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==Background==
*Also known as "PANDAS"
*Controversial hypothesis that a subset of children with rapid onset of obsessive-compulsive disorder (OCD) or tic disorders caused by [[Group A beta-hemolytic strep|group A beta-hemolytic streptococcal]] (GABHS) infections<ref>Moretti G, Pasquini M, Mandarelli G, Tarsitani L, Biondi M (2008). "What every psychiatrist should know about PANDAS: a review". Clin Pract Epidemol Ment Health. 4 (1): 13.</ref>
*Hypothesis is that antibodies against the cell wall of the streptococcal bacteria cross-react with neuronal brain tissue in the basal ganglia to cause the tics and OCD that characterize PANDAS

==Clinical Features==
*Diagnostic criteria for PANDAS include<ref>Swedo SE, Leonard HL, Garvey M, et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases. Am J Psychiatry. 1998;155(2):264-71.</ref>:
**OCD and/or tic disorder
**Pediatric onset (between three years and onset of puberty)
**Abrupt onset and episodic course of symptoms
**Temporal relation between GAS infection and onset and/or exacerbation
***GAS infection is confirmed by:
****Positive throat or skin culture or rapid antigen detection test for GAS at the beginning of a PANDAS exacerbation, or
****Clinically significant rise in antistreptococcal antibody between the onset of symptoms and four to six weeks later
**Neurologic abnormalities, such as motoric hyperactivity, choreiform movements, or tics during exacerbations

==Differential Diagnosis==
*Tic disorder or OCD 
*Sydenham [[chorea]] (due to [[Acute Rheumatic Fever]])
==Evaluation==
*Evaluate for alternative etiologies of symptoms or precipitants of decompensation

==Management==
*[[Streptococcal pharyngitis|Antistreptococcal therapy]], (even if the episode of GAS was already treated given the failure rates for penicillin and amoxicillin therapy)
*[[Azithromycin]] 12 mg/kg orally in one dose for five days (maximum dose 500 mg)
*Treatment with azithromycin or [[clindamycin]] is advocated by some experts because of the possibility that GAS is intracellular<ref>Osterlund A, Engstrand L. An intracellular sanctuary for Streptococcus pyogenes in human tonsillar epithelium--studies of asymptomatic carriers and in vitro cultured biopsies. Acta Otolaryngol. 1997;117(6):883-8.</ref>
*Standard neuropsychiatric treatment for OCD and/or tic disorders

==Disposition==

==See Also==
*[[Streptococcal pharyngitis]]
*[[Acute rheumatic fever]]
*[[Scarlet fever]]
*[[Toxic shock syndrome]]
*[[Post-streptococcal glomerular nephritis]]

==External Links==

==References==
<references/>


[[Category:Pediatrics]]
[[Category:ID]] [[Category:Neurology]]