Disorder (OCD) Triggered
By Strep Throat Infection
By H.J. Cummins
Minneapolis-St. Paul Star Tribune
Distributed by Scripps Howard News Service

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.
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.
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.
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.
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.
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.
"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."
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.
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.
"But all we have so far is guesswork," she said.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.