Sudden-Onset Acute Obsessive-Compulsive Disorder Associated with Streptococcus and Brain MRI Hyperintensity in a Young Adult
Background: Pediatric autoimmune neuropsychiatric disorders associated with streptococcal (strep) infections (PANDAS) are a recognized medical entity among children. But evidence for strep-mediated sudden-onset obsessive–compulsive disorder (OCD) in young adults is very limited. Delayed strep assess...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-01-01
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| Series: | Healthcare |
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| Online Access: | https://www.mdpi.com/2227-9032/12/2/226 |
| _version_ | 1797343602694684672 |
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| author | Joan Jory Kenneth Handelman |
| author_facet | Joan Jory Kenneth Handelman |
| author_sort | Joan Jory |
| collection | DOAJ |
| description | Background: Pediatric autoimmune neuropsychiatric disorders associated with streptococcal (strep) infections (PANDAS) are a recognized medical entity among children. But evidence for strep-mediated sudden-onset obsessive–compulsive disorder (OCD) in young adults is very limited. Delayed strep assessment and treatment may negatively impact clinical outcomes. Methods: We describe a young adult with acute sudden-onset OCD (age 24), treated unsuccessfully with medication and therapy for 3 years. At age 27, antistreptolysin-O (ASO) was tested, based on extensive pediatric history of strep infections. Antibiotic treatment was initiated. Results: Magnetic resonance imaging (MRI) identified a new temporal lobe hyperintensity at OCD onset (age 24), which persisted at ages 25 and 30. ASO titers were elevated from age 27 through 29. Following Amoxicillin treatment, ASO initially increased. Subsequent Amoxicillin + Clavulin treatment produced improved OCD symptoms and treatment response, with no adverse effects. Conclusion: These results strongly suggest an association among strep infection, neuro-inflammation and sudden-onset OCD in this young adult whose response to medication and therapy was successful only after high-dose antibiotic intervention. Greater OCD remission potential may be possible with earlier identification and antibiotic treatment than 3 years post OCD onset. These findings add to the limited literature on strep as an etiology of the sudden-onset of OCD in young adults. They also lend urgency to increased frontline awareness for early strep and ASO assessment in sudden-onset acute OCD among young adults. |
| first_indexed | 2024-03-08T10:50:10Z |
| format | Article |
| id | doaj.art-3accc0abef05468ea9285e0f1f7e6610 |
| institution | Directory Open Access Journal |
| issn | 2227-9032 |
| language | English |
| last_indexed | 2024-03-08T10:50:10Z |
| publishDate | 2024-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Healthcare |
| spelling | doaj.art-3accc0abef05468ea9285e0f1f7e66102024-01-26T16:47:22ZengMDPI AGHealthcare2227-90322024-01-0112222610.3390/healthcare12020226Sudden-Onset Acute Obsessive-Compulsive Disorder Associated with Streptococcus and Brain MRI Hyperintensity in a Young AdultJoan Jory0Kenneth Handelman1Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON L8N 3K7, CanadaDepartment of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, ON L8N 3K7, CanadaBackground: Pediatric autoimmune neuropsychiatric disorders associated with streptococcal (strep) infections (PANDAS) are a recognized medical entity among children. But evidence for strep-mediated sudden-onset obsessive–compulsive disorder (OCD) in young adults is very limited. Delayed strep assessment and treatment may negatively impact clinical outcomes. Methods: We describe a young adult with acute sudden-onset OCD (age 24), treated unsuccessfully with medication and therapy for 3 years. At age 27, antistreptolysin-O (ASO) was tested, based on extensive pediatric history of strep infections. Antibiotic treatment was initiated. Results: Magnetic resonance imaging (MRI) identified a new temporal lobe hyperintensity at OCD onset (age 24), which persisted at ages 25 and 30. ASO titers were elevated from age 27 through 29. Following Amoxicillin treatment, ASO initially increased. Subsequent Amoxicillin + Clavulin treatment produced improved OCD symptoms and treatment response, with no adverse effects. Conclusion: These results strongly suggest an association among strep infection, neuro-inflammation and sudden-onset OCD in this young adult whose response to medication and therapy was successful only after high-dose antibiotic intervention. Greater OCD remission potential may be possible with earlier identification and antibiotic treatment than 3 years post OCD onset. These findings add to the limited literature on strep as an etiology of the sudden-onset of OCD in young adults. They also lend urgency to increased frontline awareness for early strep and ASO assessment in sudden-onset acute OCD among young adults.https://www.mdpi.com/2227-9032/12/2/226adultantistreptolysinMRIOCDstreptococcusstrep |
| spellingShingle | Joan Jory Kenneth Handelman Sudden-Onset Acute Obsessive-Compulsive Disorder Associated with Streptococcus and Brain MRI Hyperintensity in a Young Adult Healthcare adult antistreptolysin MRI OCD streptococcus strep |
| title | Sudden-Onset Acute Obsessive-Compulsive Disorder Associated with Streptococcus and Brain MRI Hyperintensity in a Young Adult |
| title_full | Sudden-Onset Acute Obsessive-Compulsive Disorder Associated with Streptococcus and Brain MRI Hyperintensity in a Young Adult |
| title_fullStr | Sudden-Onset Acute Obsessive-Compulsive Disorder Associated with Streptococcus and Brain MRI Hyperintensity in a Young Adult |
| title_full_unstemmed | Sudden-Onset Acute Obsessive-Compulsive Disorder Associated with Streptococcus and Brain MRI Hyperintensity in a Young Adult |
| title_short | Sudden-Onset Acute Obsessive-Compulsive Disorder Associated with Streptococcus and Brain MRI Hyperintensity in a Young Adult |
| title_sort | sudden onset acute obsessive compulsive disorder associated with streptococcus and brain mri hyperintensity in a young adult |
| topic | adult antistreptolysin MRI OCD streptococcus strep |
| url | https://www.mdpi.com/2227-9032/12/2/226 |
| work_keys_str_mv | AT joanjory suddenonsetacuteobsessivecompulsivedisorderassociatedwithstreptococcusandbrainmrihyperintensityinayoungadult AT kennethhandelman suddenonsetacuteobsessivecompulsivedisorderassociatedwithstreptococcusandbrainmrihyperintensityinayoungadult |