Strep Throat and the Backstory for PANS and PANDAS

SUMMARY

“Strep Throat and the Backstory for PANS and PANDAS”, traces the connection between Group A Strep and rheumatic fever, highlighting how emotional and psychiatric symptoms often accompanied rheumatic chorea. Even though Rheumatic Fever, the leading cause of death for children 100 years ago, has been virtually eradicated in high income countries, there continues to be children who experience an abrupt onset of obsessive-compulsive disorder (OCD) and/or tics associated with strep in even the absence of RF. This condition, termed Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS), was first identified in 1998. In 2012, Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) was recognized as a broader category encompassing a range of behavioral and psychiatric symptoms triggered not only by streptococcal infections but also by other pathogens.

The article reviews a study analyzing 193 children diagnosed with PANS over four years, finding that 28% developed arthritis, primarily manifesting as Achilles enthesitis, inflammatory back pain, and sacroiliac joint tenderness. Unlike typical childhood arthritis, these comorbid symptoms suggest a distinct rheumatic profile. The study also notes a high prevalence of eating disorders (55%) and elevated inflammatory markers in affected children.

The findings suggest that even though most rheumatogenic strains of Group A Strep have largely disappeared from high-income countries, some children—particularly those with a genetic predisposition to spondyloarthropathy—may still experience abrupt and dramatic onset of OCD and other behavioral disturbances in response to strep and other infections. Among rheumatic diseases, spondyloarthropathies are especially linked to infectious triggers, such as urinary pathogens in reactive arthritis, skin and gut microbiome imbalances in psoriatic arthritis, or colonic bacteria in Crohn’s disease-related arthritis.

LINK TO ARTICLE: https://doi.org/10.1001/jamanetworkopen.2024.21636