Ingathi ingenakwenzeka ukuba i-strep throat ingabangela imbandezelo yokunyanzelisa . Nangona kunjalo, ngokokuqala ngqa, uphando oluninzi oluvela eDenmark lubonakala luxhasa uxhamlo lobudala.
Imvelaphi
Iibhaktheriya zinoxanduva phakathi kwama-5 no-10 ekhulwini lomqala wengqondo. I-agentriya yezona ziqhelekileyo ezichaphazelekayo emzimbeni wesifo i-group A beta-hemolytic streptococci (i-GAS okanye "strep").
Ngo-1998, abaphandi kwiZiko leSizwe lezeMpilo zeMental (NIHM) baqaphele ukuba abanye abantwana bahlakulela ngokukhawuleza ukuphazamiseka okubangelwa ngumzimba, i- tics , kunye nezinye iimpawu ze-neuropsychiatric emva kokusulelwa yi-GAS kunye nezinye iintlobo zeebhaktheriya kunye neentsholongwane. Ezi zibonakaliso ziqala ngokukhawuleza, kwaye ziphakame ngamandla ngaphakathi kweeyure ezingama-24 ukuya kuma-48.
Ngokuqhelekileyo, i-OCD iqala ngokuthe ngcembe. Ukongezelela, ukuhanjiswa kokuqala kwe-OCD kungafihla iinyanga emva komntwana osekondari ukuya kwixhala okanye ukuhlazeka ngokukhathazeka ngokungenangqondo kunye nokuziphatha.
Ekuqaleni, i-NIMH ikhethe ukugxininisa iinzame zayo zokuqala zophando kwi-intanethi phakathi kwe-infection ye-streptococcal kunye nesifo somqala. Bafika kunye neengcamango zokusebenza ezibizwa nge-Autoimmune Neuropsychiatric Disorders ezixhatshazwayo nezifo ezibangelwa yi- Streptococcal Infections okanye i- PANDAS . I-PANDAS hypothesis ichaza indlela ukusuleleka ngayo i-GABS inokubangela ukuba i-OCD isebenze ngokuzimela.
I-hypothesis ye-PANDAS iphikisana, kwaye iminyaka, kukho inkxaso ephantsi ngenxa yokuba zonke izifundo ezihlolisayo ubudlelwane phakathi kwe-infection ye-streptococcal, i-OCD, kunye ne-tics zibandakanya inani elincinci labathathi-nxaxheba.
Nangona kunjalo, kwimeko ka-Meyi 2017 ye- JAMA Psychiatry , i-Orlovska kunye nabalobi be-co-ordinate baqaphelisise uphando olukhulu oluhlolisisa ikhonkco phakathi kwe-GAS-kunye nezinye iintlobo zentsholongwane-kunye ne- OCD kunye ne-tics .
Babheka kwiirekhodi ezingaphezu kwesigidi abantwana baseDanish abaneminyaka eyi-17.
I-PANDAS Diagnosis
Akukho vavanyo lwebhubhoratri olufumanisa i-PANDAS. Kunoko, ukuxilongwa kwe-PANDAS kusekelwe kwimbali epheleleyo kunye nokuhlolwa komzimba.
Nazi iindlela ezihlanu ezisetyenziselwa ukuxilonga i-PANDAS:
- Ubukho be-OCD, i-disorder disease, okanye zombini.
- Ukuqhutyelwa kokuqala kwe-OCD, i-tics, okanye zombini eyenzeka ngokukhawuleza kwaye inokukrazula kwaye ilandele izifo ezithathayo emva kokusuka kwe-streptococcal. Ukutshatyalaliswa okugqithisileyo kufana nezibonakaliso ezimangalisayo.
- Ukuqalwa phakathi kweminyaka emi-3 kunye neminyaka eyi-11 (ekuqaleni kobuntwaba). (Lo mqathango ungabonakaliyo, kwaye abantwana abaselula abakwazi ukufumana i-PANDAS.)
