Posted by Zo on April 22, 2002, at 17:21:21
Behavioral Syndrome Linked to Strep Pharyngitis, Responds to Antibiotics
Sudden onset of behaviors associated with obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD) appear to result from repeated bouts of group A beta-hemolytic streptococcal tonsillopharyngitis. According to results of a prospective study, these neuropsychiatric symptoms respond to antibiotics if given promptly at the sentinel episode.
In the April issue of the Archives of Pediatrics and Adolescent Medicine, Drs. Marie Lynd Murphy and Michael E. Pichichero, of the University of Rochester Medical Center in New York, describe 12 cases of "pediatric autoimmune neuropsychiatric disorder associated with group A streptococcal infection (PANDAS)."
Between 1998 and 2000, 12 children ages 5 to 10 years old presented to a primary care clinic with "the abrupt, explosive onset of a significant new behavioral problem." Behaviors included urinary frequency and urgency during the daytime, repeated hand washing, and extreme separation anxiety. Two boys exhibited head tilting, nodding, and eye blinking.
All patients tested positive for group A beta-hemolytic strep, either at the time of the episode or shortly before, although the sore throats tended to be mild. Eleven had a documented streptococcal illness prior to the one that triggered OCD, but none appeared to be chronic strep carriers.Symptoms disappeared within a mean of 14 days after antibiotics were started. Six patients had a total of 16 recurrent episodes during followup, with each instance associated with beta-hemolytic strep sore throat.
The number of previous infections was associated with severity of OCD symptoms. Drs. Murphy and Pichichero speculate that a streptococcal toxin, rather than an autoimmune antibody-mediated process, is the mediator of PANDAS.
The two physicians note that all patients exhibited emotional lability and motor hyperactivity during the episodes. They suggest that "perhaps the PANDAS syndrome should be expanded to include primary diagnosis of late-onset ADHD and age-inappropriate separation anxiety disorders."
Arch Pediatr Adolesc Med 2002:156:356-361.
poster:Zo
thread:103847
URL: http://www.dr-bob.org/babble/20020416/msgs/103847.html