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Infection-triggered anorexia nervosa in children: clinical description of four cases
1Eating Disorders Program, The Menninger Clinic, Topeka, Kansas 66601, USA. sokolms@menninger.edu
Insights
This study suggests a link between streptococcal infections and some pediatric anorexia nervosa cases. Antibiotic treatment, alongside conventional care, showed promise in improving symptoms and weight gain in affected children.
Area of Science:
- Pediatric autoimmune neuropsychiatric disorders
- Infectious disease and neuropsychiatric conditions
Background:
- Anorexia nervosa (AN) is a severe eating disorder with limited treatment options.
- A hypothesis suggests some pediatric AN cases may stem from pediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS).
Observation:
- Four adolescents (11-15 years) with PANDAS AN received antibiotics plus conventional treatment.
- Evidence of streptococcal infection was assessed via clinical evaluation, cultures, and serological tests (anti-DNase B, ASO titers).
- The D8/17 B-cell marker, linked to post-streptococcal autoimmunity, was also measured.
Findings:
- All four patients showed signs of prior streptococcal infection and had the D8/17 marker (33% mean positive B cells).
- Two patients had comorbid obsessive-compulsive disorder (OCD).
- Treatment with antibiotics and conventional care led to weight restoration and reduced eating disorder and OCD symptoms.
Implications:
- Findings suggest a potential link between infectious diseases and certain anorexia nervosa cases.
- This opens avenues for novel therapeutic strategies targeting infections in AN treatment.
Background:
Anorexia nervosa (AN) is a serious illness with no definitive treatment. Clinical and research evidence led to the hypothesis that some children with AN may have a pediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS), similar in pathogenesis to other hypothesized PANDAS disorders.
Methods:
Four youngsters (ages, 11-15 years) with PANDAS AN were treated with an open trial of antibiotics, in addition to conventional treatment. They were evaluated for eating disorder and obsessive-compulsive symptoms, and for weight gain. Evidence of streptococcal infection came from clinical evaluation, throat cultures, and two serological tests: anti-deoxyribonuclease B (anti-DNase B) and anti-streptolysin O (ASO) titers. The "rheumatic" marker D8/17 was also measured. This B-cell alloantigen is associated, in several publications, with poststreptococcal autoimmunity: Rheumatic fever (RF), Sydenham's chorea (SC), and possibly PANDAS obsessive compulsive disorder (OCD) and tic disorders.
Results:
There was clinical evidence of possible antecedent streptococcal infection in all four patients, two of whom had comorbid OCD, with possible infection-triggered AN. All four had the rheumatic marker: A percentage of D8/17-positive B cells of 28-38%, with a mean of 33% (12% or more is considered positive for the marker). The patients responded to conventional treatment plus antibiotics with weight restoration and decreased eating disorder and obsessive-compulsive symptoms. Three needed to gain weight and did so.
Conclusions:
There may be a link between infectious disease and some cases of AN, which raises the possibility of new treatment.