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Does Group A  -Hemolytic Streptococcal Infection Increase Risk for Behavioral and Neuropsychiatric Symptoms in Children?
Eliana Miller Perrin, MD, MPH;
Marie Lynd Murphy, MD;
Janet R. Casey, MD;
Michael E. Pichichero, MD;
Desmond K. Runyan, MD, DrPH;
William C. Miller, MD, PhD, MPH;
Lisa A. Snider, MD;
Susan E. Swedo, MD
Arch Pediatr Adolesc Med. 2004;158:848-856.
Objective To determine whether group A  -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 -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.
From the Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics (Drs Perrin and Runyan), the Department of Social Medicine (Dr Runyan), and the Division of Infectious Diseases, Department of Medicine, School of Medicine and the Department of Epidemiology, School of Public Health (Dr Miller), University of North Carolina at Chapel Hill, Chapel Hill; Elmwood Pediatric Group, Rochester, NY (Drs Murphy, Casey, and Pichichero); the Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester (Dr Pichichero); the Pediatrics and Developmental Neuropsychiatry Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (Drs Snider and Swedo).
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