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Detecting pediatric autoimmune neuropsychiatric disorders associated with streptococcus in children with
Tanya K Murphy1, Muhammad Sajid, Ohel Soto
1Department of Psychiatry, University of Florida, Gainesville, Florida 32610-0256, USA.
Insights
Children with obsessive-compulsive disorder and tic disorders may experience symptom fluctuations linked to Group A Streptococcus infections. These children often show elevated streptococcal titers and seasonal tic exacerbations, particularly in fall and winter.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Psychiatry
Background:
- A subset of children with obsessive-compulsive disorder (OCD) and tic disorders may have an infectious etiology.
- Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) is a condition with similar clinical presentations.
Purpose of the Study:
- To investigate the association between Group A streptococcal (GAS) titers and symptom fluctuations in children with OCD and/or tic disorders.
- To explore potential infectious triggers in children exhibiting symptom variability.
Main Methods:
- Twenty-five children diagnosed with OCD and/or tic disorders were enrolled.
- Neuropsychiatric severity and GAS antibody titers (ASO, Anti-DNase B, Anti-Carbohydrate A) were monitored over at least six 6-week intervals.
- Symptom severity and antibody titers were analyzed for co-movements.
Main Results:
- Children with significant symptom fluctuations (n=15) showed a positive correlation between GAS titers and OCD severity changes (p=.0130).
- These children were more likely to have elevated GAS titers throughout the observation period (p=.001).
- Tic symptom exacerbations were more frequent during fall/winter months compared to spring/summer (p=.03).
Conclusions:
- Marked fluctuations in OCD and tic symptoms in children may be associated with elevated GAS titers.
- Evidence suggests seasonal patterns in tic symptom exacerbations, potentially linked to infections.
- Findings support further investigation into streptococcal triggers for neuropsychiatric symptom changes in pediatric populations.
Background:
A subgroup of children with obsessive-compulsive and tic disorders are proposed to have an infectious trigger. The purpose of this study was to investigate the relationship between group A streptococcal titers and symptom fluctuations in children with a clinical course resembling that described for pediatric autoimmune neuropsychiatric disorders associated with streptococcus.
Methods:
Twenty-five children with obsessive-compulsive disorder and/or tic disorder were evaluated for neuropsychiatric severity and group A streptococcal antibody titers (streptolysin O, deoxyribonuclease B, and carbohydrate A) at 6-week intervals for > or = six consecutive evaluations (total visits=277).
Results:
Children with large symptom fluctuations (n=15) were compared with children without dramatic fluctuations (n=10). Co-movements of obsessive-compulsive/tic severity and group A streptococcal antibodies were assessed. In subjects with large symptom changes, positive correlations were found between streptococcal titers and obsessive-compulsive severity rating changes (p=.0130). These subjects were also more likely to have elevated group A streptococcal titers during the majority of observations (p=.001). Tic symptom exacerbations occurred more often in the fall/winter months than spring/summer months (p=.03).
Conclusions:
Patients with marked obsessive-compulsive/tic symptom changes may be characterized by streptococcal titer elevations and exhibit evidence of seasonal tic exacerbations.
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