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Symptoms and Signs of PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections)

Doctor's Notes on PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections)

PANDAS, which stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, is a pediatric disease characterized by sudden and dramatic symptoms of obsessive-compulsive disorder (OCD) and/or tic disorders, or worsening OCD, and/or tics following a strep infection.

PANDAS affects children from age 3 to puberty, and rarely, adolescents. Strep bacteria causes PANDAS. This bacteria causes scarlet fever and strep throat.

Symptoms and signs of PANDAS include obsessions and/or compulsions and motor and/or vocal tics. Other symptoms of PANDAS include the following:

  • ADHD symptoms (hyperactivity, inattention, and fidgeting)
  • Separation anxiety (child has difficulty separating from parents or caregivers)
  • Mood changes, such as irritability, sadness, anxiety attacks, excessive emotional reactions (affect lability) such as a tendency to laugh or cry unexpectedly or inappropriately
  • Trouble sleeping (insomnia)
  • Overnight bed-wetting and/or frequent daytime urination
  • Changes in motor skills (for example, changes in handwriting)
  • Joint pains

Medical Author:
Medically Reviewed on 8/12/2019

PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections) Symptoms

Yes. Children with PANDAS often experience one or more of the following symptoms in conjunction with their OCD and/or tics:

  • ADHD symptoms (hyperactivity, inattention, fidgety)
  • Separation anxiety (child is "clingy" and has difficulty separating from his/her caregivers; for example, the child may not want to be in a different room in the house from his or her parents)
  • Mood changes, such as irritability, sadness, emotional lability (tendency to laugh or cry unexpectedly at what might seem the wrong moment)
  • Trouble sleeping, night-time bed-wetting, day-time frequent urination or both
  • Changes in motor skills (e.g. changes in handwriting)
  • Joint pains

PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections) Causes

The strep bacteria are very ancient organisms that survive in the human host by hiding from the immune system as long as possible. It hides itself by putting molecules on its cell wall so that it looks nearly identical to molecules found on the child's heart, joints, skin, and brain tissues. This hiding is called "molecular mimicry" and allows the strep bacteria to evade detection for a long time.

However, the molecules on the strep bacteria are eventually recognized as foreign to the body and the child's immune system reacts to them by producing antibodies. Because of the molecular mimicry by the bacteria, the immune system reacts not only to the strep molecules, but also to the human host molecules that were mimicked; antibodies system "attack" the mimicked molecules in the child's own tissues.

Studies at the NIMH and elsewhere have shown that some cross-reactive "anti-brain" antibodies target the brain -- causing OCD, tics, and the other neuropsychiatric symptoms of PANDAS.

Sore Throat or Strep Throat? How to Tell the Difference Slideshow

Sore Throat or Strep Throat? How to Tell the Difference Slideshow

Your throat aches and burns. It's painful to swallow. You know something is wrong, but how bad is it? Will it get better without antibiotics? Or will you need to visit the doctor?

This article is designed to help you find relief from your sore throat, and discover whether or not you may have strep throat symptoms. You will find the telltale signs and symptoms, as well as treatment options for both. It’s important to know what is causing your symptoms, because treatments for different kinds of infections vary.

What Is Strep Throat?

Strep throat is always caused by a bacterial infection. Group A Streptococcus bacteria ("group A strep") infects the throat and the tonsils, and it will quickly respond to antibiotics.

What Is the Common Sore Throat?

A sore throat can be quite painful, but it is not as painful as strep throat. When you have the common cold, the cause is usually a virus. This means it will not respond to antibiotics.

Even if it’s not strep, you may need to see a doctor for relief. It’s time to see the doctor if your symptoms

  • last longer than a week,
  • keep coming back,
  • make your voice hoarse for more than two weeks,
  • cause dehydration, or
  • worry you in some other way.

Strep (Streptococcal) Throat Infection : Test Your Infectious Disease IQ Quiz

Strep Throat Quiz
Question

Just about any painful sore throat is caused by strep.

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REFERENCE:

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.

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