Dear Doctors: I was surprised in one of your columns about obsessive-compulsive disorder that you didn’t talk about the connection to strep throat. My daughter developed OCD symptoms this way. I can only wonder how she would be struggling today at 22 without the correct diagnosis and treatment.
Dear Reader: You’re referring to a syndrome known as PANDAS, short for pediatric autoimmune neuropsychiatric disorders associated with streptococcus. First identified in 1998, it has become recognized as a treatable disorder.
PANDAS is marked by the sudden onset of OCD-like behaviors in children infected with Group A streptococcus, or strep.
OCD is a stressful and disruptive cycle of thoughts and behaviors that the affected individual finds difficult or even impossible to control. The gradual onset of symptoms—which can arise at any time from preschool through adulthood—has been linked to a variety of factors that include a genetic family history, coping behaviors for stressful life events, anxiety and other mental health disorders.
PANDAS, by contrast, always appears in proximity to a strep infection. It also occurs suddenly and escalates rapidly.
Parents say children who develop PANDAS change overnight. In addition to physical, vocal and behavioral tics and compulsions, kids can become moody, irritable, hyperactive or fearful, develop severe anxiety, lose urinary continence, have changes in motor skills and experience joint pain.
The syndrome isn’t caused by the strep bacteria but by the body’s immune response to the infection.
This genus of bacteria is skilled at something known as “molecular mimicry.” That means it can evade the immune system by disguising itself as various tissues within the body. When the immune system eventually does identify the strep, it sometimes attacks not only the invader but also some of the body’s own tissues.
Studies have shown that part of this battle can take place in the tissues of the brain. This is believed to play a role in the neurological and psychiatric symptoms of PANDAS.
It’s possible for an adult to develop PANDAS, but it’s seen most often in children. Up to one-third of sore throats in children are due to strep, compared to fewer than 10% in adults.
Even among children, PANDAS is somewhat rare. It’s estimated that one in 200 children with a strep infection develops the syndrome.
The best treatment is the use of antibiotics to eradicate the strep.
Many children respond well, and their symptoms gradually resolve.
If your doctor isn’t familiar with PANDAS, referrals are available through the International OCD Foundation (iocdf.org) and the PANDAS Physicians Network (pandasppn.org).
Dr. Eve Glazier and Dr. Elizabeth Ko are internists at UCLA Health.
