Streptococcal upper respiratory tract infections and exacerbations of tic and obsessive-compulsive symptoms: a prospective longitudinal study
James F Leckman, Robert A King, Donald L Gilbert, Barbara J Coffey, Harvey S Singer, Leon S Dure 4th, Heidi Grantz, Liliya Katsovich, Haiqun Lin, Paul J Lombroso, Ivana Kawikova, Dwight R Johnson, Roger M Kurlan, Edward L Kaplan, James F Leckman, Robert A King, Donald L Gilbert, Barbara J Coffey, Harvey S Singer, Leon S Dure 4th, Heidi Grantz, Liliya Katsovich, Haiqun Lin, Paul J Lombroso, Ivana Kawikova, Dwight R Johnson, Roger M Kurlan, Edward L Kaplan
Abstract
Objective: The objective of this blinded, prospective, longitudinal study was to determine whether new group A β hemolytic streptococcal (GABHS) infections are temporally associated with exacerbations of tic or obsessive-compulsive (OC) symptoms in children who met published criteria for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). A group of children with Tourette syndrome and/or OC disorder without a PANDAS history served as the comparison (non-PANDAS) group.
Method: Consecutive clinical ratings of tic and OC symptom severity were obtained for 31 PANDAS subjects and 53 non-PANDAS subjects. Clinical symptoms and laboratory values (throat cultures and streptococcal antibody titers) were evaluated at regular intervals during a 25-month period. Additional testing occurred at the time of any tic or OC symptom exacerbation. New GABHS infections were established by throat swab cultures and/or recent significant rise in streptococcal antibodies. Laboratory personnel were blinded to case or control status, clinical (exacerbation or not) condition, and clinical evaluators were blinded to the laboratory results.
Results: No group differences were observed in the number of clinical exacerbations or the number of newly diagnosed GABHS infections. On only six occasions of a total of 51 (12%), a newly diagnosed GABHS infection was followed, within 2 months, by an exacerbation of tic and/or OC symptoms. In every instance, this association occurred in the non-PANDAS group.
Conclusions: This study provides no evidence for a temporal association between GABHS infections and tic/OC symptom exacerbations in children who meet the published PANDAS diagnostic criteria.
Copyright © 2011 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.
Source: PubMed