- Umbutho kunye nokuqala ngokukhawuleza kweempawu zibonisa ezinye izifo ze-neuropsychiatric, kubandakanywa ubunzima beengxaki, ukuxhalabisa ngokubanzi, ukugalelwa kwebhedlele, ukunyanzeliswa kunye nokuphuhliswa kokukhula.
- Ubuhlobo besikhashana kunye nosulelo lwe-streptococcal lufuneka lubekwe ngumkhenkce we-throat okanye iimvavanyo zegazi (oko kukuthi, izikhundla ze-anti-GAS).
I-Sydenham chorea, ekhokelela ekuhambeni okukhawulezayo, ngokungenakuzibandakanya okufana ne-tics, kufuneka kwakhona ilawulwe ukuba ihlolwe i-PANDAS. Njenge-PANDAS, i-Sydenham chorea kwaye, ngokuqhelekileyo, i-rheumatic fever i-auto-mune underpinnings kwaye ivela kwinqanaba le-streptococcal infection.
I-PANDAS ivela njani?
I-Genetics, ukuphuhliswa, kunye nokuzikhusela komzimba kuncedisa ekuphuhlisweni kwePANDAS:
- Okokuqala, abantwana abathile babonakala bexhamla kwi-PANDAS, kwaye aba bantwana banokwabelana ngesimo somzimba kunye nalabo bafumana i-rheumatic fever kunye ne-Syndenham chorea.
- Okwesibini, i-PANDAS yintuthuko kwindalo kuba ihlala ichaphazela abantwana abangazange bafikelele ekufikeni ubuntwaba, abaneminyaka engama-6 okanye-7.
- Okwesithathu, njengoSyndenham chorea, abo abane-PANDAS baxilongwa ukuba bahlakulele ama-antibodies ahlasela amangqamuzana enesibindi kwingqondo.
Ibhaktheriya ye-Streptococcal yimizimba eqinile kunye neyokuqala ekwazi ukulinganisa ukubonakala kwamaselula ezincumo zomzimba ezahlukeneyo ukuphepha umzimba womzimba.
Xa i-GABS ifanisa ukubonakala kweeseli zengqondo, izicatshulwa zeengxube zengqondo zicingelwa ukuba zenze. Ezi ziqhwaga ziphelela ekuhlaseleni i-basal ganglia, kwaye esikhundleni sokubangela uSyndenham chorea, kubangela i-OCD, i-tics, njalo njalo.
PANS Diagnosis
Ngenxa yokuba kunzima ukubonisa ubungqina bobudlelwane bexeshana phakathi kokusuleleka kwe-strep kunye ne-OCD okanye i-tics, ngo-2010, oogqirha nabaphandi banwebisa ukuhlelwa kwe-PANDAS ukuze iwele phantsi kwe-ambulula ye-Pediatric Acute-upt Neuropsychiatric Syndrome (PANS).
Endaweni yokucacisa ngokucacileyo ukuxilongwa kwintsholongwane ye-streptococcal kuphela, i-PANS ibonakala ngokubanzi ngokuqala ngokukhawuleza kwe-OCD kwaye inokudibana nokusuleleka kwe-nonstreptococcal, kunye nokukhuhlane kunye ne-varicella (inkukhu yenkukhu). Ngokukodwa, nantsi imigaqo yokuxilongwa ye-PANS:
- Ukuqala ngokukhawuleza nokuqhutywe phambili kwe-OCD
- Ukufumaneka ngokufanayo kweempawu ezimbini zeeuropsychiatric ezongezelelweyo ezifana nezo zibonwe kwi-PANDAS
- Iimpawu ezingenakuchazwa ngcono ngenye ingxaki ye-neurological or motor, efana neSydenham chorea, lupus, okanye iTretrette disorder
Ngokuphawulekayo, ngokuqulunqa ukuxilongwa kwe-PANS, aba kliniki nabaphandi banethemba lokuphucula ukuxilongwa nokunyangwa kwe-OCD ngokukhawuleza.
