Research

Long COVID Syndrome Presenting as Neuropsychiatric Exacerbations in Autism Spectrum Disorder: Insights for Treatment

Jyonouchi, H.; Geng, L.; Rossignol, D.A.; Frye, R.E. Long.COVID Syndrome Presenting as Neuropsychiatric Exacerbations in Autism Spectrum Disorder: Insights for Treatment. J. Pers. Med. 2022, 12,1815. https://doi.org/10.3390/jpm12111815

Neurological and neuropsychiatric symptoms are emerging as major long-term sequalae. In patients with pre-existing behavioral symptoms, such as individuals with autism spectrum disorders (ASD), the emergence of neuropsychiatric symptoms due to long COVID can be difficult to diagnose and manage. Herein, we present three ASD cases who presented with markedly worsening neuropsychiatric symptoms following COVID-19 exposure and subsequent difficulty in managing the post-COVID neuropsychiatric symptoms.

Interdisciplinary Collaboration to Care for Students Diagnosed with PANDAS: An Education and Referral Intervention
Boyd TM, Moyer SM, Lambert D. Interdisciplinary Collaboration to Care for Students Diagnosed with PANDAS: An Education and Referral Intervention. The Journal of School Nursing. 2022;0(0). doi:10.1177/10598405221129553

Implications: This project has implications for school nursing. The results of this project suggest that an interdisciplinary education program assisted school staff to increase their knowledge on PANDAS. An increase in knowledge about PANDAS may assist school staff to identify students who may be exhibiting PANDAS behaviors and better utilize district resources, including school nurses, who can assess and care for this student population. This interdisciplinary collaboration amongst school nurses, counselors, psychologists, and principals enhances the learning environment and helps strengthen the success of students at school (Johnson, 2017; Kocoglu & Emiroglu, 2017; NASN, n.d., 2017; Yoder, 2020). Students with chronic health conditions and concerning symptoms that necessitate primary or specialty health care referrals benefit from school nurse adoption of systematic referral documentation strategies.

Long Covid brain fog: a neuroinflammation phenomenon?

Kavanagh E. Long Covid brain fog: a neuroinflammation phenomenon? J Neuroinflammation. 2022;19(1):265. doi:10.1186/s12974-022-02665-6.

Neuroinflammation and Long COVID “brain fog”

  • Reviews evidence that persistent cognitive symptoms after COVID are linked to neuroinflammation rather than ongoing viral infection.

  • Highlights roles for microglial activation, cytokine signaling, and disrupted neuroimmune regulation.

  • Proposes that immune-mediated effects on synaptic function and neuronal metabolism can explain attention, memory, and processing-speed deficits.

  • Frames brain fog as a biological inflammatory process, not a psychological or functional complaint.

Correlation between COVID-19 severity and previous exposure of patients to Borrelia spp.

Szewczyk-Dąbrowska, A., Budziar, W., Harhala, M. et al. Correlation between COVID-19 severity and previous exposure of patients to Borrelia spp.. Sci Rep 12, 15944 (2022). https://doi.org/10.1038/s41598-022-20202-x

Also, read Medical News Today article.

  • In this study, all hospitalized COVID-19 patients tested positive for Borrelia burgdorferi-specific IgG, with significantly higher levels in severe cases.
  • Patients with a history of Borrelia exposure showed increased susceptibility to severe COVID-19 upon SARS-CoV-2 infection.
  • Severe COVID-19 patients also exhibited higher levels of IgGs specific to Anaplasma antigens, suggesting a potential link between increased COVID-19 risks and tick bites and related infections.
  • Testing for Borrelia-specific IgM revealed higher positivity in hospitalized COVID-19 patients compared to mild/asymptomatic patients and those not infected with SARS-CoV-2. Logistic regression analysis indicated that the odds of COVID-19 hospitalization increased with each positive read for a Lyme disease-related antigen for IgG antibodies.
  • Multivariate analysis highlighted specific Borrelia antigens associated with increased odds of hospitalization for both IgG and IgM antibodies. These findings suggest a potential connection between Borrelia exposure and the severity of COVID-19 outcomes.
Roles of Th17 cytokines in microglial and neurovascular responses to recurrent intranasal Streptococcus pyogenes infections

Theses Doctoral. Columbia Academic Commons. https://doi.org/10.7916/62va-6330

Academic Units: Cellular, Molecular and Biomedical Studies
Thesis Advisors: Agalliu, Dritan
Degree: Ph.D., Columbia University
Published:  September 7, 2022

Obsessive-Compulsive Disorder With Inflammatory Cerebrospinal Fluid Changes and Intrathecal Antinuclear Antibody Staining

D Endres, MA Schiele, BC Frye, A Schlump, B Feige, k Nickel, B Berger, M Reisert, H Urbach, K Domschke, N Venhoff, H Prüss, L Tebartz van Elst. Obsessive-Compulsive Disorder With Inflammatory Cerebrospinal Fluid Changes and Intrathecal Antinuclear Antibody Staining. Biological Psychiatry. Elsevier. 3 September 2022. DOI:https://doi.org/10.1016/j.biopsych.2022.06.037

Autoimmune-mediated obsessive-compulsive disorder (OCD) during childhood has long been established in the context of pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection. In adult psychiatry, the topic has increasingly gained interest in light of new developments regarding autoimmune encephalitis and autoimmune psychosis. Hence, diagnostic criteria for autoimmune OCD in adulthood have been proposed recently, and the first respective cases were reported. For the detection of neuroinflammatory processes, cerebrospinal fluid (CSF) analysis (besides the far more invasive brain biopsy) is considered the most sensitive diagnostic tool. Here, we present 2 paradigmatic OCD patients with inflammatory CSF signals including antinuclear antibody staining in CSF and magnetic resonance imaging (MRI)/electroencephalography (EEG) findings compatible with OCD.

