Skip to main content
Log in

Group A Streptococcal Infections and Childhood Neuropsychiatric Disorders

Relationships and Therapeutic Implications

  • Current Opinion
  • Published:
CNS Drugs Aims and scope Submit manuscript

Summary

Recently, a hypothesis concerning the pathophysiology of some cases of pae-diatric-onset obsessive-compulsive disorder (OCD) and/or tic disorders has been proposed. Infections with group A β-haemolytic streptococci, and perhaps other agents, are believed to trigger an immune response that crossreacts with neurons in the basal ganglia, disrupting their function and resulting in neuropsychiatric symptoms. Therapeutic possibilities derived from this model have been proposed in terms of 4 sequential events that are hypothesised to occur: (i) infection; (ii) generation of an immune response; (iii) reversible injury to the basal ganglia; and (iv) irreversible injury to the basal ganglia. However, at the present time, research supporting any specific therapeutic approach is extremely limited or nonexistent.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. March JS, Leonard HL, Swedo SE. Anxiety disorders in children and adolescents. 11: Obsessive-compulsive disorder. New York: The Guilford Press, 1995: 251–75

    Google Scholar 

  2. Valleni-Basile LA, Garrison CZ, Waller JL, et al. Incidence of obsessive-compulsive disorder in a community sample of young adolescents. J Am Acad Child Adolesc Psychiatry 1996; 35(7): 898–906

    Article  PubMed  CAS  Google Scholar 

  3. American Psychiatric Association. Diagnostic and statistical manual for mental disorders. 4th ed. Washington, DC: American Psychiatric Press Inc, 1994

    Google Scholar 

  4. Leckman JF, Cohen DJ. Tic disorders. In: Lewis M, editor. Child and adolescent psychiatry: a comprehensive textbook. 2nd ed. Baltimore: Williams & Wilkins, 1996: 622–9

    Google Scholar 

  5. Insel TR. Toward a neuroanatomy of obsessive-compulsive disorder. Arch Gen Psychiatry 1992; 49: 739–44

    Article  PubMed  CAS  Google Scholar 

  6. Rapoport JL, Wise SP. Obsessive-compulsive disorder: evidence for basal ganglia dysfunction. Psychopharmacol Bull 1988; 24: 380–4

    PubMed  CAS  Google Scholar 

  7. Leckman JF, Knorr AM, Rasmusson AM, et al. Basal ganglia research and Tourette’s syndromes [letter]. Trends Neurosci 1991; 14: 94

    Article  PubMed  CAS  Google Scholar 

  8. Swedo SE. Sydenham’s chorea: a model for childhood autoimmune neuropsychiatrie disorders. JAMA 1994; 272: 1788–91

    Article  PubMed  CAS  Google Scholar 

  9. Husby G, van de Rijn I, Zabriskie JB, et al. Antibodies reacting with cytoplasm of subthalamic and caudate nuclei neurons in chorea and acute rheumatic fever. J Exp Med 1976; 144: 1094–110

    Article  PubMed  CAS  Google Scholar 

  10. Swedo SE, Leonard HL, Schapiro MB, et al. Sydenham’s chorea: physical and psychological symptoms of St Vitus dance. Pediatrics 1993; 91: 706–13

    PubMed  CAS  Google Scholar 

  11. Swedo SE, Rapoport JL, Leonard H, et al. Obsessive-compulsive disorder in children and adolescents: clinical phenomenology of 70 consecutive cases. Arch Gen Psychiatry 1989; 46: 335–41

    Article  PubMed  CAS  Google Scholar 

  12. Leonard HL, Swedo SE, Lenane MC, et al. A 2- to 7-year follow-up study of 54 obsessive-compulsive children and adolescents. Arch Gen Psychiatry 1993; 50: 429–39

    Article  PubMed  CAS  Google Scholar 

  13. Rettew DC, Swedo SE, Leonard HL, et al. Obsessions and compulsions across time in 79 children and adolescents with obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry 1992; 31: 1050–6

    Article  PubMed  CAS  Google Scholar 

  14. Neurological examination. In: Denckla MB, Rapoport JL, editors. Obsessive-compulsive disorder in children and adolescents. Washington, DC: American Psychiatrie Press Inc, 1989: 107–18

