Autoimmune neuropsychiatric sequelae of group A streptococcal infections in Aboriginal and Torres Strait Islander people: an overlooked burden?

Abstract

ObjectiveWe highlight two autoimmune neuropsychiatric sequelae of group A streptococcal (GAS) infection that may cause disproportionate levels of psychiatric morbidity in Aboriginal and Torres Strait Islander people: Sydenham's Chorea (SC) and Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). GAS infections, along with better characterised immune-mediated sequelae such as acute rheumatic fever and rheumatic heart disease, are highly prevalent in Aboriginal and Torres Strait Islander people, particularly in rural and remote communities, yet there is minimal information in the literature about the neuropsychiatric sequelae that might be expected. We suspect that there is an under-recognised burden of disease in these groups and seek to understand reasons for this.ConclusionsA multi-faceted, culturally attuned approach to better characterising and detecting the burden of these two conditions in Aboriginal and Torres Strait Islander people is required. Furthermore, larger scale clinical trials examining the efficacy of proposed treatments for SC and PANDAS are required to inform clinical guidelines.

Keywords: Aboriginal; PANDAS; Sydenham’s chorea; Torres Strait Islander; autoimmune; streptococcal infection.