Streptococcal Upper Respiratory Tract Infections and Exacerbations of Tic and Obsessive-Compulsive Symptoms: A Prospective Longitudinal Study - 10/08/11
, Robert A. King, M.D. a, Donald L. Gilbert, M.D. b, Barbara J. Coffey, M.D., M.S. c, Harvey S. Singer, M.D. d, Leon S. Dure, M.D. e, Heidi Grantz, M.S.W. a, Liliya Katsovich, M.B.A. a, Haiqun Lin, M.D., Ph.D. f, Paul J. Lombroso, M.D. a, Ivana Kawikova, M.D., Ph.D. a, Dwight R. Johnson, B.S. g, Roger M. Kurlan, M.D. h, Edward L. Kaplan, M.D. g
Correspondence to James Leckman, M.D., Child Study Center, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT 06520-7900Résumé |
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.
Le texte complet de cet article est disponible en PDF.Key Words : obsessive-compulsive disorder, Tourette syndrome, group A β hemolytic streptococci, streptococcal infections, pediatric neuropsychiatric disorders associated with streptococcal infections (PANDAS)
Plan
| This article was reviewed under and accepted by Ad Hoc Editor Daniel S. Pine, M.D. |
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| This research was funded in part by the Tourette Syndrome Association and the National Institutes of Health, grants (R01MH061940 (J.F.L.); K05 MH076273 (J.F.L.); K02 MH01527 (P.J.L.); M01RR006022; and RR00125). |
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| Disclosure: Dr. Leckman has received research support from the National Institutes of Health and the Tourette Syndrome Association. He has received salary support from the National Institutes of Health. He has received support from the Klingenstein Third Generation Foundation from the medical student fellowship program. He has received royalties from John Wiley and Sons, McGraw Hill, and Oxford University Press. Dr. Coffey receives research support from Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly and Co., the National Institute of Mental Health, the National Institute of Neurological Disorders and Stroke, and the Tourette Syndrome Association. She has served on the advisory board for Jazz Pharmaceuticals, Eli Lilly and Co., Novartis, and the Tourette Syndrome Association. She has served on the speakers' bureau for the Tourette Syndrome Association. Dr. Singer has received research and salary support from the National Institutes of Health. He has received royalties from Elsevier and has served as an editor for the journal Neurolograd. Dr. Gilbert has received honoraria from the American Academy of Pediatrics, the Tourette Syndrome Association/Center for Disease Control, the Movement Disorder Society, and the American Academy of Neurology. He has served on the advisory board for the Tourette Syndrome Association. He has received research support from the National Institutes of Health, Cincinnati Children's Hospital Research Foundation, the University of Cincinnati, and the Tourette Syndrome Association. He will receive salary support for clinical research from the Genzyme Corporation, Otsuka Pharmaceuticals, and Psyadon Pharmaceuticals. Dr. Kurlan has received research support from the National Institutes of Health, the Centers for Disease Control, the Michael J. Fox Foundation, Neurologix, Boehringer Ingelheim, and Kyowa. He has received salary support from the National Institutes of Health, Neurologix, Boehringer Ingelheim, and Kyowa. Dr. Lombroso has received research and salary support from the National Institute of Mental Health, the Institute for the Study of Aging, the American Health Assistant Foundation, and the Fragile X Foundation. Drs. King, Dure, Lin, Kawikova, and Kaplan, Ms. Grantz, Mr. Johnson, and Ms. Katsovich report no biomedical financial interests or potential conflicts of interest. |
Vol 50 - N° 2
P. 108 - février 2011 Retour au numéro
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