Neuropsychiatric disorders associated with streptococcal infection: a case-control study among privately insured children.
OBJECTIVE
To assess whether antecedent streptococcal infection(s) increase the risk of subsequent diagnosis of obsessive-compulsive disorder (OCD), Tourette syndrome (TS), other tic disorders, attention-deficit/hyperactivity disorder (ADHD), or major depressive disorder (MDD) in a national sample of privately insured children.


METHODS
Using health insurance claims data, we compared the prior year's occurrence of streptococcal infection in children ages 4 to 13 years with OCD, TS, or tic disorder newly diagnosed between January 1998 and December 2004 to that of a cohort of matched controls. Conditional logistic regression models were used to determine the association of prior streptococcal sore throat or scarlet fever with a diagnosis of OCD, TS, or tic disorder. We repeated the analyses for two other infectious diseases (otitis media and sinusitis) and one noninfectious condition (migraine). We also investigated the potential specificity of this association by performing similar analyses focused on newly diagnosed ADHD and newly diagnosed MDD.


RESULTS
Subjects with newly diagnosed OCD, TS, or tic disorder were more likely than controls to have had a diagnosis of streptococcal infection in the previous year (odds ratio 1.54, 95% confidence interval 1.29-2.15). Prior streptococcal infection was also associated with incident diagnoses of ADHD (odds ratio 1.20, 95% confidence interval 1.06-1.35) and MDD (odds ratio 1.63, 95% confidence interval 1.12-2.30).


CONCLUSIONS
These findings provide epidemiologic evidence that some pediatric-onset neuropsychiatric disorders, including OCD, tic disorders, ADHD, and MDD, may be temporally related to prior streptococcal infections. Whether this is the result of a nonspecific stress response or secondary to an activation of the immune system remains to be determined.
Leslie
Douglas L
DL
Department of Health Administration and Policy, Medical University of South Carolina, Charleston, SC 29425, USA. leslied@musc.edu
Kozma
Laura
L
Martin
Andrés
A
Landeros
Angeli
A
Katsovich
Liliya
L
King
Robert A
RA
Leckman
James F
JF
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008881:Migraine Disorders / Q000175:diagnosis / Q000453:epidemiology; D019965:Neurocognitive Disorders / Q000175:diagnosis / Q000453:epidemiology*; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D016017:Odds Ratio; D010033:Otitis Media / Q000175:diagnosis / Q000453:epidemiology; D012306:Risk; D012852:Sinusitis / Q000175:diagnosis / Q000453:epidemiology; D013290:Streptococcal Infections / Q000175:diagnosis / Q000453:epidemiology*; D013981:Tic Disorders / Q000175:diagnosis / Q000453:epidemiology*; D005879:Tourette Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D014481:United States