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Streptococcal upper respiratory tract infections and exacerbations of tic and obsessive-compulsive symptoms: a

James F Leckman1, Robert A King, Donald L Gilbert

  • 1Child 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

Journal of the American Academy of Child and Adolescent Psychiatry
|January 19, 2011
PubMed

Insights

This study found no link between new strep infections and symptom flare-ups in children with PANDAS. The research suggests pediatric autoimmune neuropsychiatric disorders are not triggered by group A beta-hemolytic streptococcal infections.

Area of Science:

  • Pediatric Neurology
  • Infectious Diseases
  • Psychiatry

Background:

  • Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is a condition where tic or obsessive-compulsive symptoms worsen after a streptococcal infection.
  • The causal link between group A beta-hemolytic streptococcal (GABHS) infections and PANDAS exacerbations requires further investigation.

Purpose of the Study:

  • To investigate the temporal association between new GABHS infections and exacerbations of tic or obsessive-compulsive (OC) symptoms in children meeting PANDAS criteria.
  • To compare these associations in children with PANDAS versus a control group with Tourette syndrome and/or OC disorder without PANDAS history.

Main Methods:

  • A prospective, longitudinal study involving 31 PANDAS subjects and 53 non-PANDAS subjects over 25 months.
  • Clinical symptom severity was rated, and GABHS infections were confirmed via throat cultures and antibody titers.
  • Blinding procedures were implemented for laboratory personnel and clinical evaluators.

Main Results:

  • No significant differences in clinical exacerbations or new GABHS infections were observed between the PANDAS and non-PANDAS groups.
  • A temporal association between GABHS infection and symptom exacerbation occurred in only 12% of cases, exclusively within the non-PANDAS group.
  • No instances of GABHS infection preceding symptom exacerbation were noted in the PANDAS group.

Conclusions:

  • The study found no evidence supporting a temporal association between GABHS infections and tic/OC symptom exacerbations in children diagnosed with PANDAS.
  • Findings suggest that GABHS infections may not be a direct trigger for symptom exacerbations in established PANDAS cases.
  • Further research is needed to understand the complex interplay of factors contributing to PANDAS.
Abstract

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