Tonsillectomies and adenoidectomies do not prevent the onset of pediatric autoimmune neuropsychiatric disorder associated with group A streptococcus

Pediatr Infect Dis J. 2013 Aug;32(8):834-8. doi: 10.1097/INF.0b013e31829062e2.


Background: In children presenting with obsessive compulsive disorder (OCD) and/or tics, especially those with a temporal association with streptococcal pharyngitis (eg, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus), there is speculation about whether tonsillectomy/adenoidectomy might improve the child's neuropsychiatric course. Our objective was to examine whether removal of the tonsils and/or adenoids impacted streptococcal antibody titers, the timing of onset of OCD and/or tics and the clinical severity of these symptoms.

Methods: Study participants (N = 112; average age = 9.2 ± 2.4; 44 women) were recruited as part of a prospective investigation of neuropsychiatric phenomena with temporal association to streptococcal pharyngitis and examined by family history, diagnostic interview, physical examination, medical record review, psychological testing and streptococcal antibodies and divided into surgical or nonsurgical groups. The surgical group consisted of children having previously had a tonsillectomy and/or adenoidectomy (n = 32). The remaining children were categorized as nonsurgical group (n = 76). Measures of OCD and tic severity, streptococcal antibody titers and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus classification were compared between both groups.

Results: There were no significant differences as determined by streptococcal antibody titers, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus classification and OCD or tic severity between the surgical and nonsurgical groups. Most participants had surgery before the onset of neuropsychiatric symptoms and surgery did not affect symptomology.

Conclusions: Streptococcal antibodies and neuropsychiatric symptom severity did not differ on the basis of surgical status. From these data, we cannot infer that tonsillectomy and adenoidectomy are likely to impact positively the course of OCD/tics or streptococcal antibody concentrations.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adenoidectomy
  • Adolescent
  • Antibodies, Bacterial / blood
  • Autoimmune Diseases / immunology
  • Autoimmune Diseases / microbiology*
  • Autoimmune Diseases / psychology*
  • Chi-Square Distribution
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Male
  • Obsessive-Compulsive Disorder / immunology
  • Obsessive-Compulsive Disorder / microbiology*
  • Obsessive-Compulsive Disorder / prevention & control
  • Obsessive-Compulsive Disorder / psychology*
  • Prospective Studies
  • Streptococcal Infections / microbiology
  • Streptococcal Infections / psychology*
  • Streptococcus pyogenes / isolation & purification*
  • Tics / complications
  • Tics / epidemiology
  • Tonsillectomy


  • Antibodies, Bacterial