Monthly Archives:
December 2023

Microbes and Mental Illness: Past, Present, and Future
Bransfield RC, Mao C, Greenberg R. Microbes and Mental Illness: Past, Present, and Future. Healthcare (Basel). 2023 Dec 29;12(1):83. doi: 10.3390/healthcare12010083. PMID: 38200989; PMCID: PMC10779437.

The review highlights five infectious diseases linked to mental illness: toxoplasmosis, COVID-19, Lyme borreliosis, and streptococcal infections/PANDAS/PANS. It emphasizes the significant role of indirect infection mechanisms, such as inflammation, neuroinflammation, autoimmunity, and neurophysiological changes, in the development and progression of some mental illnesses. The persistence of these processes can lead to chronic effects on brain structure and function. Recognizing the microbial impact on mental health is crucial, and understanding this association may lead to increased use of antimicrobial and immune-modulating agents in psychiatric treatment, preventing and reducing mental illness morbidity, disability, and mortality. Clinicians must consider infectious diseases in explaining mental health symptoms, especially in cases of treatment-resistant conditions.

Treatment approaches must be individualized and often involve a multidisciplinary strategy to include three fundamental areas: addressing infections or contributors, implementing immune interventions, and managing resulting symptoms. Intervention choices depend on understanding the disease process, the interplay of disease contributors, and the primary driver of disease perpetuation and progression. Consider antimicrobials in cases of inadequate psychotropic response and potential infection. Immune-modulating interventions may be necessary for immune-mediated symptoms from active or prior infections or non-infection immune provocation. Factors like immune suppression, excessive inflammation, autoimmunity, and adaptive immunity failure influence immune intervention choices. Non-infection environmental factors, including toxin exposure, should be considered and minimized. For relapses, revisit effective past treatments; treatment-resistant cases may require exploring unused options. Regular treatment revisions are essential, guided by symptom improvement or disease changes. Ongoing assessment is crucial, recognizing that the initial cause may differ from what perpetuates the condition, leading to necessary treatment approach adjustments.

 

 

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) Syndrome: A 10-Year Retrospective Cohort Study in an Italian Centre of Pediatric Rheumatology

La Bella S, Attanasi M, Di Ludovico A, Scorrano G, Mainieri F, Ciarelli F, Lauriola F, Silvestrini L, Girlando V, Chiarelli F, et al. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) Syndrome: A 10-Year Retrospective Cohort Study in an Italian Centre of Pediatric Rheumatology. Microorganisms. 2024; 12(1):8. https://doi.org/10.3390/microorganisms12010008

PANDAS syndrome, a rare condition in prepubertal children, presents with sudden tic disorders and/or OCD following a documented GAS infection. Current classification criteria lack specificity, resulting in misdiagnosis. In our study, 61 patients were screened by the Pediatric Rheumatology unit for suspected PANDAS, but only 19 met the criteria. Tic disorders, especially in the eyes and head/neck, were predominant, with common vocal tics and less documented OCD. Treatment with antibiotics often led to clinical improvement. Larger, controlled studies are essential to understanding PANDAS characteristics and therapeutic responses comprehensively.

The Intricate Dance of Infections and Autoimmunity: An Interesting Paradox

Rao, A.P., Patro, D. The Intricate Dance of Infections and Autoimmunity: An Interesting Paradox. Indian J Pediatr (2023). https://doi.org/10.1007/s12098-023-04928-8

Besides genetic susceptibility, infections due to viruses, bacteria and protozoa have been implicated in the development of autoimmune diseases (AD). AD can be triggered in a genetically susceptible individual by infections that disrupt immunological tolerance towards self-antigens. Pathogens can initiate autoimmunity by way of molecular mimicry, bystander activation, epitope spreading or persistent infection with polyclonal activation. This review covers two main topics: (i) the mechanisms by which an infectious agent can trigger or worsen autoimmunity; and (ii) the correlation between specific infectious agents and AD in humans with special emphasis on multisystem inflammatory syndrome in children (MIS-C).