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For this purpose, we will define an exacerbation as the time in which the infectious trigger created a misdirected immune response resulting in the onset of a multitude of symptoms, such as OCD, anxiety, sensory sensitivities, and other personality changes. An exacerbation is not an uptick in symptoms that last only a day. One may consider that a mini-episode. When it is that short term, the symptoms may have been triggered by stress, a blip in recovery, etc.


If a child receives antibiotics early after the onset of symptoms, an exacerbation typically lasts 5 to 6 weeks and then it gradually dies out.Not many children will experience a cessation of symptoms as quickly as the onset occurred. It takes time for the brain and the body to heal. One may see “blips” along the way when recovering. But a full, unremitting backslide should not occur. If it does, it could be the infection was not fully eradicated, a new infection is present, or further medical interventions are needed. It is important to try your best to keep the immune system calm while the body the child is recovering.

Low level anxiety and OCD/TIC issues may remain permanently or fade away after several weeks or months. There are times where the exacerbation can take 4 to 6 months to remit.

However, in many of the acute cases, the typical course of antibiotics is not helpful and the child continues to suffer for months and symptoms often increase in severity. The acute cases have clearly having an encephalitic reaction to strep and aggressive treatment needs to be considered.


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