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: