Detecting pediatric autoimmune neuropsychiatric disorders associated with streptococcus in children with obsessive-compulsive disorder and tics

Biol Psychiatry. 2004 Jan 1;55(1):61-8. doi: 10.1016/s0006-3223(03)00704-2.


Background: A subgroup of children with obsessive-compulsive and tic disorders are proposed to have an infectious trigger. The purpose of this study was to investigate the relationship between group A streptococcal titers and symptom fluctuations in children with a clinical course resembling that described for pediatric autoimmune neuropsychiatric disorders associated with streptococcus.

Methods: Twenty-five children with obsessive-compulsive disorder and/or tic disorder were evaluated for neuropsychiatric severity and group A streptococcal antibody titers (streptolysin O, deoxyribonuclease B, and carbohydrate A) at 6-week intervals for > or = six consecutive evaluations (total visits=277).

Results: Children with large symptom fluctuations (n=15) were compared with children without dramatic fluctuations (n=10). Co-movements of obsessive-compulsive/tic severity and group A streptococcal antibodies were assessed. In subjects with large symptom changes, positive correlations were found between streptococcal titers and obsessive-compulsive severity rating changes (p=.0130). These subjects were also more likely to have elevated group A streptococcal titers during the majority of observations (p=.001). Tic symptom exacerbations occurred more often in the fall/winter months than spring/summer months (p=.03).

Conclusions: Patients with marked obsessive-compulsive/tic symptom changes may be characterized by streptococcal titer elevations and exhibit evidence of seasonal tic exacerbations.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Antibodies, Bacterial / blood
  • Antibodies, Bacterial / immunology*
  • Bacterial Proteins
  • Carbohydrates / immunology
  • Child
  • Deoxyribonucleases / immunology
  • Diagnostic and Statistical Manual of Mental Disorders
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Obsessive-Compulsive Disorder* / diagnosis
  • Obsessive-Compulsive Disorder* / immunology
  • Obsessive-Compulsive Disorder* / microbiology
  • Severity of Illness Index
  • Streptococcal Infections / blood
  • Streptococcal Infections / immunology*
  • Streptococcal Infections / microbiology*
  • Streptolysins / immunology
  • Tics* / diagnosis
  • Tics* / immunology
  • Tics* / microbiology
  • Videotape Recording


  • Antibodies, Bacterial
  • Bacterial Proteins
  • Carbohydrates
  • Streptolysins
  • streptolysin O
  • Deoxyribonucleases
  • deoxyribonuclease B