Posts by:
Gabriella True

Case Study: A New Infection-Triggered, Autoimmune Subtype of Pediatric OCD and Tourette’s Syndrome
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 Mar;34(3):307-11. doi: 10.1097/00004583-199503000-00015. PMID: 7896671.

A review of clinical observations and literature reports leads to the hypothesis that, via a process analogous to Sydenham’s chorea, infections with group A β-hemolytic streptococci, among others, may trigger autoimmune responses that cause or exacerbate some cases of childhood-onset obsessive-compulsive disorder (OCD) or tic disorders (including Tourette’s syndrome).

The neuropsychiatric manifestations of Lyme borreliosis
Fallon BA, Nields JA, Burrascano JJ, Liegner K, DelBene D, Liebowitz MR. The neuropsychiatric manifestations of Lyme borreliosis. Psychiatr Q. 1992 Spring;63(1):95-117. doi: 10.1007/BF01064684. PMID: 1438607.
  • Lyme disease is a growing tick-borne illness affecting multiple systems.
  • While its neurological effects are well documented, its psychiatric symptoms are less recognized. This paper reviews Lyme’s neuropsychiatric impact and key research.
  • It also explores common psychiatric symptoms, patient challenges, and clinical guidance.
Borrelia burgdorferi in the nervous system: the new “great imitator”

Pachner AR. Borrelia burgdorferi in the nervous system: the new “great imitator”. Ann N Y Acad Sci. 1988;539:56-64. doi: 10.1111/j.1749-6632.1988.tb31838.x. PMID: 3190104.

Patient Vignette – Bicycle Boy
The patient was bitten by a tic. Weeks later he presented with neuropsychiatric symptoms. Was given IV antibiotics and all symptoms resolved.

  • Lyme disease shares key similarities with syphilis: spirochetal etiology, extended tissue survival, staged clinical manifestations, and antibiotic susceptibility. Lessons from syphilis, particularly regarding spirochetal brain disease mimicking other neurological conditions, apply to Lyme disease.
  • Clinicians should consider Lyme disease early due to its effective response to antibiotics.
  • Lyme meningitis in the second stage is recognizable, but milder cases often go undiagnosed.
  • Progression to third-stage disease, as in Lyme arthritis, may occur, highlighting the importance of serologic tests.
  • Serology is crucial for diagnosing later stages of Lyme disease, paralleling the situation in neurosyphilis where cultures and antigen tests are less useful.
  • Antibody titers vary in different manifestations, with Lyme arthritis and acrodermatitis atrophicans showing high titers.
  • Recognition challenges exist for CNS Lyme disease without prior stages, emphasizing the significance of serological diagnosis in later stages.
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases
Swedo SE, Leonard HL, Garvey M, Mittleman B, Allen AJ, Perlmutter S, Lougee L, Dow S, Zamkoff J, Dubbert BK. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases. Am J Psychiatry. 1998 Feb;155(2):264-71. doi: 10.1176/ajp.155.2.264. Erratum in: Am J Psychiatry 1998 Apr;155(4):578. PMID: 9464208.

Results: The children’s symptom onset was acute and dramatic, typically triggered by GABHS infections at a very early age (mean = 6.3 years, SD = 2.7, for tics; mean = 7.4 years, SD = 2.7, for OCD). The PANDAS clinical course was characterized by a relapsing-remitting symptom pattern with significant psychiatric comorbidity accompanying the exacerbations; emotional lability, separation anxiety, nighttime fears and bedtime rituals, cognitive deficits, oppositional behaviors, and motoric hyperactivity were particularly common. Symptom onset was triggered by GABHS infection for 22 (44%) of the children and by pharyngitis (no throat culture obtained) for 14 others (28%). Among the 50 children; there were 144 separate episodes of symptom exacerbation; 45 (31%) were associated with documented GABHS infection, 60 (42%) with symptoms of pharyngitis or upper respiratory infection (no throat culture obtained), and six (4%) with GABHS exposure.

Conclusions: The working diagnostic criteria appear to accurately characterize a homogeneous patient group in which symptom exacerbations are triggered by GABHS infections. The identification of such a subgroup will allow for testing of models of pathogenesis, as well as the development of novel treatment and prevention strategies.

Clinical and diagnostic manifestations of tickborne mixed infection in combination with COVID-19
Shutikova AL, Leonova GN, Popov AF, Shchelkanov MY. Clinical and diagnostic manifestations of tickborne mixed infection in combination with COVID-19. Klin Lab Diagn. 2021 Nov 29;66(11):689-694. English. doi: 10.51620/0869-2084-2021-66-11-689-694. PMID: 34882355.
  • The study investigated the coexistence of pathogens in a patient, focusing on the relationship between laboratory diagnostics and clinical manifestations during SARS-CoV-2 infection in a case of chronic encephalitis-borreliosis.
  • Blood samples collected over a year revealed Lyme disease diagnosed through IgG antibodies to Borrelia, with joint pain and erythema migrans. Subsequently, the patient contracted SARS-CoV-2 during a Lyme disease exacerbation.
  • Treatment improved the underlying disease but led to TBEV activation, possibly due to immune system focus on SARS-CoV-2. Despite TBEV activation, clinical manifestations were absent, suggesting weak virulence. Etiotropic treatment suppressing borreliosis led to TBEV activation, highlighting the dominance of B. burgdorferi in tick-borne infections.