Izvo zvinogona kunge zvisinganzwisisike kuti strep throat inogona kuva chikonzero chekusagadzikana-kusagadzikana kwepfungwa . Zvisinei, kwenguva yekutanga, kutsvakurudza kukuru kweDenmark kunoratidzika kutsigira ukama huno hukama.
Background
Mabhakitiriya anokonzera pakati pe5 ne10 muzana yemaperembudzi. Bhakitiriya anonyanya kukonzerwa nehuro neboka boka re beta-hemolytic streptococci (GAS kana "strep").
Muna 1998, vatsvakurudzi veNational Institute of Mental Health (NIHM) vakaona kuti vamwe vana vanobva vatanga kukurumidza-kusagadzikana kwepfungwa, tic , uye dzimwe zvirwere zvepurovhesi mushure mekunge vaine utachiona hweGAS nemamwe marudzi emaabhakitiriya nemavirusi. Zviratidzo izvi zvinomhanya nokukurumidza, uye inopenya mukati memaawa masere kusvika ma48.
Kazhinji, OCD inotanga zvishoma nezvishoma. Uyezve, kutaura kwekutanga kweOCD kunogona kuvanzwa kwemwedzi nemwana wechipiri kusvika kune kuzvidya mwoyo kana kunyara pamusoro pekusava nehanya nemanzwiro uye maitiro.
Pakutanga, NIMH yakasarudza kuisa pfungwa dzayo yekutsvakurudza kwekutanga pakusangana pakati pe streptococcal infection uye nehuro. Vakauya nechishuvo chekushanda chinonzi Pediatric Autoimmune Neuropsychiatric Matambudziko anosangana neStreptococcal Infections kana PANDAS . Iyo PANDAS pfungwa inotsanangura kuti hutachiona neGABS hunogona sei kukonzera OCD kuburikidza nehutachiona hwemoto.
Iyo PANDAS pfungwa inopesana, uye kwemakore, pakanga pasina zvishoma zvingotsigirwa nazvo nokuti zvese zvidzidzo kuongorora ukama pakati pehutachiona hwe streptococcal, OCD, uye tic inobatanidza nhamba shomanana yevatori vechikamu.
Zvisinei, munyaya yaMay 2017 yeJAMA Psychiatry , Orlovska uye vanyori vanyori vanotsanangura kuongorora kukuru kuongorora hukama pakati peGAS-pamwe nemamwe marudzi ehutachiona-uye OCD uye tic .
Vakatarisa pane zvinyorwa zvevana vanopfuura mamiriyoni eDanish vana vanotora makore 17.
PANDAS Kuziva
Hakuchina kuongorora kwema laboratory iyo inowanikwa PANDAS. Pane kudaro, kuongororwa kwePANDAS kunobva pane imwe nhoroondo yakawanda uye kuongorora kwepanyama.
Heano ndiyo nzira shanu dzinoshandiswa kuongorora PANDAS:
- Kuvapo kweOCD, chirwere chechichi, kana zvose.
- Kuputika mukutanga kweOCD, tics, kana zvose zviri zviviri zvinowanzoerekana zvaitika uye zvinogona kunyura uye zvinotevera zvinotevera zvirwere zve streptococcal. Zvichizo zvinowedzera kuwedzera zvakafanana zvinowanikwa nezviratidzo zvinoshamisa.
- Yakasvibiswa pakati pemakore matatu nemakore gumi nemana (kutanga kwekuyaruka). (Ichi chirevo chinongoratidzira, uye vechidiki vanogona kuwanzoonekwa nePANDAS.)
- Kushamwaridzana nekukurumidza kamwe kwezviratidzo zvinoratidza humwe hutachiona hwehutachiona hunosangana nehutachiona, hunosanganisira matambudziko ematambudziko, kushungurudzika kukuru, kurara-kunyorovesa, kusagadzikana, nekuvandudzwa kwekuvandudza.
- Kushamwaridzana kwepakati pezuva ne streptococcal zvirwere kunofanira kusimbiswa nehurosi tsika kana kuongorora ropa (kureva,, yakanyanya-anti-GAS antibody-titers).
Sydenham chorea, iyo inokonzera kufamba kwakakurumidza, kusingabatsiri kufanana nemaitiro, inofanirawo kutarisirwa kuti iongorore PANDAS. Kufanana nePANDAS, Sydenham chorea uye, kazhinji kazhinji, rheumatic fever inogadziriswa pasi uye inowedzera kune streptococcal infection.
