This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (66)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Neurology  • Pediatric Neurology  • Psychiatry  • Alert me on articles by topic  Social Bookmarking   What's this?

Marie Lynd Murphy, MD; Michael E. Pichichero, MD

Arch Pediatr Adolesc Med. 2002;156:356-361.

Background  The current diagnostic criteria for pediatric autoimmune neuropsychiatric disorder associated with group A streptococcal infection (PANDAS) are pediatric onset, neuropsychiatric disorder (obsessive-compulsive disorder [OCD]) and/or tic disorder; abrupt onset and/or episodic course of symptoms; association with group A ß-hemolytic streptococcal (GABHS) infection; and association with neurological abnormalities (motoric hyperactivity or adventitious movements, including choreiform movements or tics).

Objective  To assess new-onset PANDAS cases in relation to acute GABHS tonsillopharyngitis.

Design  Prospective PANDAS case identification and follow-up.

Results  Over a 3-year period (1998-2000), we identified 12 school-aged children with new-onset PANDAS. Each patient had the abrupt appearance of severe OCD behaviors, accompanied by mild symptoms and signs of acute GABHS tonsillopharyngitis. Throat swabs tested positive for GABHS by rapid antigen detection and/or were culture positive. The GABHS serologic tests, when performed (n = 3), showed very high antideoxyribonuclease antibody titers. Mean age at presentation was 7 years (age range, 5-11 years). In children treated with antibiotics effective in eradicating GABHS infection at the sentinel episode, OCD symptoms promptly disappeared. Follow-up throat cultures negative for GABHS were obtained prospectively after the first PANDAS episode. Recurrence of OCD symptoms was seen in 6 patients; each recurrence was associated with evidence of acute GABHS infection and responded to antibiotic therapy, supporting the premise that these patients were not GABHS carriers. The OCD behaviors exhibited included hand washing and preoccupation with germs, but daytime urinary urgency and frequency without dysuria, fever, or incontinence were the most notable symptoms in our series (58% of patients). Symptoms disappeared at night, and urinalysis and urine cultures were negative.

Conclusion  To our knowledge, this is the first prospective study to confirm that PANDAS is associated with acute GABHS tonsillopharyngitis and responds to appropriate antibiotic therapy at the sentinel episode.

From the Elmwood Pediatric Group, University of Rochester Medical Center, Rochester, NY.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcus: Comparison of Diagnosis and Treatment in the Community and at a Specialty Clinic
Gabbay et al.
Pediatrics 2008;122:273-278.
ABSTRACT | FULL TEXT  

Streptococcal Infection and Exacerbations of Childhood Tics and Obsessive-Compulsive Symptoms: A Prospective Blinded Cohort Study
Kurlan et al.
Pediatrics 2008;121:1188-1197.
ABSTRACT | FULL TEXT  

Mycoplasma pneumoniae Infection and Obsessive-Compulsive Disease: A Case Report
Ercan et al.
J Child Neurol 2008;23:338-340.
ABSTRACT  

Selecting the Optimal Antibiotic in the Treatment of Group A {beta}-Hemolytic Streptococci Pharyngitis
Casey
CLIN PEDIATR 2007;46:25S-35S.
ABSTRACT  

Topical Review: Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infection: Sydenham Chorea, PANDAS, and PANDAS Variants
Pavone et al.
J Child Neurol 2006;21:727-736.
ABSTRACT  

Pathogen Shifts and Changing Cure Rates for Otitis Media and Tonsillopharyngitis
Pichichero
CLIN PEDIATR 2006;45:493-502.
ABSTRACT  

The M Protein Is Dispensable for Maturation of Streptococcal Cysteine Protease SpeB
Zimmerlein et al.
Infect. Immun. 2005;73:859-864.
ABSTRACT | FULL TEXT  

Does Group A {beta}-Hemolytic Streptococcal Infection Increase Risk for Behavioral and Neuropsychiatric Symptoms in Children?
Perrin et al.
Arch Pediatr Adolesc Med 2004;158:848-856.
ABSTRACT | FULL TEXT  

Group A Streptococcal Vaccines
Pichichero
JAMA 2004;292:738-739.
FULL TEXT  

A Possible Association of Recurrent Streptococcal Infections and Acute Onset of Obsessive-Compulsive Disorder
Kim et al.
J. Neuropsychiatry Clin. Neurosi. 2004;16:252-260.
ABSTRACT | FULL TEXT  

Dyskinesias and associated psychiatric disorders following streptococcal infections
Dale et al.
Arch. Dis. Child. 2004;89:604-610.
ABSTRACT | FULL TEXT  

The Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infection (PANDAS) Etiology for Tics and Obsessive-Compulsive Symptoms: Hypothesis or Entity? Practical Considerations for the Clinician
Kurlan and Kaplan
Pediatrics 2004;113:883-886.
ABSTRACT | FULL TEXT  

The Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infection (PANDAS) Subgroup: Separating Fact From Fiction
Swedo et al.
Pediatrics 2004;113:907-911.
FULL TEXT  

Short-Course Antimicrobial Therapy of Streptococcal Pharyngitis
Block
CLIN PEDIATR 2003;42:663-671.
 

Serum Opacity Factor (SOF) of Streptococcus pyogenes Evokes Antibodies That Opsonize Homologous and Heterologous SOF-Positive Serotypes of Group A Streptococci
Courtney et al.
Infect. Immun. 2003;71:5097-5103.
ABSTRACT | FULL TEXT  

Demographic and Clinical Characteristics of Adolescents in Hawaii With Obsessive-compulsive Disorder
Guerrero et al.
Arch Pediatr Adolesc Med 2003;157:665-670.
ABSTRACT | FULL TEXT  

Autoimmunity and the basal ganglia: new insights into old diseases
Dale
QJM 2003;96:183-191.
ABSTRACT | FULL TEXT  

Pathophysiology of Pediatric Movement Disorders
Sanger
J Child Neurol 2003;18:S9-S24.
ABSTRACT  

Strep Causes Neuropsychiatric Disorders in Children
JWatch Psychiatry 2002;2002:11-11.
FULL TEXT  

Strep Causes Neuropsychiatric Disorders in Children
JWatch General 2002;2002:5-5.
FULL TEXT