title: Tonsillectomies and adenoidectomies do not prevent the onset of pediatric autoimmune neuropsychiatric disorder associated with group A streptococcus.
abstract: BACKGROUND
  In children presenting with obsessive compulsive disorder (OCD) and/or tics, especially those with a temporal association with streptococcal pharyngitis (eg, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus), there is speculation about whether tonsillectomy/adenoidectomy might improve the child's neuropsychiatric course. Our objective was to examine whether removal of the tonsils and/or adenoids impacted streptococcal antibody titers, the timing of onset of OCD and/or tics and the clinical severity of these symptoms.
  
  
  METHODS
  Study participants (N = 112; average age = 9.2 ± 2.4; 44 women) were recruited as part of a prospective investigation of neuropsychiatric phenomena with temporal association to streptococcal pharyngitis and examined by family history, diagnostic interview, physical examination, medical record review, psychological testing and streptococcal antibodies and divided into surgical or nonsurgical groups. The surgical group consisted of children having previously had a tonsillectomy and/or adenoidectomy (n = 32). The remaining children were categorized as nonsurgical group (n = 76). Measures of OCD and tic severity, streptococcal antibody titers and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus classification were compared between both groups.
  
  
  RESULTS
  There were no significant differences as determined by streptococcal antibody titers, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus classification and OCD or tic severity between the surgical and nonsurgical groups. Most participants had surgery before the onset of neuropsychiatric symptoms and surgery did not affect symptomology.
  
  
  CONCLUSIONS
  Streptococcal antibodies and neuropsychiatric symptom severity did not differ on the basis of surgical status. From these data, we cannot infer that tonsillectomy and adenoidectomy are likely to impact positively the course of OCD/tics or streptococcal antibody concentrations.
authors.affiliation: Department of Pediatrics, University of South Florida, St. Petersburg, FL 33701, USA. tmurphy@health.usf.edu
authors.forename: Tanya K
authors.initials: TK
authors.lastname: Murphy
authors.forename: Adam B
authors.initials: AB
authors.lastname: Lewin
authors.forename: E Carla
authors.initials: EC
authors.lastname: Parker-Athill
authors.forename: Eric A
authors.initials: EA
authors.lastname: Storch
authors.forename: P Jane
authors.initials: PJ
authors.lastname: Mutch
mesh_terms: D000233:Adenoidectomy; D000293:Adolescent; D000907:Antibodies, Bacterial / Q000097:blood; D001327:Autoimmune Diseases / Q000276:immunology / Q000382:microbiology* / Q000523:psychology*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000276:immunology / Q000382:microbiology* / Q000517:prevention & control / Q000523:psychology*; D011446:Prospective Studies; D013290:Streptococcal Infections / Q000382:microbiology / Q000523:psychology*; D013297:Streptococcus pyogenes / Q000302:isolation & purification*; D020323:Tics / Q000150:complications / Q000453:epidemiology; D014068:Tonsillectomy
chemical_list: D000907:Antibodies, Bacterial