PANDAS

TL;DR

Strep infection can cause neuropsychiatric symptoms in kids.

Terms

PANDAS – Paediatric Autoimmune Neuropsychiatric Disorder Associated with group A Streptococci (GAS)

• Symptoms of OCD, Tics, and Anxiety are worse with GAS

PANS/CANS – Pediatric Acute-onset Neuropsychiatric Syndrome

• Symptoms due to other events than GAS

Criteria

• OCD +/- Tic Disorder

• Paediatric onset

• Abrupt onset

• An episodic course of symptoms

• Relation between GAS infection and onset/exacerbation

• Neuro symptoms e.g. motor hyperactivity, choreiform movements, or tics

Areas of agreement

• GAS is one of several factors that exacerbate OCD or tic disorders

• Children with GAS + OCD/Tics require standard treatment from GAS

• Sydenham chorea is a manifestation of GAS

• Possible 1 to 8-month latency between GAS and onset Sydenham chorea

• Pharyngeal GAS may be mild

Pathogenesis

• GAS infection > Autoimmune response

• Antibodies cross-react with brain and heart valves

• Kids 5 to 12 are more susceptible

• Possible altered gut microbiota plays a role

Epidemiology

• Rare

• 1 in 3000 throat culture-positive GAS infections

Diagnosis

• Consider if abrupt onset OCD / Tics, separation anxiety, or urinary frequency

• Positive throat culture

• Significant ASOT rise in the 4-6 weeks post symptoms

DDx

• Tic disorder or OCD

• Sydenham chorea

Management

• ABx for acute GAS infection

• Neuropsychiatric therapy

• Immune modulating therapy

• Oral asteroids

• NSAIDs

Reference:

• PANDAS - up To Date