Ndezvipi ZVINOITIKA?
Genetics, kukurudzirwa, nekudzivirira muviri kunobatsira pakugadzirwa kwePANDAS:
- Kutanga, vamwe vana vanoita sevanopesana nePANDAS, uye vana ava vanogona kugovana maitiro ehutano neavo vanoona rheumatic fever uye Syndenham chorea.
- Chechipiri, PANDAS inobudirira mune zvechisikiro nokuti inowanzokonzera vana vasati vambova mucheche, nezera rinopfuura 6 kana 7.
- Chechitatu, sezvakaita Syndenham chorea, avo vane PANDAS vanofungidzirwa kukura zvirwere zvinorwisa masero emagetsi muuropi.
Mabhakitiriya emu Streptococcal mhuka yakasimba uye yepamusoro inogona kutevedzera maitiro emasikirwo akasiyana-siyana emuviri kuti azvidzivirire muviri wemuviri.
Apo GABS inofanidza kuonekwa kwemasero europi, zvirwere zvepfungwa kumakumbo europi zvinofungidzirwa kuumba. Aya ma antibodies anoguma achirwisana ne-basal ganglia, uye panzvimbo pekukonzera Syndenham chorea, anoita kuti OCD, tics, nezvimwe zvakadaro.
PANS Diagnosis
Nemhaka yokuti kazhinji zvakaoma kufungidzira hukama hwehutano hwakanaka pakati pe strep infection neOCD kana tic, muna 2010, vanachiremba nevatsvakurudzi vakawedzera huwandu hwePANDAS zvokuti hunowa pasi pemuraira wePedat Acute-allt Neuropsychiatric Syndrome (PANS).
Panzvimbo pekunyatsotsanangurira kuongororwa kune zvirwere zve streptococcal chete, PANS inowanzotsanangurwa nekutanga kweOCD uye inogona kusanganiswa nehutachiona husina kuitika, zvakare, kusanganisira furuwenza uye varicella (chicken pox). Kunyanya, apa ndiyo nzira yekuongororwa yePANS:
- Nokukurumidza uye kunoshamisa kweiyo OCD
- Kuvepo kwechinguva kwezvipiri zviratidzo zvepurovhesi yechipatara zvakafanana nezvinoonekwa muPANDAS
- Zviratidzo zvisingave zviri nani zvinotsanangurwa nemamwe maitiro emagetsi kana motokari, zvakadai seSydenham chorea, lupus, kana Tourette disorder
Zvinonzwisisika, kuburikidza nekugadzira chirongwa chePANS, avo vanakiriniki nevatsvakurudzi vanoda kutarisira kuongororwa uye kurapwa kwekudengenyeka kweOCD.
Ukama huripo pakati pePANDAS nePANS hwakafananidza nehukama pakati pemaranoma nekenza. Mune mamwe mazwi, sezvakaita melanoma ndiyo ganda rekenza, PANDAS ichinyorwa chePANS. Nezvinyorwa, kuongororwa kwePANS kunowanikwawo pane zvakadzama zvakaitika uye kuongorora muviri.
Tsvakurudzo Itsva
Orlovska uye vashandi pamwe chete vakaongorora zvinyorwa zvevarwere zveDenmark vaine makore 17 (1996 kusvika muna 2013) uye vanomirira 1,067.743 vana (vanotsanangurwa sevasingasviki nemakore 18). Ichi chidzidzo ndechekutsvakurudza kwakanyanya-kuderedzwa kwePANDAS hypothesis kusvikira zuva, uye migumisiro inotsigira zvinhu zvakakosha zveiyi pfungwa.
Heino zvakanyanya kuputsika kwezvinyorwa zvevarwere:
- 519 821 vasikana
- 547 922 vakomana
- 638 265 vana vakagamuchira test streptococcal
- 349 982 vaiva neshamwari imwechete ye streptococcal test
Vatsvakurudzi vakawana kuti vana vane chitubu chakanaka chekuongorora chiitiko chainyanya kuratidza zvirwere zvepfungwa-kunyanya OCD uye tic-vachienzanisa nevana vasina ruzivo rwe strep.
Kunyanya kunyanya, vana vane chirwere chekuita zvakanaka vaiva nematambudziko gumi nematanhatu ekukwirira kwepfungwa chero ipi zvayo yepfungwa, 51% yepamusoro dambudziko rekuwedzera OCD, uye 35 muzana yakanyanya dambudziko rekuita zvirwere zvechi.
