---
title: "Streptococcal upper respiratory infection and child psychiatric outcomes"
id: "pubmed-42765389"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42765389"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42765389/"
doi: "10.1017/S0033291726105820"
published_at: "2026-09-21T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Streptococcal upper respiratory infection and child psychiatric outcomes
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42765389
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42765389/)
- **DOI:** [10.1017/S0033291726105820](https://doi.org/10.1017%2FS0033291726105820)
- **Published At:** 2026-09-21T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This large retrospective cohort study used the TriNetX federated electronic health-record network to examine psychiatric outcomes after pediatric streptococcal versus non-streptococcal acute upper respiratory infection (URTI). - Children aged 3–16 with an acute URTI (ICD-10 J00–J06) and a Streptococcus pyogenes test result within 2 weeks were identified and grouped by test positivity. - Initial cohorts comprised 464,513 streptococcal-positive and 1,023,171 streptococcal-negative children; after propensity matching on 70 baseline variables, each cohort contained 456,221 children, 48% female. - Primary endpoints were 1-year incidence of any psychiatric disorder, and prespecified outcomes of **obsessive-compulsive disorder (OCD)**, **tic disorder**, **anxiety disorder**, and restricted oral intake. - At 1 year the streptococcal-positive group had a lower risk of any psychiatric disorder (RR 0.92, 95% CI 0.90–0.94), lower risk of restricted oral intake (RR 0.81, 95% CI 0.77–0.86), and a modestly lower risk of anxiety disorder (RR 0.94, 95% CI 0.91–0.97). - Risks of **OCD** (RR 0.98, 95% CI 0.86–1.12) and **tic disorder** (RR 0.95, 95% CI 0.87–1.04) did not differ significantly between cohorts. - The authors concluded there was no evidence that exposure to **Streptococcus pyogenes** was associated with increased risk of the measured psychiatric outcomes in this sample. - Keywords and context include PANDAS and immunopsychiatry; the paper addresses a long-standing hypothesis about streptococcal infections and subsequent psychiatric conditions in children. - Specifics beyond the abstract (for example detailed demographics, geographic distribution, testing methods, antibiotic use, follow-up completeness, or sensitivity analyses) were not reported in the provided source text.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK. * 2 MRC Social Genetic and Developmental Psychiatry Research Centre: King's College London, UK. * 3 TriNetX LCC, Cambridge, USA. * 4 Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience: King's College London, UK. * PMID: **42765389** * DOI: [ 10.1017/S0033291726105820 ](https://doi.org/10.1017/s0033291726105820) Item in Clipboard # Psychiatric outcomes after streptococcal upper respiratory tract infection in children Danish Hafeez et al. Psychol Med. 2026. Show details Display options Display options Format Abstract PubMed PMID Psychol Med Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Psychol+Med%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Psychol+Med%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42765389/) . 2026 Sep 21:56:e282. doi: 10.1017/S0033291726105820. ### Authors [Danish Hafeez](https://pubmed.ncbi.nlm.nih.gov/?term=Hafeez+D&cauthor_id=42765389)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42765389/#short-view-affiliation-1 "Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK."), [Katharine Lynch-Kelly](https://pubmed.ncbi.nlm.nih.gov/?term=Lynch-Kelly+K&cauthor_id=42765389)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42765389/#short-view-affiliation-1 "Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK."), [Cameron Watson](https://pubmed.ncbi.nlm.nih.gov/?term=Watson+C&cauthor_id=42765389)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42765389/#short-view-affiliation-2 "MRC Social Genetic and Developmental Psychiatry Research Centre: King's College London, UK."), [Sarah Williford](https://pubmed.ncbi.nlm.nih.gov/?term=Williford+S&cauthor_id=42765389)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42765389/#short-view-affiliation-3 "TriNetX LCC, Cambridge, USA."), [Mark Edwards](https://pubmed.ncbi.nlm.nih.gov/?term=Edwards+M&cauthor_id=42765389)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42765389/#short-view-affiliation-4 "Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience: King's College London, UK."), [Thomas A Pollak](https://pubmed.ncbi.nlm.nih.gov/?term=Pollak+TA&cauthor_id=42765389)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42765389/#short-view-affiliation-1 "Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.") ### Affiliations * 1 Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK. * 2 MRC Social Genetic and Developmental Psychiatry Research Centre: King's College London, UK. * 3 TriNetX LCC, Cambridge, USA. * 4 Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience: King's College London, UK. * PMID: **42765389** * DOI: [ 10.1017/S0033291726105820 ](https://doi.org/10.1017/s0033291726105820) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** Associations between childhood streptococcal upper respiratory infections and subsequent psychiatric outcomes have been described for over 25 years, although clinical evidence remains limited. This study explored psychiatric outcomes after pediatric streptococcal versus non-streptococcal upper respiratory tract infections. **Methods:** This retrospective cohort study used TriNetX, a global federated health research network of over 150 million deidentified electronic medical records. We compared children aged 3-16 with a diagnosis of acute upper respiratory infection (ICD-10 J00-J06) and a _Streptococcus pyogenes_ test result (positive or negative) within 2 weeks, propensity matched on 70 baseline variables. Main outcomes were the 1-year incidence of any psychiatric disorder, obsessive-compulsive disorder (OCD), tic disorder, anxiety, and restricted oral intake. **Results:** Before matching, 464,513 children were streptococcal positive and 1,023,171 children were streptococcal negative. After matching, there were 456,221 children in each cohort (48% female). The streptococcal-positive cohort had a reduced risk of any psychiatric disorder (RR 0.92 [0.90, 0.94]), restricted oral intake (0.81 [0.77, 0.86]), and anxiety disorder (0.94 [0.91, 0.97]) at 1 year. Risk of OCD (RR 0.98 [0.86, 1.12]) and tic disorder (RR 0.95 [0.87, 1.04]) was not significantly different between the two cohorts. **Conclusion:** This large-scale cohort study found no evidence that exposure to _S. pyogenes_ is associated with increased risk of the measured psychiatric outcomes. **Keywords:** PANDAS; immunopsychiatry; obsessive-compulsive disorder; strep throat; tic disorder. 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