Pediatric autoimmune neuropsychiatric disorders associated with streptococci (PANDAS): update

  title={Pediatric autoimmune neuropsychiatric disorders associated with streptococci (PANDAS): update},
  author={Stanford T. Shulman},
  journal={Current Opinion in Pediatrics},
  • S. Shulman
  • Published 1 February 2009
  • Medicine
  • Current Opinion in Pediatrics
Purpose of review To review recent developments related to the proposed entity Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococci (so-called ‘PANDAS’). Recent findings The relationship between obsessive–compulsive disorder (OCD) or tics/Tourette's syndrome in childhood to antecedent group A streptococci (GAS) is unclear. One recent prospective cohort study found that more than 85% of clinical exacerbations in OCD/tic behavior in patients who met criteria for PANDAS had… 

Pediatric Autoimmune Neuropsychiatric Disorders Associated With Group A Streptococci: Etiopathology and Diagnostic Challenges

The literature on PANDAS was explored in terms of its epidemiology, pathophysiology, the role of group A streptococcal infection, associated complications, and prophylactic and treatment modalities, with a view to proposing a therapeutic strategy for children with acute symptoms that meet PANDas criteria.

From Research Subgroup to Clinical Syndrome: Modifying the PANDAS Criteria to Describe PANS (Pediatric Acute-onset Neuropsychiatric

Modifying the PANDAS criteria to eliminate etiologic factors and to clarify the initial clinical presentation produced three potential diagnostic criteria for PANS, which are discussed in detail.

The evaluation of a relationship between group A streptococcal infection with tic disorders in children.

The relationship between pediatric autoimmune neuropsychiatric disorders associated with streptococci (PANDAS) in childhood to antecedent GABHS remains elusive and further studies are required to revise the boundaries of PANDAS, develop psychometrically reliable and valid diagnostic strategies, and institute appropriate management.

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections.

Evidence does not support a recommendation for long-term antibiotic prophylaxis or immunomodulatory therapy in children with PANDAS, and based on only a few studies, positive results have been found using antibiotic proPHylaxis and immunomODulatory therapy.

Moving from PANDAS to CANS.

Streptococcal upper respiratory tract infections and exacerbations of tic and obsessive-compulsive symptoms: a prospective longitudinal study.

Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus Immunology

  • A. WallsMaricel Cubangbang E. Harley
  • Medicine, Biology
    Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
  • 2015
Patients diagnosed with PANDAS appear to maintain significantly different concentrations of cytokines when compared with patients afflicted by chronic group A beta hemolytic streptococcus infections and obstructive sleep apnea, which could be a basis for future mechanistic and epidemiological studies.

A comparative study of streptococal infection in children with PANDAS: a case-control study

It is shown here how to identify the different types of phytochemical deposits in the blood stream of a person using a simple X-ray.

Group A β-hemolytic Streptococcal Infection in Children and the Resultant Neuro-psychiatric Disorder; a Cross Sectional Study; Tehran, Iran

Findings support that a post infectious immune mechanism to GABHS may play a role in the pathogenesis of PANDAS in children in Iran.



Pediatric autoimmune neuropsychiatric disorders associated with streptococci (PANDAS).

  • S. Shulman
  • Medicine
    The Pediatric infectious disease journal
  • 1999
It is possible that GAS infection may be but one of the many stressors that can exacerbate tic/Tourette’s or OCD in a subset of such patients and they were more likely to be treated with unjustified short-term to chronic antibiotic and/or immunomodulatory therapy.

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases.

The working diagnostic criteria appear to accurately characterize a homogeneous patient group in which symptom exacerbations are triggered by GABHS infections.

The pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) subgroup: separating fact from fiction.

Questions about the veracity of data presented in this issue of Pediatrics are raised and a brief literature review and clarification of the guidelines for management of a patient in the PANDAS subgroup are provided.

Streptococcal Infection and Exacerbations of Childhood Tics and Obsessive-Compulsive Symptoms: A Prospective Blinded Cohort Study

Patients who fit published criteria for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections seem to represent a subgroup of those with chronic tic disorders and obsessive-compulsive disorder who may be vulnerable to group A β-hemolytic strePTococcus infection as a precipitant of neuroPsychiatric symptom exacerbations.

Serial Immune Markers Do Not Correlate With Clinical Exacerbations in Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections

The failure of immune markers to correlate with clinical exacerbations in children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections raises serious concerns about the viability of autoimmunity as a pathophysiological mechanism in this disorder.

Anti‐basal ganglia antibodies in PANDAS

ELISA measurements do not differentiate between PANDAS and controls, suggesting a lack of major antibody changes in this disorder, and further immunoblot analyses using a caudate supernatant fraction are required to completely exclude the possibility of minor antibody repertoire differences in PANDAs subjects.

Mimicry and autoantibody-mediated neuronal cell signaling in Sydenham chorea

Chorea monoclonal antibodies showed specificity for mammalian lysoganglioside and N-acetyl-β-D-glucosamine (GlcNAc), the dominant epitope of the group A streptococcal (GAS) carbohydrate, which will lead to a better understanding of other antibody-mediated neurological disorders.

Guidelines for the Diagnosis of Rheumatic Fever: Jones Criteria, Updated 1992 Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, American Heart Association

The Jones criteria for guidance in the diagnosis of acute rheumatic fever were first published by T. Duckett Jones, MD, in 1944 are updated and clarify the available antibody tests for detecting antecedent group A streptococcal infection.