Vatsvakurudzi vakawanawo kuti vana vaiva nehutachiona hwemakumbo eusstreptococcal (kureva, kuedza kwakanyanya streptococcal) zvakare kwaive kune ngozi yakawedzerwa yezvirwere zvepfungwa, OCD, uye zvinetso zvechi. Zvisinei, hukuru hwehutachiwana uyu hwaive hwakaderera kupfuura iyo yekutapukirwa kwe streptococcal.
Vatsvakurudzi vakawana kuti, sezvinotsanangurwa nemitemo yePANDAS, vana vari pakati pezera remakore matatu ne11 vaiva nehuwandu hwekuwedzera kweOCD uye zvinetso zvechi.
Maererano nevatsvakurudzi, migumisiro yekudzidza inotsigira PANDAS pfungwa kune imwe nzvimbo. Nezvematachiona asina kukwana, vanonyora zvinotevera:
Zvatinowana kuti njodzi yehutano hwepfungwa inongova shoma shoma mushure mekunge chirwere chisina kugadziriswa nehuro mushure mekunge chirwere che streptococcal chichiratidza kuti zvimwe, zvinokonzerwa nehutachiona, zvirwere zvinotapukira zvinobatanidzwawo nekugadzirwa kweOCD uye zvinetso zvechi. Izvi zvinogona kunge zvichitsigira pfungwa ichangobva kunyoreswa yehutano hwevana mukuisa chinonzi neuropsychiatric syndrome ... Vanachiremba-onset neuropsychiatric syndrome inopa imwe nzira yePANDAS nemagariro ekuwedzera ekuongorora; iyo inonyanya kufungidzirwa kuva mamiriro ekufambisa asi pasina kuvharirwa ku streptococcal zvirwere.
PANDAS Kurapa nekudzivirira
Sezvinorondedzerwa muFegin uye Cherry's Textbook yeAIDS Zvirwere :
Ichi chinorondedzerwa chirwere [PANDAS] iye zvino inofungidzira, uye inoramba ichikakavadzana. Vanyori vanoverengeka vanotenda mukurwara uku sechinhu chakasiyana uye vanokurudzira kurapa uye prophylaxis. Vamwe vanopikisa kuti inongova kungofungidzira uye kuti humwe humwe humwe uchapupu huine huwandu hwemapofu-mapofu hunodiwa husati huri kurumbidza kurapwa nekudzivirirwa kwevana vanopiwa chirwere chePANDAS.
Mune mamwe mazwi, dzimwe nyanzvi dzinoona PANDAS (uye PANS) semafungiro. Vamwe, zvisinei, vanofunga kuti PANDAS inorwara uye ichaitora zvakakodzera. Nhoroondo, iyo NIMH inorayira mamwe maitiro ekurapa kune avo vanofungidzirwa kuti vane mamiriro acho ezvinhu:
Vana vane zviratidzo zvePANDAS zvakanyanyisa-zvinokonzera kubatsirwa vanozobatsirwa nemafungiro ehutano hwehutano (CBT) uye / kana anti-obsessional mishonga. Zvidzidzo zvinoratidza kuti zvibereko zvakanakisisa zvinobudiswa kubva mukubatanidza kweC CBT nemishonga yeSSRI (yakadai se fluoxetine, fluvoxamine, sertaline, kana paroxetine). Vana vane PANDAS vanoita sevasingazivikanwi nemigumisiro yemigumisiro yeSSRIs nemimwe mishonga, saka zvakakosha kuti "TANGA FUNGA UYE KUENDA KUNA !!" paunenge uchishandisa mishonga iyi.
Nokutanga vana pamadhora mashoma ekurapa kwepfungwa, nhamba uye kuoma kwemigumisiro yakaipa inoderedzwa. Kana mwana apedzisira ava nemigumisiro yakaipa paanenge aine mishonga, kuyerwa kunofanira kuderedzwa pakarepo. Nemaziso, mishonga yepfungwa inofanirwa kuregererwa haifaniri kumira pakarepo nokuti kuita izvozvo kunogona kuva nengozi.
Iyo NIMH inofungidzira kuti kana chirwere che strep chichiripo, kurapa kwakanakisisa kwePANDAS mishonga inorwisa mabhakitiriya, kusanganisira amoxicillin, penicillin, azithromycin, uye cephalosporins. Nekatsika dzemakumbo emakumbo, imwe nzira yemishonga inouraya inofanira kunge yakakwana. Zvimwe zviyero zvinosanganisira kushandura mabhanhire emasero uye kuedza mhuri dzemhuri kune strep kunogadzirisa njodzi yekuwanazve utachiona.
