Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS)



  • Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) most commonly present as obsessive-compulsive disorder (OCD) and/or tic disorder developing abruptly or acutely worsening during or following a group A β-hemolytic Streptococcus (GABHS) infection.
  • Proposed associations are GABHS pharyngitis or skin/soft tissue infection.
  • Symptoms begin abruptly (hours) and peak by 24 to 48 hours.
  • Symptoms include motor tics, vocal tics, obsessions and/or compulsions, anxiety attacks, separation anxiety, bed wetting, and hyperactivity.
  • It remains unclear if PANDAS represent a true entity distinct from similar disorders in children.



  • Unknown, thought to be rare
  • Considered a subset of pediatric acute-onset neuropsychiatric syndrome (PANS); abrupt onset of OCD and associated symptoms not better explained by a known neuropsychiatric condition (1)
  • GABHS infection likely accounts for a small proportion of antecedent exacerbations among patients meeting diagnostic criteria for PANS (1).

Etiology and Pathophysiology

  • Unknown, several hypotheses
  • Proposed “pseudoautoimmunity.” GABHS antibodies target brain tissue (basal ganglia) possibly causing OCD, tics, and other neuropsychiatric symptoms by suspected molecular mimicry (2)[C].
  • Genetic factors (susceptible host) and environmental trigger (GABHS) (3)[B]

Risk Factors

  • Streptococcal infection
  • Tic disorder, Tourette syndrome, OCD
  • More common in boys (3)[B]
  • More common in children with family history of rheumatic fever (3)[B]

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