical and Psychological Study of Different Presentations of Rheumatic Fever and Pediatric Autoimmune Neuropsychiatric Disorders After Streptococcal Infection

Abstract

Rheumatic fever (RF) still forms a major community health problem m Egypt (Eissa et al., 1988). Rheumatic chorea occurs in 1 0-30% of children with RF (Veasy eta/., 1987). It may serve as the sole diagnostic criterion for acute RF (Sweda et al., 1993). The prevalence of rheumatic chorea in Egypt was 621100000 population

(Kandil et al., 1994).

There is a high prevalence of obsessive compulsive features among patients with rheumatic chorea (Sweda et al., 1989).

Recent evidence suggests that there may be a spectrum of neurobehavioral disturbances, particularly including tics and obsessive compulsive disorder, that develop following streptococcal infection by the process of molecular mimicry, whereby antibodies directed against bacterial antigens cross react with brain targets. This proposed post infectious, immune mediated condition has been termed Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection "PANDAS" (Kurian, 1999).

This work was done to clarify the clinical link between RF "and its variant rheumatic chorea" and PANDAS.

This study was done on 86 children, their aged ranged from 5-15 years, collected from those admitted to pediatric department, Tanta university hospital. They were grouped into the following: Group A: 6 children with PANDAS.