Ubudlelwane phakathi kwe-PANDAS kunye ne-PANS bufana nolwalamano phakathi kwe-melanoma nomhlaza. Ngamanye amazwi, njenge-melanoma yintlupheko yomhlaza, i-PANDAS yi-subset ye-PANS. Ingqalelo, ukuxilongwa kwe-PANS kwakhona kusekelwe kwimbali epheleleyo kunye nokuhlolwa komzimba.
Uphando olutsha
I-Orlovska kunye noogxa bavavanya iirekhodi zezigulane zaseDenmark ezineminyaka eyi-17 (1996 ukuya ku-2013) kunye nabantwana abayi-1,067,743 (bachazwe njengabantu abangaphantsi kweminyaka eyi-18 ubudala). Olu pho nonongo lubaluleke kakhulu ukuhlalutya okuphezulu kakhulu kwe-PANDAS hypothesis kuze kube yimini, kwaye iziphumo zixhasa iinkalo ezibalulekileyo zale ngcamango.
Nantsi ukuchithwa okuthe ngqo kwezirekhodi zesigulane:
- 519,821 amantombazana
- 547,922 abafana
- Abantwana abangama-638 265 bafumana uvavanyo lwe-streptococcal
- I-349 982 yayinomyinge ovavanyo olulodwa lwe-streptococcal
Abaphandi bafumanisa ukuba abantwana abaneempembelelo zokuvavanya iziphumo ezintle babekho amathuba okubonakalisa ukuphazamiseka kwengqondo-ngokukodwa i-OCD kunye ne-tic-xa kuthelekiswa nabantwana ngaphandle kovavanyo lwe-strep.
Ngokukodwa, abantwana abaneengxaki ezifake imvavanyo emihle babe neengcipheko ezili-18 eziphezulu zokuphuhlisa izifo zengqondo, ingozi engama-51 ephezulu yokuphuhlisa i-OCD, kunye nengozi ephezulu engama-35 yokuphucula izifo ezinzima.
Abaphandi bafumanisa ukuba abantwana abane-infection ye-throat nonstreptococcal (oko kukuthi, ukuvavanywa kwe-streptococcal negative) kwakhona kwingozi yobunzima beengqondo, i-OCD, kunye neengxaki zokuziphatha. Nangona kunjalo, ubukhulu belo mngcipheko bezantsi kunokuba kusuleleka kwi-streptococcal infection.
Abaphandi bafumanisa ukuba, njengoko kuchazwe nge-criteria ye-PANDAS, abantwana abaneminyaka engama-3 ukuya kwe-11 babenomngcipheko omkhulu ukwanda kwee-OCD kunye neengxaki zokuziphatha.
Ngokutsho kwabaphandi, iziphumo zenkxaso yokufunda i-PANDAS hypothesis kwinqanaba elithile. Ngokubhekiselele kwintsholongwane engaphelelanga, babhala oku kulandelayo:
Iziphumo zethu ukuba umngcipheko weengxaki zengqondo zingaphakanyiswa ngaphantsi emva kokusuleleka kwe-nonstreptococcal kwintsholongwane emva kokuba emva kokusuleleka kwe-streptococcal ukuthethelela ukuba ezinye, mhlawumbi zentsholongwane, ezichaphazelekayo zidibaniswa nokuphuhliswa kweengxaki ze-OCD kunye neengxaki. Oku kunokuthi kunokwakho ukuxhasa inkcazo esandul 'ingcaciso nje yentsholongwane yabantwana ekusetyenzisweni kwe-neuropsychiatric syndrome ... Iintsholongwane eziphuthumayo ze-neuropsychiatric syndrome zinika enye indlela kwi-PANDAS ngemilinganiselo ephezulu yokuxilonga; Ngokuyinqobo kucatshangelwa ukuba yimeko engasetyenziswanga kodwa ngaphandle kokuthintela ukusuleleka kwe-streptococcal.
