The relationship between group A streptococcal infections and Tourette syndrome: a study on a large service-based cohort

Dev Med Child Neurol. 2011 Oct;53(10):951-7. doi: 10.1111/j.1469-8749.2011.04018.x. Epub 2011 Jun 17.


Aim: To evaluate the relationship between diagnosis and clinical course of Tourette syndrome and group A Streptococcus (GAS).

Method: GAS infections, anti-streptococcal, and anti-basal ganglia antibodies (ABGA) were compared between 168 patients (136 males, 32 females) with Tourette syndrome; (median [range] age [25th-75th centile] 10y [8-11y]); median Tourette syndrome duration (25th-75th centile), 3y (1y 3mo-5y 9mo) and a comparison group of 177 patients (117 males, 60 females) with epileptic or sleep disorders median age [25th-75th centile], 10y [8y-1y 6mo]). One hundred and forty-four patients with Tourette syndrome were followed up at 3-month intervals; exacerbations of tics, obsessive-compulsive symptoms, and other psychiatric comorbidities were defined by a bootstrap procedure. The effect of new GAS infections and identification of new ABGA upon risk of exacerbation was assessed using logistic regression analysis.

Results: Cross-sectionally, patients with Tourette syndrome exhibited a higher frequency of GAS infection (8% vs 2%; p=0.009), higher anti-streptolysin O (ASO) titres (246 [108-432] vs 125 [53-269]; p<0.001), and higher ABGA frequency (25% vs 8%; p<0.001) than the comparison group. On prospective analysis, ASO titres were persistently elevated in 57% of patients with Tourette syndrome; however, new infections or newly identified ABGA did not predict clinical exacerbations (all p>0.05).

Interpretation: Patients with Tourette syndrome might be more prone to GAS infections and develop stronger antibody responses to GAS, probably as a result of underlying immune dysregulation. New GAS infections are unlikely to exert, years after their onset, a major effect upon the severity of neuropsychiatric symptoms.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attention Deficit Disorder with Hyperactivity / epidemiology
  • Child
  • Child, Preschool
  • Cohort Studies
  • Cross-Sectional Studies
  • Developmental Disabilities / epidemiology*
  • Female
  • Humans
  • Infant
  • Learning Disabilities / diagnosis
  • Learning Disabilities / etiology
  • Logistic Models
  • Male
  • Obsessive-Compulsive Disorder / epidemiology
  • Psychiatric Status Rating Scales
  • Severity of Illness Index
  • Streptococcal Infections / complications
  • Streptococcal Infections / diagnosis*
  • Streptococcal Infections / epidemiology*
  • Tourette Syndrome / complications
  • Tourette Syndrome / diagnosis*
  • Tourette Syndrome / epidemiology*