Kubva pane nhamba shomanana yenyaya, mamwe makiriniki anobata varwere vanoratidza zviratidzo zvePANDAS nemishonga inorwisa mabhakitiriya kunyange kana miedzo ye streptococcal isingaiti. Izvi zvinoda kuongorora zvakare.
Immune-based therapies, kusanganisira kushandiswa kweplasma (kureva, plasmapheresis) uye intravenous immunoglobulin, yakaratidzawo kushandiswa kugadzirisa zviratidzo zvakabatana nePANDAS.
Steroid inoshandiswawo kubata PANDAS. Zvisinei, migumisiro yechirwere che steroid inosanganiswa, ine mimwe mimwe mibairo yekubatsirwa uye mamwe mimwe mibairo yekuderedza tics. Uyezve, steroid inofanira kushandiswa kwenguva pfupi chete nokuti inogona kuva nengozi kana inoshandiswa kwenguva refu. Pakupedzisira, varwere vane PANDAS vanogamuchira steroid vanogona kutarisana nemagumisiro anoguma anoguma zviratidzo zvePANDAS zvakatoipisisa kudarika apo steroid inotanga. Nokuda kwezvikonzero izvi, steroid kazhinji haigamuchirwi kurapwa mune vana vane PANDAS.
Nyaya, dzimwe nguva kurapwa kwenguva pfupi nesteroids kunogona kubatsira vanachiremba kuti vaone kuti varwere vachabvumirana nei plasma kutengesa uye kuvharana kwema immunoglobulin.
Pamusoro penyaya inofanirwa, chirongwa chinotangira kurapwa chinonyanya kushanda kuPANDAS kwete PANS, nokuti PANS inotanga kuongororwa pasina mishonga yakaongororwa. Kunyange zvakadaro, kana PANS inoratidzika inokonzerwa nehutachiona hunotapukira, kurapwa kwehutachiona kunogona kuvhara zviratidzo zveOCD uye dzimwe zviratidzo zveuropipsychiatric. Uyezve, kurapwa kunoshanda kwePANDAS, yakadai sezvirwere zvekudzivirira zvirwere, uyewo maitiro ekudzivirira, inogonawo kubatsira kana kurapa zviratidzo zvine chokuita nePANS.
Mumakirini maviri emakiriniki miedzo, prophylactic mishonga nemishonga inorwisa mabhakitiriya-kana kurapwa kusati kwaitika kuitika kwe streptococcal throat infection uye zviratidzo zvePANDAS-zvakaratidza kubudirira pakudzivirira zvirwere zve strep uye kuderedza kudzokorora kwezviratidzo zvePANDAS. Kunyanya, vamwe vana avo vaimboona zviratidzo zvine chokuita nePANDAS mwedzi yakawanda pagore vakawana zvishoma kudarika zvakapiwa prophylactic antibiotics. Ava vana vakabata pamwe ne penicillin kana azithromycin.
Nenzira yekufananidzira, kurapa neprophylactic antibiotics kwakaratidza kunobatsira nedzimwe streptococcal sequelae dzinotangira maitiro, zvakadai se rheumatic fever uye Sydenham chorea nokudaro kupa humwe hutsigiro hwekupindira uku.
> Sources:
> Cherry, JD, Harrison, GJ, Kaplan, SL, Steinbach, W, Hotez, PJ. Feigin uye Cherry's Textbook yeAIDS inotapukisa zvirwere . Shanduro yechinomwe.
> Hayes, CS, et al. Kutungamirira Kweboka A Beta-Hemolytic Streptococcal Pharyngitis. American Family Physician. 2001 Apr 15; 63 (8): 1557-1565.
> Mashoko Pamusoro PANDAS. https://www.nimh.nih.gov/labs-at-nimh/research-areas/clinics-and-labs/pdnb/web.shtml. NIMH.
> Orlovska, S, et al. Sangano reStreptococcal Throat Infection Nehutano Hwepfungwa: Kuedza Kukosha Zvikamu zvePANDAS Mafungiro Munyika Yose Yokudzidza. JAMA Psychiatry. 2017.
> Stagi, S, et al. Kuongororwa kwega autommune phenomena kune varwere vane chirwere chepachimbuzi autoimmune neuropsychiatric matenda anosangana ne streptococcal infections (PANDAS). Autoimmunity Reviews 13 (2014) 1236-1240.
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