I-PANDAS Ukwelashwa nokukhusela
Njengoko kuchazwe kwi-Fegin neCherry's Bookbook yeZifo zeMatriki :
Isifo esicetywayo [i-PANDAS] njengangoku iyingcamango, kwaye ihlala isingqinisiso. Abalobi abaninzi bakholelwa kule ngxaki njengento ehlukeneyo kwaye batusa unyango kunye neprophylaxis. Abanye bathi iyingcamango kuphela kwaye kukho ubungqina obuninzi bokufunda iimpumputhe ezifunekayo ngaphambi kokucebisa unyango kunye nokukhusela kubantwana abanikwa ukuxilongwa kwe-PANDAS.
Ngamanye amazwi, ezinye iingcali zijonga i-PANDAS (kunye ne-PANS) njengengqiqo. Abanye, nangona kunjalo, bacinga i-PANDAS ukuxilongwa kwaye baya kuyiphatha ngokufanelekileyo. Ingqalelo, i-NIMH incoma ukhetho oluthile lwenyango kulabo bacingelwa ukuba banemeko:
Abantwana abaneempawu ezihambelana ne-PANDAS ezinxulumene ne-PANDAS baya kuzuza kwi-ctnitive therapy (CBT) kunye / okanye imishanguzo yokulwa ne-anti-obsessional. Izifundo zibonisa ukuba iziphumo eziphambili ziveliswa kwi-CBT kunye neyeza le-SSRI (njenge-fluoxetine, i-fluvoxamine, i-sertaline, okanye i-paroxetine). Abantwana abane-PANDAS babonakala bengabonakali kakhulu kwimiphumo emibi ye-SSRI kunye neminye imichiza, ngoko kubalulekile ukuba "QALISELE UKUYA KUKHULU!" Xa usebenzisa le myeza.
Ngokuqalisa abantwana kumayeza amancinci amayeza e-psychotropic, inani kunye nobukhulu beempembelelo ezingalunganga ziyancitshiswa. Ukuba umntwana uphelela ekujonganeni nemiphumo embi engemihle ngelixa kumachiza, umlinganiselo kufuneka uhlawule ngokukhawuleza. Ingqalelo, amayeza e-psychotropic akufanele agqitywe ngokukhawuleza kuba ukwenza oko kuya kuba yingozi.
I-NIMH igxininisa ukuba ukuba isifo sokusuleleka kwe-strep sisaphila, unyango olungcono lwe-PANDAS yi-antibiotics, kuquka i-amoxicillin, i-penicillin, i-azithromycin kunye ne-cephalosporins. Ngeenkcubeko zomlomo we-throat, inkqubo enye ye-antibiotics kufuneka iwanele. Amanye amanyathelo afaka ukutshintshwa kweebhokhwe kunye nokuvavanya amalungu omndeni kwi-strep ukunciphisa umngcipheko wokusuleleka.
Ngokusekelwe kwinani elincinci leengxelo, ezinye iikliniki ziphatha izigulane ezibonisa iimpawu ze-PANDAS ngamayeza okulwa neentlobo ze-anti-antibiotics, nangona uvavanyo lwe-streptococcal lubi. Lo mkhuba udinga uphando olungakumbi.
Izifo ezisekelwe kumzimba, kuquka i-plasma exchange (oko kukuthi, i-plasmapheresis) kunye ne-immunoglobulin engena-intravenous, ziye zaboniswa zisetyenziselwa ukuphatha kakuhle iimpawu ezinxulumene ne-PANDAS.
