Does Group A β-Hemolytic Streptococcal Infection Increase Risk for Behavioral and Neuropsychiatric Symptoms in Children?
Open Access
- 1 September 2004
- journal article
- research article
- Published by American Medical Association (AMA) in Archives of Pediatrics & Adolescent Medicine
- Vol. 158 (9), 848-856
- https://doi.org/10.1001/archpedi.158.9.848
Abstract
Objective To determine whether group A β-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 β-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" (≥ 2 new PANDAS symp-toms) 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.Keywords
This publication has 18 references indexed in Scilit:
- Group A streptococcal infections and tic disorders in an Italian pediatric populationThe Journal of Pediatrics, 2001
- Preliminary Findings of Antistreptococcal Antibody Titers and Basal Ganglia Volumes in Tic, Obsessive-compulsive, and Attention-Deficit/Hyperactivity DisordersArchives of General Psychiatry, 2000
- MRI Assessment of Children With Obsessive-Compulsive Disorder or Tics Associated With Streptococcal InfectionAmerican Journal of Psychiatry, 2000
- Therapeutic plasma exchange and intravenous immunoglobulin for obsessive-compulsive disorder and tic disorders in childhoodThe Lancet, 1999
- A pilot study of penicillin prophylaxis for neuropsychiatric exacerbations triggered by streptococcal infectionsBiological Psychiatry, 1999
- A Case of Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal InfectionsAmerican Journal of Psychiatry, 1998
- Topical Review: PANDAS: The Search for Environmental Triggers of Pediatric Neuropsychiatric Disorders. Lessons from Rheumatic FeverJournal of Child Neurology, 1998
- Obsessive—Compulsive Disorder in Post-Streptococcal InfectionAustralian & New Zealand Journal of Psychiatry, 1998
- Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections: Clinical Description of the First 50 CasesAmerican Journal of Psychiatry, 1998
- Case Study: Acute Basal Ganglia Enlargement and Obsessive-Compulsive Symptoms in an Adolescent BoyJournal of the American Academy of Child & Adolescent Psychiatry, 1996