Download STREP OR PANDAS?

Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS)
Source- http://pandasnetwork.org/
Group A Beta Hemolytic Strep
PANDAS is caused by a “normal” Strep Infection, the difference is the P.A.N.D.A.S. child’s antibodies do not react normally. Instead
of attacking the infection, the antibodies attack the basal ganglia in the brain. The basal ganglia remain inflamed and cause numerous
psychiatric symptoms as well as motor and vocal tics, and headaches. Often, serum levels of ASO titer, AntiDNase B titer are
elevated. The blood level (number) of strep antibodies can help guide treatment protocols. A throat culture may or may not be positive
for strep, and does not facilitate the clinical diagnosis. If your child is being “treated for strep”, it is not a safe assumption they are
being treated for PANDAS. PANDAS may also be caused by other bacterial or viral infections.
Hypothesis/Pathophysiology: Antibiotics are given to treat strep (bacterial) infections. However, it never kills all of the bacteria. The
antibiotics are intended to help the body to start fighting the bacteria. It still requires the immune system to function normally, and
take over the job, once the antibiotic is finished. In PANDAS, the immune system malfunctions and is not effective in completely
removing the bacteria. The strep lingers in hidden places in the body (deep in the throat, sinuses, Eustachian tubes, gastrointestinal
tract) and the antibodies to strep continue to develop to high levels. These antibodies attack the brain. Patients who are diagnosed with
PANDAS may receive a prescription for two antibiotics, and must take it for a longer period of time (one month or more).
Psychiatric symptoms.
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OCD symptoms (intrusive thoughts, anxiety, different phobias, unfounded fears)
Sleep Disorder(s) (insomnia, inability to fall asleep, frightful sleep, nightmares)
Behavioral regression (separation anxiety, insistence to remain at or close to home, “baby-talk”, temper tantrums)
Aggressiveness
Hyperactivity and inattentiveness
Learning disability particularly affecting mathematics’ skills
Inability to concentrate
Hallucinations
Eating disorders, fear of choking, fear of being poisoned
Physical symptoms.
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Adventitious movements
Wide pupils
Tics
Deterioration in fine motor skills and handwriting
Short-memory loss
Bedwetting and/or urinary frequency
Increased sensory responses (Increased sensitivity to light, sound, touch, smell, emotions
Clinical presentation.
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Sudden (sometimes overnight) onset of symptoms. Parents frequently recall the exact date and/or time of the day when
symptoms appeared.
Wax-and-wane pattern of symptoms. Symptoms exacerbation is frequently associated with or may occur following an
infectious event, sometimes even to a live virus vaccine administration.
The initial episode is usually associated with Group A Strep (GABHS infection); however subsequent episodes do not
necessarily have to be related to GABHS.
It can be a challenge to evaluate and treat PANDAS. Sometimes, the primary care provider is willing to order blood work to determine
the presence of strep antibodies, and then make an appropriate referral for long -term treatment. PANDAS referral and testing
information can be found at http://pandasnetwork.org/.
Please contact me if you have questions about PANDAS.
Betty Anne Nixon, MSN, RN, CSN, FN-CSA, SANE-P, CF-L1
609-584-1800 ext 229
[email protected]