I-Steroids sele isetyenziselwe ukuphatha iPANDAS. Nangona kunjalo, iziphumo zonyango lwe-steroid zixutywe, kunye neengxelo ezithile zentlawulo kunye nezinye iingxelo zengxaki ezimbi. Ngaphezu koko, i-steroids imele isetyenziswe kuphela ixesha elifutshane nje ngokuba linokuyingozi xa lisetyenziswe ixesha elide. Ekugqibeleni, izigulane ezine-PANDAS ezifumana i-steroids ziyakwazi ukufumana impembelelo enokubangela ukuba iimpawu ze-PANDAS zibi ngakumbi kunokuba ziqaliswe i-steroids. Ngenxa yezi zizathu, i-steroids ayilunyanzelwanga unyango kubantwana abane-PANDAS.
Ingqalelo, ngamanye amaxesha unyango olufutshane kunye ne-steroids lunokunceda iiklinikhi ukuba zijonge zeziphi izigulane eziza kuphendulwa kwi-plasma exchange and immunvenous immunoglobulin.
Kwinqaku edibeneyo, isikhokelo esilandulelayo sonyango sisebenza ngokubanzi kwi-PANDAS ayikho i-PANS, kuba i-PANS iyicatshulwa esitsha esingahlolwayo. Nangona kunjalo, ukuba i-PANS ibonakala ibangelwa yi-arhente echaphazelayo, unyango lwentsholongwane lunokuthi luthintele iimpawu ze-OCD kunye nezinye iimpawu ze-neuropsychiatric. Ukongezelela, unyango olusebenza kwi-PANDAS, njengezonyango ezikhuselweyo nomzimba, kwakunye nezicwangciso zokukhusela, lunokubaluleka xa unyanga iimpawu ezinxulumene ne-PANS.
Kwizilingo ezimbini ezincinci zekliniki, unyango lweprophylactic kunye namachiza-antibiotics-okanye unyango ngaphambi kokuba kwenzeke isifo se-throptococcal emqaleni kwaye iimpawu ze-PANDAS-zenzeke ngempumelelo ekukhuseleni ukusulelwa kwe-strep kunye nokunciphisa ukuphindaphinda kweempawu ze-PANDAS. Ngokukodwa, abanye abantwana abaye bafumana iimpawu ezinxulumene ne-PANDAS ezinyangeni eziliqela ngonyaka bafumana ubunzima obuncinane obuye banikwa i-prophylactic antibiotics. La bantwana baphathwa nge-penicillin okanye i-azithromycin.
Ngokwahlukileyo, unyango lwe-prophylactic antibiotics lubonakalise luncedo kunye nezinye i-streptococcal sequelae ezivela kwimimandla eyimimandla, njenge-rheumatic fever kunye ne-Sydenham chorea ngaloo ndlela inikeza ngenkxaso engaphezulu kwolu ngenelelo.
> Imithombo:
> Cherry, JD, Harrison, GJ, Kaplan, SL, Steinbach, W, Hotez, PJ. I-Feigin neCherry's Bookbook ye-Pediatric Infectious Diseases . Uluhlu lweShenxe.
> Hayes, CS, et al. Ulawulo lweqela I-Beta-Hemolytic Streptococcal Pharyngitis. WaseMerika ugqirha. 2001 Apr 15; 63 (8): 1557-1565.
> Ulwazi malunga nePANDAS. https://www.nimh.nih.gov/labs-at-nimh/research-areas/clinics-and-labs/pdnb/web.shtml. NIMH.
> Orlovska, S, et al. Umbutho we-Streptococcal Infroction Infection: Iingxaki eziphambili ze-PANDAS Hypothesis kwiSizwe soPhando. JAMA Psychiatry. 2017.
> Stagi, S, et al. Ukuvavanya kweziganeko ezizenzekelayo kwizigulane ezinezifo ezizimeleyo zengxaki ze-neuropsychiatric ezichaphazelekayo nezifo ezibangelwa yi-streptococcal infections (PANDAS). Iziphakamiso ze-Autoimmunity 13 (2014) 1236-1240.
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