PANDAS: FACT or FICTION

Objectives: Several inflammatory disorders have been associated with preceding streptococcal infections, including acute rheumatic fever (ARF), poststreptococcal reactive arthritis, post-streptococcal glomerulonephritis, and cutaneous polyarteritis. The spectrum of poststreptococcal disease has expanded with the addition of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection (PANDAS). However there is controversial argument in concern with PANDAS in literature. To determine correlation between symptoms of our patient and recent streptococcal infection. We followed these patients based on ASO titer rising.

Methods: This prospective multicenter study enrolled 25 children with PANDAS who have been followed up for 3 years in Iran, aged 5–18 years (mean11.5years), 15 girls and 10 boys (F/M ratio: 1.5) complaining from (PANDAS).

Results: We came to definite diagnosis of PANDAS in 25 cases from 75 patients coming with different type of movement and behavior disorder. All cases had similar clinical features, including emotional lability, attention and impulsivity, motor hyperactivity, abnormal choreiform hand movements, and deterioration in fine motor skills, which are often observed at the onset of an exacerbation. We came to diagnosis of Clinical criteria proposed for the diagnosis of PANDAS including: childhood onset; an abrupt onset of symptoms; exacerbations of symptoms temporally related to a preceding streptococcal infection; and the association of neurological abnormalities.

Conclusion: The above findings highlight possible correlation between Streptococcal infection and PANDAS, however since we did'nt trace Streptococcus in 2:3 of our cases, so other etiologies should be also considered in concern with PANDAS.