scholarly journals Plasmapheresis, Rituximab, and Ceftriaxone Provided Lasting Improvement for a 27-Year-Old Adult Male with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS)

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Adam Krouse ◽  
Huihua Li ◽  
Joseph A. Krenzer ◽  
William Nicholas Rose
Keyword(s):  
Clinical Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Neuropsychiatric Disorders ◽  
Sudden Onset ◽  
Autoimmune Response ◽  
Urine Drug Screen ◽  
Streptococcal Infections ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Old Adult

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is a specific autoimmune response to group-A streptococcal (GAS) infections in children and adolescents with a sudden onset of neuropsychiatric disorders including obsessive-compulsive disorder (OCD) or tic-like symptoms. We present a case report of a 27-year-old male patient who had lasting improvement with plasmapheresis, rituximab, and ceftriaxone. Our patient first developed sudden psychosis and confusion after GAS infections at age 17. He had elevated anti-streptolysin O (ASO) titers, negative urine drug screen, no ETOH in blood, normal CBC, normal TSH, normal salicylate, normal acetaminophen, and a normal head CT. The tentative diagnosis of PANDAS was made, and the patient was thereafter treated with antipsychotics, antibiotics, tonsillectomy, and IVIG which resulted in remissions and relapses of his neuropsychiatric symptoms. Once he reached age 27, he received a trial of therapeutic plasma exchange (TPE), rituximab, and ceftriaxone. This eventually resulted in sustained benefit and minimal fluctuations of his clinical symptoms. Our report is noteworthy in three ways.One, he is a 27-year-old adult with PANDAS.Two, he improved after TPE, rituximab, and ceftriaxone. Our literature search yielded minimal data on the use of plasmapheresis for nonteenage adults with PANDAS. Three, he had unusual symptoms of PANDAS, as the typical OCD and/or tic-like symptoms were not observed.

scholarly journals Diagnostic Approach to Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS): A Narrative Review of Literature Data

2021 ◽  
Vol 9 ◽  
Author(s):  
Adriana Prato ◽  
Mariangela Gulisano ◽  
Miriam Scerbo ◽  
Rita Barone ◽  
Carmelo M. Vicario ◽  
...  
Keyword(s):  
Neuropsychiatric Symptoms ◽  
Diagnostic Procedures ◽  
Neuropsychiatric Disorders ◽  
Sudden Onset ◽  
Acute Onset ◽  
Streptococcal Infections ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Appropriate Treatment ◽  
Clinical Conditions

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are clinical conditions characterized by the sudden onset of obsessive–compulsive disorder and/or tics, often accompanied by other behavioral symptoms in a group of children with streptococcal infection. PANDAS-related disorders, including pediatric acute-onset neuropsychiatric syndrome (PANS), childhood acute neuropsychiatric symptoms (CANS), and pediatric infection triggered autoimmune neuropsychiatric disorders (PITANDs), have also been described. Since first defined in 1998, PANDAS has been considered a controversial diagnosis. A comprehensive review of the literature was performed on PubMed and Scopus databases, searching for diagnostic criteria and diagnostic procedures of PANDAS and related disorders. We propose a test panel to support clinicians in the workout of PANDAS/PANS patients establishing an appropriate treatment. However, further studies are needed to improve our knowledge on these acute-onset neuropsychiatric conditions.

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Mohammad O AL fattani ◽  
Asmaa M Al Refaie ◽  
Shuruq Hassan Alsulami ◽  
Najia Al Hojaili
Keyword(s):  
Febrile Illness ◽  
Neuropsychiatric Disorders ◽  
Age Group ◽  
Pediatric Age ◽  
Streptococcal Infections ◽  
Obsessive Compulsive ◽  
Tic Disorder ◽  
Compulsive Disorder ◽  
Pediatric Age Group ◽  
Suicidal Attempts

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is a rear disease in pediatric age group which constitute a unique manifestation associated with obsessive-compulsive disorder (OCD) and tic disorder in children. However, this diagnosis has carried a lot of controversies, related mainly to its management. Here we are presenting one case of PANDAS syndrome who was treated successfully with full coarse of antibiotic for 10 days, where all his symptoms disappeared completely in subsequent days including suicidal attempts. PANDAS should be considered in children with neuropsychiatric disorders (tics, obsessive behavior etc.) especially if symptoms associated within a period of infection such as febrile illness or sore throats.

