br Case report The patient was

Case report The patient was born through a C-section, weighing 3.330g; among his previous personal morbidities there were chicken pox and circumcision; he was updated as far as immunization procedures were concerned. Among his familiar morbidities, his father had a diagnostic of sleep obstructive apnea syndrome (SOAS). The following tables demonstrate the exams that were altered (Tables 1–5). After ear, nose and throat evaluation, a tonsillectomy was performed, with the introduction of 1,200,000 IU of intramuscular penicillin G-benzathine during 48h before the surgery. The patient initiated treatment with an orthodontist due to his ogival palate.
Discussion Recent populational epidemiological studies have shown that the risk of narcolepsy is increased by 5.4 times for individuals with a medical history of oropharyngeal streptococcal infection [13]. The correlation between streptococcal infections and seasonality is associated with protective or deleterious immune factors, for those that are under the influence of the yearly climatic changes [5]. The involvement of streptococcal infections upon the disease׳s development is supported by the presence of anti-streptococcal buy RG7204 in 65% of the patients, in comparison to the 26% of paired controls [14]. Streptococcal infections can also increase the risk of narcolepsy through its nonspecific effects, such as the general immunity activation or increased hematoencephalic barrier permeability to T-active cells, caused by inflammatory agents or fever [15,16]. Previous infection by streptococcus of the A group and serum positivity of anti-streptolysin O (ASLO) is related to narcolepsy and auto-immunity [13,14]. Streptococci of the B group are part of the normal intestinal and genital flora, and are present in 20–40% of all women. The colonization is positively associated to the number of previous pregnancies and to the exposition to neonatal infection and can occur during the birth, in colonized women [17]. Although infection by group B streptococci are not known to be associated with auto-immunity, the results of Watson et al., associating narcolepsy to birth order suggest that the exposition to group B streptococci, during birth, might have a role in the development of narcolepsy in genetically susceptible individuals [8]. According to Kornum et al., the possible ways for the role of Streptococcus pyogenes and H1N1 virus upon the development of auto-immunity for the hypocretin-producing cells, would be the stimulus of T or B cells, through their molecular mimetism, beginning with streptococci super-antigens, the production of auto-antibodies, general immune activation and the migration of lymphocytes to the central nervous system. It has been suggested that these pathogens have a tropism for the hypocretin-secreting neurons, making them activate the microglia and increase the signals through the molecules of the main histocompatibility complex (MHC), class II, inducing the neurotoxicity through the release of quinolinic acid or glutaminase [18]. With a few exceptions, such as the celiac disease in older children, auto-immune diseases rarely affect children. During the last years, however, the number of children with diagnostic of auto-immune disorders has increased. It has also been established that children below 10 years of age and senior citizens with 65 years or more, have increased susceptibility to complications after a seasonal infection and a decreased response to vaccination [19]. Natarajan et al. reported a case where a child of 8 years of age could have had narcolepsy triggered by a streptococcal infection. In this case, the patient showed increase in the ASLO values when diagnosed with this affection. ASLO is an indication of a previous contact (during the past 2 months) with S. pyogenes (beta-hemolytic streptococcus of the A group) [20].
Conclusion