  15. Osler W. On chorea and choreiform affections. Philadelphia: P. Blakiston, Son & Co., 1894: 33

    Google Scholar 

  16. Selling L. The role of infection in the etiology of tics. Arch Neurol Psychiatry 1929; 22: 1163–71

    Google Scholar 

  17. Kerbeshian J, Burd L, Pettit R. A possible post-streptococcal movement disorder with chorea and tics. Dev Med Child Neurol 1990; 32: 642–4

    Article  PubMed  CAS  Google Scholar 

  18. Kiessling LS, Marcotte AC, Culpepper L. Antineuronal antibodies in movement disorders. Pediatrics 1993; 92: 39–43

    PubMed  CAS  Google Scholar 

  19. Swedo SE, Leonard HL, Kiessling LS. Speculations on antineuronal antibody-mediated neuropsychiatrie disorders of childhood. Pediatrics 1994; 93: 323–6

    PubMed  CAS  Google Scholar 

  20. Allen AJ, Leonard HL, Swedo SE. Case study: a new infectiontriggered, autoimmune subtype of pediatric OCD and Tourette’s syndrome. J Am Acad Child Adolesc Psychiatry 1995; 34(3): 307–11

    Article  PubMed  CAS  Google Scholar 

  21. Kiessling LS, Marcotte AC, Culpepper L. Antineuronal antibodies: tics and obsessive-compulsive symptoms. Dev Behav Pediatrics 1994; 15(6): 421–5

    CAS  Google Scholar 

  22. Swedo SE, Leonard HL, Mittleman B, et al. Identification of children with pediatric autoimmune neuropsychiatrie disorders associated with streptococcal infections by a marker associated with rheumatic fever. Am J Psychiatry 1997; 154: 110–2

    PubMed  CAS  Google Scholar 

  23. Swedo SE, Leonard HL, Garvey M, et al. Pediatric Autoimmune Neuropsychiatrie Disorders Associated with Streptococcal infections (PANDAS): a clinical description of the first fifty cases. Am J Psychiatry. In press

  24. Tucker DM, Leckman JF, Scahill L, et al. A putative poststreptococcal case of OCD with chronic tic disorder, not otherwise specified. J Am Acad Child Adolesc Psychiatry 1996; 35(12): 1684–91

    Article  PubMed  CAS  Google Scholar 

  25. Khanna AK, Buskirk DR, Williams Jr RC, et al. Presence of a non-HLA B cell antigen in rheumatic fever patients and their families as defined by a monoclonal antibody. J Clin Invest 1989; 83: 1710–6

    Article  PubMed  CAS  Google Scholar 

  26. Gibofsky A, Khanna A, Suh E, et al. The genetics of rheumatic fever: relationship to streptococcal infection and autoimmune disease. J Rheumatol Suppl 1991; 30: 1–5

    PubMed  CAS  Google Scholar 

  27. Kemeny E, Husby G, Williams Jr RC, et al. Tissue distribution of antigen(s) defined by monoclonal antibody D8/17 reacting with B lymphocytes of patients with rheumatic heart disease. Clin Immunol Immunopathol 1994; 72: 35–43

    Article  PubMed  CAS  Google Scholar 

  28. Murphy TK, Goodman WK, Fudge MW, et al. B lymphocyte antigen D8/17: a peripheral marker for childhood-onset obsessive-compulsive disorder and Tourette’s syndrome. Am J Psychiatry 1997; 154: 402–7

    PubMed  CAS  Google Scholar 

  29. Berrios X, Quesney F, Morales A, et al. Are all recurrences of pure Sydenham chorea true recurrences of acute rheumatic fever? J Pediatr 1985; 107: 867–72

    Article  PubMed  CAS  Google Scholar 

  30. Cheyette SR, Cummings JL. Encephalitis lethargica: lessons for contemporary neuropsychiatry. J Neuropsychiatry Clin Neurosci 1995; 7: 125–34

    PubMed  CAS  Google Scholar 

  31. Vollmer TL. Multiple sclerosis: new approaches to immunotherapy. Neuroscientist 1996; 2(2): 127–36

    Article  Google Scholar 

  32. American Psychiatrie Association. Diagnostic and statistical manual of mental disorders. 3rd rev. ed. Washington, DC: American Psychiatrie Association, 1987

