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    Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS)

    Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is a topic covered in the 5-Minute Clinical Consult.

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    Basics

    Description

    • Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) most commonly presents 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 represents a true entity distinct from similar disorders in children.

    Epidemiology

    Incidence
    • 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)[A]
    • GABHS infection likely accounts for a small proportion of antecedent exacerbations among patients meeting diagnostic criteria for PANS (1)[A].

    Etiology and Pathophysiology

    • Unknown, several hypotheses
    • Proposed “pseudoautoimmunity.” GABHS antibodies target brain tissue (basal ganglia) possibly causing OCD, tics, and other neuropsychiatric symptoms (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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    Citation

    Stephens, Mark B., et al., editors. "Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS)." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816832/all/Pediatric_Autoimmune_Neuropsychiatric_Disorders_Associated_with_Streptococcal_Infections__PANDAS_.
    Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816832/all/Pediatric_Autoimmune_Neuropsychiatric_Disorders_Associated_with_Streptococcal_Infections__PANDAS_. Accessed April 18, 2019.
    Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816832/all/Pediatric_Autoimmune_Neuropsychiatric_Disorders_Associated_with_Streptococcal_Infections__PANDAS_
    Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS) [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 18]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816832/all/Pediatric_Autoimmune_Neuropsychiatric_Disorders_Associated_with_Streptococcal_Infections__PANDAS_.
    * Article titles in AMA citation format should be in sentence-case
    TY - ELEC T1 - Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) ID - 816832 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816832/all/Pediatric_Autoimmune_Neuropsychiatric_Disorders_Associated_with_Streptococcal_Infections__PANDAS_ PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -