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Neuropsychiatric disorders associated with streptococcal infection: a case-control study among privately insured

Douglas L Leslie1, Laura Kozma, Andrés Martin

  • 1Department of Health Administration and Policy, Medical University of South Carolina, Charleston, SC 29425, USA. leslied@musc.edu

Journal of the American Academy of Child and Adolescent Psychiatry
|August 30, 2008
PubMed

Insights

Pediatric streptococcal infections may increase the risk of developing obsessive-compulsive disorder (OCD), tic disorders, attention-deficit/hyperactivity disorder (ADHD), and major depressive disorder (MDD). This study suggests a potential link between these infections and subsequent neuropsychiatric diagnoses in children.

Area of Science:

  • Pediatric neuropsychiatry
  • Infectious disease epidemiology
  • Child and adolescent mental health

Background:

  • Streptococcal infections are common in children.
  • The potential link between infections and neuropsychiatric disorders is an area of ongoing research.
  • Previous studies have explored associations between pediatric infections and conditions like PANDAS/PANS.

Purpose of the Study:

  • To investigate if prior streptococcal infections elevate the risk of new diagnoses for obsessive-compulsive disorder (OCD), Tourette syndrome (TS), other tic disorders, attention-deficit/hyperactivity disorder (ADHD), and major depressive disorder (MDD) in children.
  • To assess the specificity of this association by comparing streptococcal infections to other infectious and non-infectious conditions.
  • To analyze data from a large national sample of privately insured children.

Main Methods:

  • Utilized health insurance claims data for children aged 4-13 years.
  • Compared the incidence of streptococcal infections in the year preceding new diagnoses of OCD, TS, or tic disorders against matched controls.
  • Employed conditional logistic regression to determine the association between streptococcal infections and neuropsychiatric diagnoses, including ADHD and MDD, while controlling for other conditions.

Main Results:

  • Children with newly diagnosed OCD, TS, or tic disorders were more likely to have had a prior streptococcal infection (OR 1.54).
  • Prior streptococcal infection was also significantly associated with incident ADHD (OR 1.20) and MDD (OR 1.63).
  • The association was specific to streptococcal infections compared to otitis media, sinusitis, or migraine.

Conclusions:

  • Epidemiological evidence suggests a temporal relationship between prior streptococcal infections and pediatric-onset neuropsychiatric disorders like OCD, tic disorders, ADHD, and MDD.
  • The findings indicate that streptococcal infections may play a role in the development or exacerbation of these conditions.
  • Further research is needed to determine if the observed association is due to a general stress response or immune system activation.
Abstract

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