By Anne Harding
CHICAGO (Reuters Health) – Group A streptococcal tonsillopharyngitis, if it occurs repeatedly and is untreated, can lead to the development of obsessive compulsive disorder (OCD) and Tourette's syndrome, according to study findings presented on Tuesday at a major infectious disease meeting.
OCD and Tourette's have been linked to infection with group A streptococcus in the past, but this is the first prospective study to confirm the link and demonstrate that antibiotic treatment can resolve the symptoms, study co-author Dr. Michael Pichichero, from the University of Rochester Medical Center in New York, said. He presented the findings at the Interscience Conference on Antimicrobial Agents and Chemotherapy.
Dr. Pichichero and Dr. M. Lynd Murphy, from the Elmwood Pediatric Group in Rochester, have identified 25 cases of the condition, known as Pediatric onset, Neuropsychiatric Disorder (PANDAS). At the meeting, they reported on findings in 12 children.
The children's mean age was 7 years. Parents usually brought the children for medical attention after they began exhibiting "severe OCD behavior," Dr. Pichichero said. Tests confirmed that the children had group A streptococcal tonsillopharyngitis, he added.
Once the children received antibiotic treatment, with either penicillin or a cephalosporin, their psychiatric symptoms disappeared. When symptoms reappeared in six children, another course of antibiotics cleared them up.
Dr. Pichichero believes that such infections might account for a significant number of OCD and Tourette's cases in children. He proposes that repeated group A streptococcal infections could lead to "kindling" in the brain. Once neural damage occurs, a permanent case of OCD or Tourette's syndrome may be the result. For this reason, he noted, rapid treatment of these infections is vital.
Drs. Pichichero and Dr. Murphy have begun a National Institutes of Health-funded study to investigate the relationship between strep A and OCD in 800 children.
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