Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: an overview

  • S. EspositoEmail author
  • S. Bianchini
  • E. Baggi
  • M. Fattizzo
  • D. Rigante


The acronym PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) has been used to describe a syndrome characterized by various obsessions, compulsions, tics, hyperactivity, motor stereotypies, and paroxysmal movement disorders that are correlated with prior infection by group A beta-hemolytic Streptococcus pyogenes (GABHS) infections. Five clinical criteria can be used to diagnose PANDAS: (1) the presence of obsessive–compulsive disorder (OCD) and/or any other tic disorders; (2) prepuberal onset (between 3 years of age and the start of puberty); (3) abrupt onset and relapsing–remitting symptom course; (4) a distinct association with GABHS infection; and (5) association with neurological abnormalities during exacerbations (adventitious movements or motoric hyperactivity). The exact pathogenesis of PANDAS remains unclear, and several theories that focus on multiple etiologic or contributive factors have emerged. PANDAS appears to be a neurobiological disorder that potentially complicates GABHS infections in genetically susceptible individuals. The current standard of care for PANDAS patients remains symptomatic, and cognitive behavioral therapy, such as exposure and response prevention, combined with family counseling and psychoeducation, should be the first approach for treating PANDAS. This review examines current theories of PANDAS pathogenesis, identifies possible treatments for managing this complex condition, and highlights areas for future research. Moving forward, developing more standardized diagnostic criteria and identifying specific laboratory markers to facilitate PANDAS diagnoses are crucial.


Streptococcal Infection Scarlet Fever Tiapride Acute Disseminate Encephalomyelitis Pediatric OCDs 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors are financially supported by Bando Giovani Ricercatori 2009 (Italian Ministry of Health).

Conflict of interest

The authors have no conflict of interest to declare.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • S. Esposito
    • 1
    Email author
  • S. Bianchini
    • 1
  • E. Baggi
    • 1
  • M. Fattizzo
    • 1
  • D. Rigante
    • 2
  1. 1.Pediatric Highly Intensive Care Unit, Department of Pathophysiology and TransplantationUniversità degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
  2. 2.Institute of PediatricsUniversità Cattolica Sacro CuoreRomeItaly

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