Prospective Longitudinal Study of Children With Tic Disorders and/or Obsessive-Compulsive Disorder: Relationship of Symptom Exacerbations to Newly Acquired Streptococcal Infections
Open Access
- 1 June 2004
- journal article
- Published by American Academy of Pediatrics (AAP) in Pediatrics
- Vol. 113 (6), e578-e585
- https://doi.org/10.1542/peds.113.6.e578
Abstract
Background. It has been proposed that infection by group A β-hemolytic streptococci (GABHS) can trigger acute symptom exacerbations among patients with Tourette’s syndrome (TS) or obsessive-compulsive disorder (OCD), via autoimmune mechanisms. Objective. To examine the temporal relationship between newly acquired GABHS infections (and other immunologic indices) and acute exacerbations of tics and obsessive-compulsive symptoms. Methods. Pediatric patients (7–17 years of age) with TS and/or OCD (N = 47) and healthy control subjects (N = 19) were prospectively monitored for newly acquired GABHS infections, nonspecific markers of acute inflammatory responses, and D8/17-reactive cells (a marker of rheumatic fever). Objective monthly ratings of tic and obsessive-compulsive symptom severity were used to determine the timing of symptom exacerbations. Results. The overall rate of acute exacerbations of neuropsychiatric symptoms was 0.56 exacerbations per patient per year. The average rate of new GABHS infections, using a stringent definition, was 0.42 infections per subject per year among patients, compared with 0.28 infections per subject per year for control subjects. The association between symptom exacerbations and new GABHS infections among patients was no greater than that expected on the basis of chance. At baseline, patients demonstrated significantly higher levels of D8/17-reactive cells and neopterin, compared with control subjects, but there was no consistent pattern of change when exacerbation time points were compared with baseline or follow-up time points. Conclusions. The results suggest no clear relationship between new GABHS infections and symptom exacerbations in an unselected group of patients with TS and/or OCD.Keywords
This publication has 46 references indexed in Scilit:
- Clinical Utility of Selected Disease Activity Markers in Patients with Systemic Lupus ErythematosusClinical Rheumatology, 2001
- Elevated D8/17 Expression on B Lymphocytes, a Marker of Rheumatic Fever, Measured With Flow Cytometry in Tic Disorder PatientsAmerican Journal of Psychiatry, 2001
- A Complete Genome Screen in Sib Pairs Affected by Gilles de la Tourette SyndromeAmerican Journal of Human Genetics, 1999
- Epidemiology and Prevention of Group A Streptococcal Infections: Acute Respiratory Tract Infections, Skin Infections, and their Sequelae at the Close of the Twentieth CenturyClinical Infectious Diseases, 1999
- The prevalence of Tourette syndrome in a mainstream school populationDevelopmental Medicine and Child Neurology, 1998
- Daily urinary neopterin excretion as an immunological marker of disease activity in multiple sclerosisBrain, 1997
- An outbreak of invasive group A streptococcal disease associated with high carriage rates of the invasive clone among school-aged childrenPublished by American Medical Association (AMA) ,1997
- Increased plasma kynurenine and its relationship to neopterin and tryptophan in Tourette's syndromePsychological Medicine, 1996
- Serologic Evidence for a Class I Group A Streptococcal Infection among Rheumatic Fever PatientsThe Journal of Infectious Diseases, 1995
- Diagnosis of Streptococcal Pharyngitis: Differentiation of Active Infection from the Carrier State in the Symptomatic ChildThe Journal of Infectious Diseases, 1971