It remains to be determined whether altered mucosal immunity involving the oropharynx—potentially leading to increased risk for scarlet fever and RF—might be causally related to the pathogenesis of OCD or simply represent nonspecific relationships among psychiatric and medical diseases. For example, the putative associations described herein may represent shared genetic and/or environmental risks predisposing individuals to both peripheral and central inflammation with neurodevelopmental consequences, including OCD (Hanamsagar and Bilbo 2017).
