Streptococcal upper respiratory tract infections and exacerbations of tic and obsessive-compulsive symptoms: A prospective longitudinal study

James F. Leckman, Robert A. King, Donald L. Gilbert, Barbara J. Coffey, Harvey S. Singer, Leon S. Dure IV, Heidi Grantz, Liliya Katsovich, Haiqun Lin, Paul J. Lombroso, Ivana Kawikova, Dwight R. Johnson, Roger M. Kurlan, Edward L. Kaplan

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117 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)108-118.e3
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number2
StatePublished - Feb 2011
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Developmental and Educational Psychology
  • Psychiatry and Mental health


  • Tourette syndrome
  • group A β hemolytic streptococci
  • obsessive-compulsive disorder
  • pediatric neuropsychiatric disorders associated with streptococcal infections (PANDAS)
  • streptococcal infections


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