title: Relationship of movements and behaviors to Group A Streptococcus infections in elementary school children.
abstract: BACKGROUND
  Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus (PANDAS) research is based on the hypothesis that infections trigger changes in behavior and movement in children.
  
  
  METHODS
  We enrolled 693 children (ages 3 to 12 years) into a systematic, longitudinal study. Data were collected monthly for 8 months (October-May) to determine point prevalence of Group A Streptococcal (GAS) infections, tics, behavior, and choreiform movements. Simultaneous throat cultures were obtained, and relational analyses were made between GAS and movement/observation ratings.
  
  
  RESULTS
  Combined behavior/GAS associations (concurrent with or 3 subsequent months to GAS) revealed a strong relationship, relative risk (RR) of 1.71 (p < .0001). Detailed analysis revealed that balance/swaying and non-tic grimacing were responsible for a significant proportion of this association (RR = 2.92, p < .0001). A strong seasonal pattern was found, with fall being more significant for GAS infections and observation ratings (p < .0001) compared with winter/spring. Children with repeated streptococcus (n = 64) showed higher rates of behavior and distal choreiform observations (p = .005).
  
  
  CONCLUSIONS
  Motor/behavior changes were noted to occur in relationship to positive GAS culture with support that repeated GAS increases risk.
authors.affiliation: Department of Psychiatry, College of Medicine, Gainesville, Florida 32610, USA. tmurphy@psychiatry.ufl.edu
authors.forename: Tanya K
authors.initials: TK
authors.lastname: Murphy
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Snider
authors.forename: P Jane
authors.initials: PJ
authors.lastname: Mutch
authors.forename: Elaine
authors.initials: E
authors.lastname: Harden
authors.forename: Annette
authors.initials: A
authors.lastname: Zaytoun
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Edge
authors.forename: Eric A
authors.initials: EA
authors.lastname: Storch
authors.forename: Mark C K
authors.initials: MC
authors.lastname: Yang
authors.forename: Giselle
authors.initials: G
authors.lastname: Mann
authors.forename: Wayne K
authors.initials: WK
authors.lastname: Goodman
authors.forename: Susan E
authors.initials: SE
authors.lastname: Swedo
mesh_terms: D000293:Adolescent; D002648:Child; D002653:Child Behavior Disorders / Q000453:epidemiology* / Q000523:psychology; D002675:Child, Preschool; D002819:Chorea / Q000453:epidemiology* / Q000503:physiopathology; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009460:Neurologic Examination; D010614:Pharynx / Q000382:microbiology; D011446:Prospective Studies; D012621:Seasons; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D013297:Streptococcus pyogenes; D013981:Tic Disorders / Q000453:epidemiology / Q000523:psychology