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could be an important article and relate eventually to some types of IBS: Vol. 287 No. 7,February 20, 2002 Medical News & Perspectives See Related:Authors' Articles Return toTable of Contents Strep A, Neuropsychiatric Disorders Tie Found Joan Stephenson, PhD ChicagoThe abrupt onset of obsessive-compulsive disorder (OCD) and tic disorders in children appears to be linked in some cases to acute streptococcal infections and may respond to prompt treatment with antibiotics, according to findings presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy.Previous research had linked a sudden appearance of neuropsychiatric symptoms (such as obsessions, compulsions, and motor or vocal tics, alone or in combination) following a strep throat infection caused by group A -hemolytic Streptococcus (GABHS)an association known as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, or PANDAS.The new work, which is the first study to identify children at the onset of a first episode of PANDAS and follow them prospectively, confirms the association of such symptoms and acute GABHS tonsillopharyngitis and demonstrates that the symptoms may respond to appropriate antibiotic treatment, said Michael Pichichero, MD, of the University of Rochester Medical Center in Rochester, NY, who presented the findings.During a 3-year period (1998-2001), Pichichero and Marie Lynd Murphy, MD, of the Elmwood Pediatric Group in suburban Rochester, identified 12 children who were experiencing a first episode of neuropsychiatric symptoms that met PANDAS criteria. Such criteria include presence of OCD or a tic disorder, onset of symptoms in childhood, abrupt onset and episodic course of symptoms, association of GABHS infections (a positive throat culture for strep or a history of scarlet fever), and GABHS in association with neurological abnormalities (such as hyperactivity and tics).Unlike typical OCD, which presents during the teen years and is characterized by a gradual onset over months to years, patients in this study were much younger (aged 5-11 years) and experienced an explosive onset of symptoms that sometimes could be pinpointed to a particular day. Parents sought care for their children because they suddenly began to show severe obsessive-compulsive behavior, including a constant urge to urinate, excessive hand washing, and preoccupation with germs. In fact, more than half the children were initially examined for a possible urinary tract infection, which was ruled out in all of them, said Pichichero."Most obsessive thoughts were in the categories of fears: fear of germs, illness, death, or harm to self or a loved one," the researchers said. "Many presented with a compulsive urinary frequency or ritualistic urinary hygiene or a compulsive need to remain with their parent," they said.Some children exhibited a recurrence of behavioral symptoms even before the throat culture results were positivebut when they returned as instructed 72 hours later and were retested, the cultures confirmed a diagnosis of GABHS infection. Symptoms disappeared in an average of 14 days when the children were treated with an antibiotic such as penicillin or a cephalosporin.Half of the children had at least one recurrence of OCD associated with GABHS disease, and there was a seasonal peak of episodes between September and April. "Negative GABHS throat cultures were obtained prospectively before PANDAS became manifest and after antibiotic treatment/before recurrences, supporting the premise that these were not GABHS carriers," the researchers noted.Symptoms that flared during recurrences again subsided after antibiotic therapy."This finding is in contrast to documented lack of response to antibiotics when children with long-standing PANDAS have been treated with antibiotics," said Pichichero. He and colleagues at the Elmwood Pediatric Group are now involved in a study of the link between GABHS and symptoms such as behavioral changes and tics in 800 children400 with strep and 400 controls.In addition, two National Institute of Mental Health-sponsored trials are now recruiting participants for two trials aimed at treating or preventing neuropsychiatric symptoms related to strep infection: one studying plasma exchange as a treatment for OCD and tic disorder symptoms in children with PANDAS and the other examining whether antibiotic streptococcal prophylaxis can prevent strep-related OCD and tics. Information about the trials is available online at http://www.nimh.nih.gov/studies/3anxdisocdtourette.cfm). � 2002 American Medical Association. All rights reserved. Choose a JournalJAMAMedical Student JAMAJAMA Information CentersScience News UpdateAmerican Medical NewsArchives of
ermatologyFacial Plastic SurgeryFamily MedicineGeneral PsychiatryInternal MedicineNeurologyOphthalmologyOtolaryngology - Head and Neck SurgeryPediatrics and Adolescent MedicineSurgery tom
 
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