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Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS)

Haidy Marzouk, MD Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) most commonly present as obsessive-compulsive disorder (OCD) and/or tic disorder dev...

DIAGNOSIS

HISTORY

  • PANDAS are a clinical diagnosis.

  • Diagnostic criteria (2)[C],(3)[B]

    • Presence of OCD or tic disorder symptoms

    • Age of onset between 3 years and puberty

    • Abrupt onset of symptoms or dramatic...

TREATMENT

GENERAL MEASURES

  • Antibiotics indicated specifically for the treatment of acute GABHS infections (2)[C]

  • Symptomatic treatment of OCD/tics with cognitive-behavioral therapy or selective serotoni...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Primary care or pediatric infectious disease for recurrent episodes of GABHS infection

  • Pediatric psychiatry

  • Pediatric neurology

  • Children enrolled in clinical trials ...

REFERENCES

1
Shulman ST. Pediatric autoimmune neuropsychiatric disorders associated with streptococci (PANDAS): update. Curr Opin Pediatr.  2009;21(1):127–130. [View Abstract on OvidMedline]
2
Natio...

ADDITIONAL READING

  • Chiarello F, Spitoni S, Hollander E, et al. An expert opinion on PANDAS/PANS: highlights and controversies. Int J Psychiatry Clin Pract.  2017;21(2):91–98. [View Abstract on Ov...

CODES

ICD10

  • B95.0 Streptococcus, group A, causing diseases classd elswhr

  • D89.89 Other specified disorders involving the immune mechanism, not elsewhere classified

  • F95.9 Tic disorder, unspecified

  • F42 Obses...

CLINICAL PEARLS

  • Consider testing for acute GABHS infection in children with abrupt onset of OCD symptoms or tics.

  • Prophylactic antibiotics and/or immunomodulatory therapy to treat PANDAS is not recomme...

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