Published online October 31, 2008
PEDIATRICS Vol. 122 No. 5 November 2008, pp. 1157-1158 (doi:10.1542/peds.2008-2642)

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LETTER TO THE EDITOR

The Role of Group A β-Hemolytic Streptococcal Infection in Neuropsychiatric Disorders: In Reply

Roger Kurlan, MD
On Behalf of the Tourette Syndrome Study Group

We appreciate the compliments from Alvarenga et al about our recently published article on the topic of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).¹ We, in turn, want to acknowledge their group for leadership in the investigation of a possible link between rheumatic fever (RF) and obsessive-compulsive disorder (OCD). In discussing a possible etiologic role of group A β-hemolytic streptococcus (GABHS) for OCD or tics, we think that it is critical to not mix information about the RF-related condition and PANDAS, because they may well be very different conditions. PANDAS has been specifically presented as a nonrheumatological entity, with patients having no history of RF and no evidence of the sequelae of RF such as cardiac valvular abnormalities.² It is PANDAS that our study addressed.

We are unable to fully disagree with the conclusion of Alvarenga et al that "GABHS may still have a major role in PANDAS," because as we pointed out, our study was designed to examine the relationship between acute GABHS infection and exacerbations of PANDAS but not the onset of PANDAS. Our results strongly indicate that GABHS infection does not have a major role in exacerbations. The fact that our findings contradict one of the major constructs of the PANDAS hypothesis raises the possibility that GABHS has no etiologic role, but we did not investigate its possible role in onset. We noted that Perrin et al³ followed a large number of children presenting with sore throat in a community pediatrics practice and found no evidence that those whose cultures were positive for GABHS were more likely to develop tics or OCD over the next few months. These findings cast doubt on an etiologic role of GABHS in PANDAS onset.

We agree that further research on the relationship between RF and development of OCD or tics is rational. However, it may not be relevant to the controversy surrounding the veracity of the PANDAS hypothesis.

REFERENCES

1. Kurlan R, Johnson D, Kaplan EL; Tourette Syndrome Study Group. Streptococcal infection and exacerbations of childhood tics and obsessive-compulsive symptoms: a prospective blinded cohort study. Pediatrics. 2008;121 (6):1188 –1197[Abstract/Free Full Text]
2. Swedo SE, Leonard HL, Garvey M, et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases [published correction appears in Am J Psychiatry. 1998;155(4):578]. Am J Psychiatry. 1998;155 (2):264 –271[Abstract/Free Full Text]
3. Perrin EM, Murphy ML, Casey JR, et al. Does group A beta-hemolytic streptococcal infection increase risk for behavioral symptoms in children? Arch Pediatr Adolesc Med. 2004;158 (9):848 –856[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Kurlan, R. Search for Related Content PubMed Articles by Kurlan, R. Related Collections Infectious Disease & Immunity Related AAP Red Book topics: Non-Group A or B Streptococcal and... Group A Streptococcal Infections Social Bookmarking                         What's this?