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Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: an overview

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Abstract

The acronym PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) has been used to describe a syndrome characterized by various obsessions, compulsions, tics, hyperactivity, motor stereotypies, and paroxysmal movement disorders that are correlated with prior infection by group A beta-hemolytic Streptococcus pyogenes (GABHS) infections. Five clinical criteria can be used to diagnose PANDAS: (1) the presence of obsessive–compulsive disorder (OCD) and/or any other tic disorders; (2) prepuberal onset (between 3 years of age and the start of puberty); (3) abrupt onset and relapsing–remitting symptom course; (4) a distinct association with GABHS infection; and (5) association with neurological abnormalities during exacerbations (adventitious movements or motoric hyperactivity). The exact pathogenesis of PANDAS remains unclear, and several theories that focus on multiple etiologic or contributive factors have emerged. PANDAS appears to be a neurobiological disorder that potentially complicates GABHS infections in genetically susceptible individuals. The current standard of care for PANDAS patients remains symptomatic, and cognitive behavioral therapy, such as exposure and response prevention, combined with family counseling and psychoeducation, should be the first approach for treating PANDAS. This review examines current theories of PANDAS pathogenesis, identifies possible treatments for managing this complex condition, and highlights areas for future research. Moving forward, developing more standardized diagnostic criteria and identifying specific laboratory markers to facilitate PANDAS diagnoses are crucial.

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Acknowledgments

The authors are financially supported by Bando Giovani Ricercatori 2009 (Italian Ministry of Health).

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The authors have no conflict of interest to declare.

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Authors and Affiliations

  1. Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda n. 9, 20122, Milan, Italy

    S. Esposito, S. Bianchini, E. Baggi & M. Fattizzo

  2. Institute of Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy

    D. Rigante

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  1. S. Esposito
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  2. S. Bianchini
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  3. E. Baggi
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  4. M. Fattizzo
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Correspondence to S. Esposito.

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Esposito, S., Bianchini, S., Baggi, E. et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: an overview. Eur J Clin Microbiol Infect Dis 33, 2105–2109 (2014). https://doi.org/10.1007/s10096-014-2185-9

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  • DOI: https://doi.org/10.1007/s10096-014-2185-9

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