 

 

Group A Beta-Hemolytic Streptococcus-Induced Tic-Like Movement Disorder in an Adult: A Case Report

Ilyas U, Umar Z, Lin D (August 26, 2022) Group A Beta-Hemolytic Streptococcus-Induced Tic-Like Movement Disorder in an Adult: A Case Report. Cureus 14(8): e28451. doi:10.7759/cureus.28451

“Our case report highlights the importance of a thorough history, including inquiring about past infections and investigations to look for autoimmune and infectious etiologies, including ASO and positive DNAse B titers, in adult patients with new onset movement disorders and no other identifiable etiology and risk factors. Further research is mandatory to investigate the incidence of movement disorders in the adult population after a streptococcal infection and the diagnostic approach and treatment modalities needed to manage such patients.”

An unusual case of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections(PANDAS) – diagnostic evaluation, treatment and the remarkable outcome
Divya Raj T, Santosh H, Chaturvedi S. 589 An unusual case of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections(PANDAS) – diagnostic evaluation, treatment and the remarkable outcome Archives of Disease in Childhood 2022;107:A224-A225.

“Conclusion Our observation in this case confirms the value of early diagnosis to reduce the risk of progression to disabling chronic neurologic sequelae in the PANDAS. Children with PANDAS derive a favourable response to IVIG. Our findings support its administration early in the course of the disease and continued until significant improvement or remission is achieved without side-effects.”

Sex and Aggression Characteristics in a Cohort of Patients with Pediatric Acute-Onset Neuropsychiatric Syndrome

Jaynelle Gao, Avis Chan, Theresa Willett, Bahare Farhadian, Melissa Silverman, Paula Tran, Sana Ahmed, Margo Thienemann, and Jennifer Frankovich.Sex and Aggression Characteristics in a Cohort of Patients with Pediatric Acute-Onset Neuropsychiatric Syndrome.Journal of Child and Adolescent Psychopharmacology.ahead of print http://doi.org/10.1089/cap.2021.0084

  • Males had a higher median Modified Overt Aggression Scale (MOAS) score in the first year of clinic when compared with females and a higher median subscore for physical aggression.
  • The median time from PANS symptom onset to first administration of immunotherapy, which did not include nonsteroidal anti-inflammatory drugs or short bursts of oral steroids, was 6.9 years for females and 3.7 years for males.
  • Although the physical aggression measured by the MOAS was significantly higher in males, caregivers of males and females reported similar levels of caregiver burden.
  • The two groups did not differ significantly in age of PANS onset, time from onset to clinic entry, other psychiatric symptom measures, or laboratory markers of inflammation.

Conclusion: Among patients with PANS, males exhibit more aggressive behavior when compared with females, which may advance the decision to treat with immunotherapy. Scores that capture a more global level of functioning show that despite there being a higher level of aggression in males, female patients with PANS have similar levels of overall impairment.

Cytokine dynamics and targeted immunotherapies in autoimmune encephalitis

Nicolás Lundahl Ciano-Petersen, Sergio Muñiz-Castrillo, Cristina Birzu, Alberto Vogrig, Antonio Farina, Macarena Villagrán-García, Bastien Joubert, Dimitri Psimaras, Jérôme Honnorat, Cytokine dynamics and targeted immunotherapies in autoimmune encephalitis, Brain Communications, Volume 4, Issue 4, 2022, fcac196, https://doi.org/10.1093/braincomms/fcac196

“Autoimmune encephalitides constitute a diverse group of immune-mediated central nervous system disorders mainly characterized by the presence of antibodies targeting neuronal or glial antigens. Despite the notable contribution of antibody discovery to the understanding of their physiopathology, the specific immune cells and inflammatory mediators involved in autoimmune encephalitis are still poorly defined. However, cytokines have recently emerged as crucial signalling molecules in the pathogenesis of autoimmune encephalitis…. Autoimmune encephalitides constitute a diverse group of immune-mediated central nervous system disorders mainly characterized by the presence of antibodies targeting neuronal or glial antigens. Despite the notable contribution of antibody discovery to the understanding of their physiopathology, the specific immune cells and inflammatory mediators involved in autoimmune encephalitis are still poorly defined. However, cytokines have recently emerged as crucial signalling molecules in the pathogenesis of autoimmune encephalitis.”

Back to the Future: The Role of Infections in Psychopathology. Focus on OCD

Della Vecchia A, Marazziti D. Back to the Future: The Role of Infections in Psychopathology. Focus on OCD. Clin Neuropsychiatry. 2022;19(4):248-263. doi:10.36131/cnfioritieditore20220407

“Several pathogens have been associated with an increased risk to develop a broad spectrum of neuropsychiatric conditions, such as schizophrenia, mood disorders, autism, attention-deficit/hyperactivity disorder, anorexia nervosa, and post-traumatic stress disorder. Some evidence supported a possible role of infections also in the pathophysiology of OCD. Infections from Herpes simplex virus 1, Borna disease virus, Group A-Beta Hemolytic Streptococcus, Borrelia spp., and Toxoplasma gondii were actually found in patients with OCD. Although different mechanisms have been hypothesized, all would converge to trigger functional/structural alterations of specific circuits or immune processes, with cascade dysfunctions of several other systems.”