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Does group A beta-hemolytic streptococcal infection increase risk for behavioral and neuropsychiatric symptoms in
Eliana Miller Perrin1, Marie Lynd Murphy, Janet R Casey
1Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, 200 Mason Farm Road, Chapel Hill, NC 27599-7220, USA. eliana_perrin@med.unc.edu
Insights
Group A streptococcal infections do not increase the risk of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) in children treated with antibiotics. Further research is needed on PANDAS in asymptomatic carriers.
Area of Science:
- Pediatric autoimmune disorders
- Infectious diseases
- Neuropsychiatry
Background:
- Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is a diagnosis linked to streptococcal infections.
- The potential causal relationship between Group A beta-hemolytic streptococcal (GAS) infections and PANDAS symptoms requires further investigation.
Purpose of the Study:
- To investigate if GAS infections elevate the risk of PANDAS symptoms in children.
- To assess the development of PANDAS symptoms in children with GAS infection compared to viral infections or healthy controls.
Main Methods:
- A prospective cohort study enrolled 814 children aged 4-11 years.
- Parents and children completed questionnaires assessing PANDAS symptoms and behavioral changes over 12 weeks.
- Risk of developing a "mild PANDAS variant" was analyzed based on illness type (GAS, viral, well) and reporting source.
Main Results:
- While ill children showed more PANDAS symptoms at baseline, no increased risk was observed 12 weeks post-infection for GAS-infected children.
- Neither new symptoms nor a mild PANDAS variant developed more frequently in GAS-infected children compared to viral or well children.
- Parent and child reports yielded similar findings regarding PANDAS symptom development.
Conclusions:
- Treated GAS infections in children do not appear to increase the risk of developing PANDAS symptoms or a mild PANDAS variant.
- Further research is warranted to explore the role of antibiotics and PANDAS in asymptomatic carriers.
Objective:
To determine whether group A beta-hemolytic streptococcal infections increase the risk of developing symptoms characteristic of the diagnosis pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).
Design:
Prospective cohort study.
Methods:
Children (N = 814) aged 4 to 11 years seen for sore throat or well-child care in a large pediatric practice in Rochester, NY, were enrolled from October 2001 to June 2002 (group A beta-hemolytic streptococcal [GAS] infected, n = 411; GAS uninfected, n = 403, of whom 207 had a sore throat of presumed viral etiology and 196 were well children). Symptomatic children with GAS infection (n = 399) were treated with antibiotics. At baseline and 2 and 12 weeks following baseline, all parents completed a 20-item questionnaire about the presence/absence of recent PANDAS symptoms in their children, and capable children answered 10 items about worries, obsessions, and compulsions. The relative risk of developing a "mild PANDAS variant" (> or = 2 new PANDAS symptoms) by illness type (GAS positive, presumed viral, or well child) and by parent and child report was determined and adjusted for potential covariates.
Results:
By parent report, ill children more frequently manifested several PANDAS symptoms at baseline than well children. However, neither new symptoms nor the risk of developing a mild PANDAS variant developed during the subsequent 12 weeks more commonly in children with GAS infection than in those with presumed viral illness or in well children by parent or child report.
Conclusions:
Ill children with GAS infection, treated for their GAS infection, were not at increased risk for developing PANDAS symptoms or a mild PANDAS variant compared with children with presumed viral illness or well children. The role of antibiotics in the prevention or treatment of PANDAS as well as the investigation of PANDAS in the asymptomatic, infectious host deserves future research.
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