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

Shulman, Stanford Ta,b

doi: 10.1097/MOP.0b013e32831db2c4
Infectious diseases and immunization: Edited by Robert S. Baltimore and Hal B. Jenson

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 no relationship to GAS infection. Another study found no correlation between clinical exacerbations and changes in a variety of markers of brain autoimmunity, the proposed pathogenesis of PANDAS. A third recent study concluded that, compared with specialty clinic diagnoses, patients diagnosed with tics or Tourette's by physicians in the community were significantly more likely to be diagnosed with PANDAS without meeting the proposed criteria, most lacked supporting laboratory evidence of GAS infection, and they were more likely to be treated with unjustified short-term to chronic antibiotic and/or immunomodulatory therapy.

Summary Despite continued research in the field, the relationship between GAS and specific neuropsychiatric disorders (PANDAS) remains elusive. 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.

aThe Feinberg School of Medicine, Northwestern University, USA

bDivision of Infectious Diseases, The Children's Memorial Hospital, Chicago, Illinois, USA

Correspondence to Stanford T. Shulman, MD, Chief, Division of Infectious Diseases, The Children's Memorial Hospital, 2300 Children's Plaza, Box #20, Chicago, IL 60614, USA Tel: +1 773 880 4187; fax: +1 773 880 8226; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.