Pediatric autoimmune neuropsychiatric disorder associated with group A streptococci

Background

• Controversial hypothesis that a subset of children with rapid onset of obsessive-compulsive disorder (OCD) or tic disorders caused by group A beta-hemolytic streptococcal (GABHS) infections
• 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

• See evaluation

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

• 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
• Standard neuropsychiatric treatment for OCD and/or tic disorders

See Also

Streptococcal pharyngitis

• Acute rheumatic fever
• Scarlet fever
• Toxic shock syndrome
• Post-streptococcal glomerular nephritis