ORIGINAL ARTICLE

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

  1. DAVIDE MARTINO1,
  2. FLAVIA CHIAROTTI2,
  3. MAURA BUTTIGLIONE3,
  4. FRANCESCO CARDONA4,
  5. ROBERTA CRETI2,
  6. NARDO NARDOCCI5,
  7. GRAZIELLA OREFICI2,
  8. EDVIGE VENESELLI6,
  9. RENATA RIZZO7,
  10. ON BEHALF OF THE ITALIAN TOURETTE SYNDROME STUDY GROUP†

Article first published online: 17 JUN 2011

DOI: 10.1111/j.1469-8749.2011.04018.x

Issue

Developmental Medicine & Child Neurology

Developmental Medicine & Child Neurology

Volume 53, Issue 10, pages 951–957, October 2011

Additional Information

How to Cite

MARTINO, D., CHIAROTTI, F., BUTTIGLIONE, M., CARDONA, F., CRETI, R., NARDOCCI, N., OREFICI, G., VENESELLI, E., RIZZO, R. and ON BEHALF OF THE ITALIAN TOURETTE SYNDROME STUDY GROUP (2011), The relationship between group A streptococcal infections and Tourette syndrome: a study on a large service-based cohort. Developmental Medicine & Child Neurology, 53: 951–957. doi: 10.1111/j.1469-8749.2011.04018.x

Author Information

  1. 1

     Department of Neurological and Psychiatric Sciences, University of Bari, Bari.

  2. 2

     Istituto Superiore di Sanità, Rome.

  3. 3

     Department of Biomedical Sciences and Human Oncology, University of Bari, Bari.

  4. 4

     Department of Child and Adolescent Neuropsychiatry, University of Rome ‘La Sapienza’, Rome.

  5. 5

     Besta Neurological Institute, Milan.

  6. 6

     Istituto G Gaslini, Genoa.

  7. 7

     Child and Adolescent Neuropsychiatry, Department of Paediatrics, University of Catania, Italy.

  1. †

    A list of other members of the Italian Tourette Syndrome Study Group can be found in Appendix S1 (supporting information online).

*Dr Davide Martino at Department of Neurological and Psychiatric Sciences, University of Bari, Piazza Giulio Cesare 11, I-70124 Bari, Italy. E-mail: davidemartino@virgilio.it

Publication History

  1. Issue published online: 6 SEP 2011
  2. Article first published online: 17 JUN 2011
  3. PUBLICATION DATA Accepted for publication 11th April 2011. Published online 17th June 2011.

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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.

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