Does group A beta-hemolytic streptococcal infection increase risk for behavioral and neuropsychiatric symptoms in children?
OBJECTIVE
To determine whether group A beta-hemolytic streptococcal infections increase the risk of developing symptoms characteristic of the diagnosis pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).


METHODS
Prospective cohort study.


METHODS
Children (N = 814) aged 4 to 11 years seen for sore throat or well-child care in a large pediatric practice in Rochester, NY, were enrolled from October 2001 to June 2002 (group A beta-hemolytic streptococcal [GAS] infected, n = 411; GAS uninfected, n = 403, of whom 207 had a sore throat of presumed viral etiology and 196 were well children). Symptomatic children with GAS infection (n = 399) were treated with antibiotics. At baseline and 2 and 12 weeks following baseline, all parents completed a 20-item questionnaire about the presence/absence of recent PANDAS symptoms in their children, and capable children answered 10 items about worries, obsessions, and compulsions. The relative risk of developing a "mild PANDAS variant" (> or = 2 new PANDAS symptoms) by illness type (GAS positive, presumed viral, or well child) and by parent and child report was determined and adjusted for potential covariates.


RESULTS
By parent report, ill children more frequently manifested several PANDAS symptoms at baseline than well children. However, neither new symptoms nor the risk of developing a mild PANDAS variant developed during the subsequent 12 weeks more commonly in children with GAS infection than in those with presumed viral illness or in well children by parent or child report.


CONCLUSIONS
Ill children with GAS infection, treated for their GAS infection, were not at increased risk for developing PANDAS symptoms or a mild PANDAS variant compared with children with presumed viral illness or well children. The role of antibiotics in the prevention or treatment of PANDAS as well as the investigation of PANDAS in the asymptomatic, infectious host deserves future research.
Perrin
Eliana Miller
EM
Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, 200 Mason Farm Road, Chapel Hill, NC 27599-7220, USA. eliana_perrin@med.unc.edu
Murphy
Marie Lynd
ML
Casey
Janet R
JR
Pichichero
Michael E
ME
Runyan
Desmond K
DK
Miller
William C
WC
Snider
Lisa A
LA
Swedo
Susan E
SE
D020274:Autoimmune Diseases of the Nervous System / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology*; D001526:Behavioral Symptoms / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology*; D020805:Central Nervous System Viral Diseases / Q000453:epidemiology / Q000503:physiopathology / Q000821:virology; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D003072:Cognition Disorders / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D009518:New York / Q000453:epidemiology; D011135:Polysaccharides, Bacterial; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000502:physiology; D012307:Risk Factors; D013290:Streptococcal Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology*; D011795:Surveys and Questionnaires
D011135:Polysaccharides, Bacterial; C036112:streptococcal polysaccharide group A