Relationship between several early onset behavioral disorders; Image via Wikipedia

Steph Weakland found the discussion of the complication of St. pyogenes infection (rheumatic fever) interesting, and sent me this tidbit about another sequelae of Group A Strep infections. Here’s Steph:

As we discussed in class, Rheumatic fever occurs due to antibody production in response to a Strep. infection.  A condition similar to this is known as Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, or PANDAS.  PANDAS results from antibodies attacking neurons in the Basal Ganglia of the brain, which is believed to control movement and behavior, and so symptoms generally resemble those of OCD and/or Tourrette’s Syndrome.

There are no lab tests that can diagnose PANDAS, which makes the confirmation of this disorder a challenge to the medical community.   The following criteria are typically used in a suspected case of PANDAS:

1.     Presence of Obsessive-compulsive disorder and/or a tic disorder

2.     Pediatric onset of symptoms (age 3 years to puberty)

3.     Episodic course of symptom severity

4.     Association with group A Beta-hemolytic streptococcal infection (a positive throat culture for strep. or history of Scarlet Fever.)

5.     Association with neurological abnormalities

Children with PANDAS may also experience ADHD symptoms, separation anxiety, mood changes, sleep disturbance, night-time bed wetting and/or day-time urinary frequency, fine/gross motor changes, and joint pains.

Since this disorder, like Rheumatic fever, is the result of antibody production, antibiotics are ineffective.  Instead, physicians prescribe treatments used for other types of OCD or tic disorders.  If the strep. infection is still present, antibiotics are prescribed to eliminate that as well as those used to decrease the symptoms.

PANDAS is typically only considered when a strep. infection precedes the abrupt onset or worsening of OCD and/or tics, so it may prove very difficult to diagnose due to the variety of symptoms of the strep. infections themselves.  An episode of Mystery Diagnosis (“the Boy Who Only Hopped”) details the case of a boy who suffered from this condition, though he was unaware of the initial strep. infection.

This story also appeared on the Today Show, which can be found here:


About ycpmicro

My name is David Singleton, and I am an Associate Professor of Microbiology at York College of Pennsylvania. My main course is BIO230, a course taken by allied-health students at YCP. Views on this site are my own.

Posted on April 7, 2011, in Guest Post, Lecture, Microbes in the News. Bookmark the permalink. 4 Comments.

  1. Because of Pandas having symptoms similar to many other disease caused by Group A strep it can be very hard to diagnose it and also it can be confused with other disorder like the one mention ADHD, OCD, strep throat and other.
    The treatment for it are the same as if they had other types of OCD or tic disorders.
    The combination of a medication like fluoxetine and cognitive behavioral therapy was the best treatment for OCD, and that medication alone or cognitive behavioral therapy alone are also very good treatment for it. It often takes time for these treatments to work, so the sooner therapy is started, the better it is for the child.

    • PANDAS is actually a subset of OCD, yet it often has other manifestations, such as ADHD. In PANDAS, the difference is sudden and dramatic presentation of symptoms in a child who has previously not suffered from these manifestations.

      While meds such as SSRI’s help some children with the condition, those who truly have PANDAS may decline on these medications. Please be cautious suggesting psych meds and/or counseling alone will help a child who has PANDAS, which is triggered by infection as without arresting the infection, the basal ganglia remains under attack, resulting in continuation of symptoms.

      Yes, in the case of PANDAS, it is critically important that the strep infection be eliminated as quickly as possible and the child may require further medical intervention, such as steroids and/or IVIG or Plasmapheresis. Therapy is often beneficial in either case; however, if a child has PANDAS and their basal ganglia continues to be attacked by their immune system, counseling may prove more effective following medical intervention.

      Denise Grubbs, RN

  2. Great article… I too, have a child with PANDAS. Feel free to view my blog for further information:

    • Thank you for your comments! Steph’s article above came about after our class discussion about Streptococcal infections, and the issues that can occur if strep throat were to be untreated or undiagnosed. From a microbiology standpoint, I find the interplay between host and pathogen fascinating, however that approach leaves the human point of view out of the picture. Your perspective helps us to focus on that.

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