Can Strep Infection Cause Obsessive Compulsive Disorder?

Can Strep Infection Cause Obsessive Compulsive Disorder?

A new book, Saving Sammy, sheds light on a controversial childhood illness

strep throat Not all Pandas are cute bamboo-eating mammals. PANDAS is an acronym for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. In laymen's terms, that translates to cases of obsessive compulsive disorder (OCD) and even Tourette's syndrome-like tic behavior, which are linked to untreated strep infections—a hypothesis currently being tested by the National Institute of Mental Health (NIMH).

Many doctors and parents believe that, when left untreated, the streptococcus bacterium that causes strep throat can trigger a sudden-onset form of these conditions in children from age 3 through puberty. The hypothesis: The body launches antibodies against the strep invader, which then mistakenly attack healthy organs, such as the heart, the kidney and the brain. This autoimmune reaction can lead to the abrupt onset, or worsening, of OCD and tics. According to NIMH’s Susan Swedo, M.D., who first described the syndrome in 1998, 10 to 20 percent of children with OCD may have it from PANDAS.

“An untreated strep infection can trigger obsessive-compulsive symptoms and tics in a way very similar to the process that produces rheumatic heart disease and post-strep arthritis,” says Swedo. “These children were perfectly healthy until they ‘caught’ OCD.” If strep is diagnosed and treated quickly, there’s essentially no risk, doctors say.

In Saving Sammy: Curing the Boy Who Caught OCD, author Beth A. Maloney writes about how, even though she wasn’t aware that her son had ever had a strep infection, her otherwise-healthy 12-year-old son suddenly started walking and eating with his eyes shut, and using his limbs instead of his hands to touch light switches, door knobs and faucets. An attorney, Maloney argues that strep caused his obsessive-compulsive disorder—and that medication such as the antibiotic Augmentin cured him.

Not all experts believe that PANDAS is real, however. “It is hypothesized but not proven that strep, treated or not, might trigger a first episode and/or flares of OCD in young children,” says Stanford Shulman, M.D., professor of pediatric infectious disease at Northwestern University’s Feinberg School of Medicine and head of infectious disease at Children’s Memorial Hospital, both in Chicago. “I think it is fair to say that the bulk of evidence doesn’t really support this.”

"The PANDAS nonbelievers are a committed group," Maloney writes in Saving Sammy. Indeed, it's tricky to prove cause-and-effect theories in medicine, especially when they involve frequently occurring conditions such as strep and OCD. According to NIMH, 2.2 million Americans suffer from OCD, which usually begins during childhood or early adolescence.

“When you have two common disorders that are associated with one another, it’s always hard to prove that one causes the other,” says David Darrow, M.D., professor of otolaryngology and pediatrics at Eastern Virginia Medical School and chair of the American Academy of Pediatrics’ Section on Otolaryngology—Head & Neck Surgery.

The National Institutes of Health does recognize PANDAS, but their advice differs from the program that Beth Maloney believes saved her son. For example, they state that antibiotics are not recommended except against active infection, while the doctors who treated Sammy relied on them. Nor do they recommend removing tonsils, which are sometimes associated with frequent infections, but ironically may help fight strep throat.

“It’s reasonable for parents to ask the question: 'Could my child have a strep-related neuropsychiatric disorder?'” says Darrow. “But without appropriate evaluation and accurate diagnosis of both the strep and the behavioral disorder, treatment of recurrent infection with antibiotics or a tonsillectomy would be a real leap.”

Here's what most experts do agree on:

Untreated strep can cause serious medical problems, including rheumatic fever (which affects the heart), acute renal disease and PANDAS.
If you think your child may have strep throat, make an appointment with the pediatrician as soon as possible. "Any time your child has a sore throat that persists (one that doesn't go away after her first drink of juice in the morning), whether or not it is accompanied by fever, headache, stomachache or extreme fatigue, you should call your pediatrician,” recommends the American Academy of Pediatrics.
The doctor can swab your child’s throat, run a strep test, and if positive, prescribe antibiotics. Fortunately, common antibiotics such as penicillin are very effective against strep throat. If there’s no evidence of strep, don’t ask your child’s doctor to prescribe antibiotics.
The flu shot has no effect on strep since flu is a virus and strep is a bacterial infection.
Kids can test positive for strep throat if they have an acute infection, but also if they are simply asymptomatic strep “carriers.” Carriers don't need antibiotics, says Fuad Baroody, M.D., director of pediatric otolaryngology at the University of Chicago.

If your child has or has had strep and is diagnosed with a condition such as OCD, don't assume strep is the cause, says Elizabeth Berger, M.D., a child psychiatrist and author of Raising Kids with Character. You may want to bring the issue up with the doctor, but be aware that “each of these illnesses and syndromes needs to be diagnosed according to established criteria and treated according to established recommendations,” says Berger. “If the child has a problem now, the child can be brought to the doctor. If the child doesn’t seem to have a problem now, I would not rush to bring this child to the doctor.” Of course, Beth Maloney and the doctors who treated Sammy would likely have a different recommendation.

The bottom line: Don’t panic. The vast majority of children with strep throat will not develop a psychiatric problem. “It is very, very rare,” says Swedo.

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