Psychiatric outcomes after streptococcal upper respiratory tract infection in children

Associations between childhood streptococcal upper respiratory infections and subsequent psychiatric outcomes have been described for over 25 years, although clinical evidence remains limited. This study explored psychiatric outcomes after pediatric streptococcal versus non-streptococcal upper respiratory tract infections.

This retrospective cohort study used TriNetX, a global federated health research network of over 150 million deidentified electronic medical records. We compared children aged 3-16 with a diagnosis of acute upper respiratory infection (ICD-10 J00-J06) and a Streptococcus pyogenes test result (positive or negative) within 2 weeks, propensity matched on 70 baseline variables. Main outcomes were the 1-year incidence of any psychiatric disorder, obsessive-compulsive disorder (OCD), tic disorder, anxiety, and restricted oral intake.

Before matching, 464,513 children were streptococcal positive and 1,023,171 children were streptococcal negative. After matching, there were 456,221 children in each cohort (48% female). The streptococcal-positive cohort had a reduced risk of any psychiatric disorder (RR 0.92 [0.90, 0.94]), restricted oral intake (0.81 [0.77, 0.86]), and anxiety disorder (0.94 [0.91, 0.97]) at 1 year. Risk of OCD (RR 0.98 [0.86, 1.12]) and tic disorder (RR 0.95 [0.87, 1.04]) was not significantly different between the two cohorts.

This large-scale cohort study found no evidence that exposure to S. pyogenes is associated with increased risk of the measured psychiatric outcomes.