Antistreptolysin O Titers, Symptom Burden, and Multidimensional Correlates in Children with Suspected Streptococcal-Associated Neuropsychiatric Presentations: A Cross-Sectional Observational Study in a Clinically Referred Cohort

SUMMARY

This cross-sectional observational study examined the relationship between antistreptolysin O (ASO) titers and neuropsychiatric symptom burden in children and adolescents evaluated in Romanian in-patient and outpatient psychiatric settings who had a history suggestive of strep exposure.

Researchers found higher ASO values were associated with a more recent reported strep infection, higher PANS-31 item symptom rating scale scores, and abrupt symptom onset. Those with a higher PANS-31 score also demonstrated a history of recurrent infections, functional digestive symptoms, prematurity, and selected EEG abnormalities.

Selected EEG abnormalities were associated with higher ASO and symptom burden, but were not considered diagnostic of PANS/PANDAS. Similarly, the PANS-31 findings support its use for assessing symptom burden, but are not considered a stand-alone diagnostic threshold. The authors interpreted elevated Antistreptolysin O (ASO) titers as supportive evidence of prior strep exposure or infection, but do not consider them a definitive marker for determining a PANS/PANDAS diagnosis.

Overall, the study supports a multifaceted approach in which clinical symptom presentation, laboratory findings, and type of onset are considered collectively when evaluating possible PANS or PANDAS.

LINK TO PAPER: https://www.mdpi.com/2673-5318/7/4/155