Infectious Disease Book

http://www.fpnotebook.com/

PANDAS

Aka: PANDAS, Pediatric Autoimmune Neuropsychiatric Disorders, Post-streptococcal Autoimmune Neuropsychiatric Disorder, Streptoccal Associated Neuropsychiatric Disorder
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  1. Definition
    1. Pediatric Autoimmune Neuropsychiatric Disorders
    2. Associated with Streptococcal Infections
  2. Precautions
    1. Controversial diagnosis
      1. Streptococcal infection is common
      2. Tic Disorders are common
      3. When both are present, is it simply coincidence?
    2. Avoid testing ASO Titers (rarely helpful)
    3. Even if diagnosis is made, there is no treatment
      1. Even daily Penicillin does not alter Tic Disorder
  3. Pathophysiology
    1. Autoantibodies form to streptococcal infection
      1. Associated with Group A Beta Hemolytic Streptococcus
    2. Antibodies stimulate basal ganglia autoimmune disease
    3. Similar mechanism as Rheumatic Fever and PSGN
  4. Associated conditions
    1. Sydenham's Chorea
  5. Diagnosis (5 criteria need to be present)
    1. Psychiatric illness
      1. Obsessive-compulsive Disorder
      2. Tic Disorder
    2. Prepubertal symptom onset
    3. Acute, severe onset with symptom exacerbations
    4. Neurologic abnormalities
      1. Example: Choreiform movements
    5. Exacerbation follows Group A streptococcal infection

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