Malady Wise

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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

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