Streptococcal upper respiratory tract infections and exacerbations of tic and obsessive-compulsive symptoms: a prospective longitudinal study.
OBJECTIVE
The objective of this blinded, prospective, longitudinal study was to determine whether new group A β hemolytic streptococcal (GABHS) infections are temporally associated with exacerbations of tic or obsessive-compulsive (OC) symptoms in children who met published criteria for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). A group of children with Tourette syndrome and/or OC disorder without a PANDAS history served as the comparison (non-PANDAS) group.


METHODS
Consecutive clinical ratings of tic and OC symptom severity were obtained for 31 PANDAS subjects and 53 non-PANDAS subjects. Clinical symptoms and laboratory values (throat cultures and streptococcal antibody titers) were evaluated at regular intervals during a 25-month period. Additional testing occurred at the time of any tic or OC symptom exacerbation. New GABHS infections were established by throat swab cultures and/or recent significant rise in streptococcal antibodies. Laboratory personnel were blinded to case or control status, clinical (exacerbation or not) condition, and clinical evaluators were blinded to the laboratory results.


RESULTS
No group differences were observed in the number of clinical exacerbations or the number of newly diagnosed GABHS infections. On only six occasions of a total of 51 (12%), a newly diagnosed GABHS infection was followed, within 2 months, by an exacerbation of tic and/or OC symptoms. In every instance, this association occurred in the non-PANDAS group.


CONCLUSIONS
This study provides no evidence for a temporal association between GABHS infections and tic/OC symptom exacerbations in children who meet the published PANDAS diagnostic criteria.
Child Study Center and the Yale Center for Clinical Investigation, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT 06520-7900, USA. james.leckman@yale.edu
James F
JF
Leckman
Robert A
RA
King
Donald L
DL
Gilbert
Barbara J
BJ
Coffey
Harvey S
HS
Singer
Leon S
LS
Dure
Heidi
H
Grantz
Liliya
L
Katsovich
Haiqun
H
Lin
Paul J
PJ
Lombroso
Ivana
I
Kawikova
Dwight R
DR
Johnson
Roger M
RM
Kurlan
Edward L
EL
Kaplan
D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000382:microbiology*; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000150:complications*; D012720:Severity of Illness Index; D013290:Streptococcal Infections / Q000150:complications*; D013297:Streptococcus pyogenes; D005879:Tourette Syndrome / Q000382:microbiology*; D014481:United States
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