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Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections
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Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections

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Contributors: David Sullo MD
Other Resources UpToDate PubMed

Synopsis

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is a sudden-onset or worsening episodic pediatric neurological disorder characterized by tics (vocal or motor) or obsessive-compulsive behaviors following group A beta-hemolytic streptococcal infection such as scarlet fever or strep throat. Other signs and symptoms include anxiety, agitation, irritability, hyperactivity, mood changes, sleep disturbance, arthralgia, urinary frequency, and nocturnal enuresis. The existence of this disorder is the subject of much controversy. Onset in infancy through beginning of puberty. Resolution of episodic flare-ups may occur within weeks or months. Researchers suggest an underlying autoimmune process by which antibodies effect changes in the basal ganglia.

Management begins with antibiotic treatment of streptococcal infection and removal of opportunities for reinfection (eg, removing nonsterile toothbrush, treating family members). Management of neurological findings may include induction of medication regime and behavioral therapies. Intravenous immunoglobulin therapy and plasma exchange are reserved for severe cases and only while balancing benefits and risks (side effects or infection). The value of tonsillectomy to treat frequent tonsillitis in a child with PANDAS lacks consensus.

Codes

ICD10CM:
B94.8 – Sequelae of other specified infectious and parasitic diseases

SNOMEDCT:
446682003 – Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection

Differential Diagnosis & Pitfalls

References

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Last Updated: 07/06/2017
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Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections
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Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) : ASO positive, Choreiform movements, Recurring episodes or relapses
Copyright © 2018 VisualDx®. All rights reserved.