Infectious Disease Book

Bacterial Infections

  • Childhood Acute Neuropsychiatric Symptoms

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Childhood Acute Neuropsychiatric Symptoms

Aka: Childhood Acute Neuropsychiatric Symptoms, PANDAS, Pediatric Autoimmune Neuropsychiatric Disorders, Post-streptococcal Autoimmune Neuropsychiatric Disorder, Streptoccal Associated Neuropsychiatric Disorder
  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. Multiple infectious, toxic and metabolic causes have been proposed
      1. Initially thought specific to autoantibody formation in response to streptococcal infection
        1. Associated with Group A Beta Hemolytic Streptococcus
    2. Autoantibodies stimulate Basal Ganglia autoimmune disease
    3. Similar Mechanism as Rheumatic Fever and PSGN
  4. Associated conditions
    1. Sydenham's Chorea
  5. Diagnosis: Criteria (all 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
  6. References
    1. Singer (2012) J Pediatr 160(5): 725-31 [PubMed]

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