- One Friday night last February, an 8-year-old
boy in Minneapolis went to bed with an infection of strep throat. He slept
well. But he woke Saturday convinced that the world had been contaminated
by graphite, the "lead" in the center of pencils.
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- He knew there were pencils in his desk
at school, in his mom's kitchen drawers, and even in the hands of his beloved
sister and brother.
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- He rose to his toes and stepped scrupulously
close to the wall as he went to warn his family. He avoided the hall carpet
as best he could, for it surely was contaminated -- if not by pencils,
then by fallen erasers. Or shoes that had stepped accidentally on erasers.
Or even a hand that had tied such a shoe.
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- That winter weekend this boy came down
with strep-induced obsessive-compulsive disorder (OCD), an illness so newly
recognized, but probably rare, that even the National Institute of Mental
Health (NIMH) is just beginning its research on it. OCD is not new, but
the idea that it might be triggered by an infection of an ordinary strep
A bacteria is unexpected.
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- Doctors don't believe this is a case
of another new, mutated supergerm. There are glimpses of the phenomenon
in medical literature of the early 1800s. But it's only in the past few
years, with the coming of brain scans and sophisticated blood tests, that
the disorder has been connected to strep throat, a common childhood illness.
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- Life for Andrew, now 9, changed literally
overnight. He and his family agreed to be interviewed, and the Star Tribune
agreed to use only their first names to protect their privacy.
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- "What's difficult for families is
that virtually everybody has had strep," said Elizabeth Reeve, a child
psychiatrist at Regions Hospital in St. Paul, Minn., and Andrew's doctor.
"I try to be optimistic. Just the fact we have more knowledge and
more understanding makes it more likely we're going to find more help and
more answers."
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- Psychiatrists began to pick up on strep-induced
OCD a few years ago, in part because its onset is extraordinarily fast
-- sometimes only a matter of a day or two. They quickly noticed that all
youngsters affected so suddenly had strep throats.
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- Sue Swedo, a physician at the NIMH, is
a leading researcher in the field. She said scientists don't know how common
this phenomenon is. Some data indicate that one in 100 to 200 youngsters
has OCD, she said. Other, unpublished research estimates that about half
of those had the "rapid onset" associated with the strep virus.
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- "But all we have so far is guesswork,"
she said.
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- Many people were introduced to obsessive-compulsive
disorder through Jack Nicholson's character in the movie "As Good
As It Gets." Like Nicholson, many with the disorder endlessly feel
compelled to wash their hands, or to check that a door is locked or a light
is on or off. Behind those compulsions is an obsessive worry that if they
fail in these tasks, some vague but bad thing will happen.
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- In Andrew's case, he washed his hands
until they blistered. If his feet touched his pants legs in any way, he'd
have to change into freshly laundered trousers. One Sunday in church, after
Andrew's mother put her hand on his shoulder, he had to remove the now-contaminated
shirt.
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- Swedo said this is what researchers know
about the course that strep-induced OCD runs: It hits youngsters before
puberty, but not necessarily with a child's first strep throat. Typically
the strep brings an explosion of OCD symptoms, which then fade over several
months. But the symptoms are likely to reappear with any later strep throats.
And, as in the first illness, they often fade over time, but sometimes
they don't.
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- Because doctors have tracked these youngsters
only a couple of years, Reeve said, no one knows how the disorder will
play out over each child's lifetime.
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- Scientists believe that youngsters who
come down with strep-induced OCD have some sort of predisposition to it.
They are the same youngsters who would be prone to rheumatic fever, another
aftereffect of strep infections.
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- Swedo said researchers are just beginning
to look into the possibility of strep-induced OCD in adults. The disorder,
overall, has several known causes, Reeve said, including certain brain
tumors, brain injuries and stress. The 1918 flu epidemic, which spiked
the worldwide count of encephalitis, also left huge numbers of OCD cases,
she said.
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- Prevention for strep-related OCD seems
improbable. Swedo said it does not look like a promising idea to keep affected
youngsters permanently on antibiotics to try to stop a strep infection
before it starts. Missing a single dose opens the child to two to three
days of vulnerability. And perfect compliance is hard with children.
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- The institute is testing several treatments
involving blood, Swedo said. Researchers have had good results with intravenous
immunoglobulin, essentially proteins that neutralize aberrant antibodies.
Two other procedures also reduced OCD symptoms in children in small test
groups. One is "blood cleansing," a process that involves removing
a child's own blood, replacing the plasma in it with a protein solution,
and then returning the mix to the child. The other treatment, "pooled
human donor product," pools tiny proteins from thousands of donors
and thus is seen as less practical.
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- Ultimately, there's hope for a strep
vaccine. Within the next few months, Vincent Fischetti at Rockefeller University
in New York said he will start clinical trials on a nose-and-mouth spray
that he developed. He said he has had wide success with the spray in animal
tests, and if it's effective on people, he expects the vaccine to be generally
available in four to five years.
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- In the meantime, researchers are asking
parents and pediatricians to be especially vigilant about any emotional
changes in youngsters found to have strep throat. They also advised that
psychiatrists treat youngsters who have strep-induced OCD as they would
anyone with obsessive-compulsive disorder, Reeve said. That could include
antidepressants and behavior-modification therapies designed to ease youngsters
into recognizing that their fears are unrealistic.
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