    Google Scholar 

  33. Sokol MS, Gray NS. Case study: an infection-triggered, autoimmune subtype of anorexia nervosa. J Am Acad Child Adolesc Psychiatry 1997; 36: 1128–33

    Article  PubMed  CAS  Google Scholar 

  34. Knecht JG. Sydenham’s chorea: a case report of neurologic sequelae in the foot. J Am Podiatry Assoc 1983; 73: 581–5

    PubMed  CAS  Google Scholar 

  35. Bird MT, Palkes H, Prensky AL. A follow-up study of Sydenham’s chorea. Neurology 1976; 26: 601–6

    Article  PubMed  CAS  Google Scholar 

  36. Amigo M-C, Martinez-Lavin M, Reyes PA. Acute rheumatic fever. Rheum Dis Clin North Am 1993; 19(2): 333–50

    PubMed  CAS  Google Scholar 

  37. Froude JR, Gibofsky A, Zabriskie JB. Rheumatic fever. Curr Opin Rheumatol 1989; 1: 205–8

    Article  PubMed  CAS  Google Scholar 

  38. Medaglini D, Pozzi G, King TP, et al. Mucosal and systemic immune responses to recombinant protein expressed on the surface of the oral commensal bacterium Streptococcus gordonii after oral colonization. Proc Natl Acad Sci USA 1995; 92(15): 6868–72

    Article  PubMed  CAS  Google Scholar 

  39. Fischetti VA, Bessen DE, Schneewind O, et al. Protection against streptococcal pharyngeal colonization with vaccines composed of M protein conserved regions. In: Atassi MZ, editor. Immunobiology of proteins and peptides. New York: Plenum Press, 1991: 159–67

    Chapter  Google Scholar 

  40. Weiner HL, Friedman A, Miller A, et al. Oral tolerance: immunologic mechanisms and treatment of animal and human organ-specific autoimmune diseases by oral administration of autoantigens. Annu Rev Immunol 1994; 12: 809–37

    Article  PubMed  CAS  Google Scholar 

  41. Ridgway WM, Weiner HL, Fathman CG. Regulation of autoimmune response. Curr Opin Immunol 1994; 6: 946–55

    Article  PubMed  CAS  Google Scholar 

  42. Friedman A, al-Sabbagh A, Santos LM, et al. Oral tolerance: a biologically relevant pathway to generate peripheral tolerance against external and self antigens. Chem Immunol 1994; 58: 259–90

    Article  PubMed  CAS  Google Scholar 

  43. Matarazzo EB. Tourette’s syndrome treated with ACTH and prednisone: report of two cases. J Child Adolesc Psycho-pharmacol 1992; 2(3): 215–26

    Article  CAS  Google Scholar 

  44. Brown KS. New uses for thalidomide yielding valuable lessons. Scientist 1997 Feb 3; 11(3): 1, 8

    Google Scholar 

  45. Drachman DB. Myasthenia gravis. N Engl J Med 1994; 330: 1797–810

    Article  PubMed  CAS  Google Scholar 

  46. Kreeger KY. New molecular targets reviving anti-inflammatory therapeutics. Scientist 1997 Jul 7; 11(14): 1, 6

    Google Scholar 

  47. Spector SL. Management of asthma with zafirlukast: clinical experience and tolerability profile. Drugs 1996; 52 Suppl. 6: 36–46

    Article  PubMed  Google Scholar 

  48. Wenzel SE. Arachidonic acid metabolites: mediators of inflammation in asthma. Pharmacotherapy 1997; 17 (1 Pt 2): 3S–12S

    PubMed  CAS  Google Scholar 

  49. Anxiety disorders. In: Kaplan HI, Sadock BJ, Grebb JA, editors. Synopsis of psychiatry. 7th ed. Baltimore: Williams & Wilkins, 1994: 573-616

  50. Tic disorders. In: Kaplan HI, Sadock BJ, Grebb JA, editors. Synopsis of psychiatry. 7th ed. Baltimore: Williams & Wilkins, 1994: 1080-7

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Albert J. Allen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Allen, A.J. Group A Streptococcal Infections and Childhood Neuropsychiatric Disorders. CNS Drugs 8, 267–275 (1997). https://doi.org/10.2165/00023210-199708040-00001

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00023210-199708040-00001

Keywords

Navigation