Obsessive—Compulsive Disorder in Post-Streptococcal Infection

1998 ◽  
Vol 32 (4) ◽  
pp. 579-581
Author(s):  
Erik Monasterio ◽  
Roger T. Mulder ◽  
Thomas D. Marshall
Keyword(s):  
Streptococcal Infection ◽  
Past History ◽  
Sudden Onset ◽  
Autoimmune Response ◽  
Progressive Reduction ◽  
Obsessive Compulsive ◽  
Obsessive Compulsive Symptoms ◽  
Compulsive Disorder ◽  
History Of ◽  
Peritoneal Infection

Objective: We describe the sudden onset of obsessive—compulsive symptoms fol lowing a peritoneal infection with α-haemolytic streptococci. Clinical picture: A 35–year-old woman with no past history or family history of obsessions or compulsions developed these symptoms 2 weeks after a peritoneal infection. Treatment: The patient received 80 mg fluoxetine daily. Outcome: She responded to treatment with a progressive reduction in symptoms. Conclusions: It is suggested that these obsessions and compulsions may be related to an autoimmune response to the streptococcal infection.

The PANDAS Subgroup: Recognition and Treatment

CNS Spectrums ◽  
2001 ◽  
Vol 6 (5) ◽  
pp. 419-426 ◽  
Author(s):  
Susan E. Swedo ◽  
Marjorie Garvey ◽  
Lisa Snider ◽  
Charlotte Hamilton ◽  
Henrietta L. Leonard
Keyword(s):  
Controlled Trial ◽  
Neuropsychiatric Symptoms ◽  
Sudden Onset ◽  
Tic Disorders ◽  
Temporal Association ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Treatment And Prevention ◽  
Group A ◽  
Immunomodulatory Therapies

AbstractA subgroup of patients with childhood-onset obsessive-compulsive disorder (OCD) has been identified who share a common clinical course characterized by dramatic symptom exacerbations following Group A beta-hemolytic streptococcal (GABHS) infections. The term PANDAS has been applied to the subgroup, to indicate the postulated etiology of their symptoms: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections. Five clinical characteristics define the PANDAS subgroup: presence of OCD and/or tic disorder, prepubertal symptom onset, sudden onset or abrupt exacerbations (sawtooth course), association with neurological abnormalities (presence of adventitious movements or motoric hyperactivity during exacerbations), and temporal association between symptom exacerbations and GABHS infections. Post-streptococcal symptom exacerbations are typically quite dramatic, with patients reporting that their symptoms “…came on overnight” or “…appeared all of a sudden a few days after I had a sore throat.” The post-streptococcal inflammatory nature of the neuropsychiatric symptoms provides novel opportunities for treatment and prevention, including immunomodulatory therapies such as therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIG). A recently completed placebo-controlled trial revealed that both IVIG and TPE were effective in reducing neuropsychiatric symptom severity (40% to 55% reductions, respectively) for a group of severely ill children with OCD and/or tic disorders. Further research is required to determine why the treatments are helpful, as well as to ascertain whether or not antibiotic prophylaxis can help prevent post-streptococcal symptom exacerbations.

The Potential Role of 5-HT1D Receptors in the Pathophysiology and Treatment of Obsessive-Compulsive Disorder

CNS Spectrums ◽  
1998 ◽  
Vol 3 (8) ◽  
pp. 46-49 ◽  
Author(s):  
Liat Stern ◽  
Joseph Zohar ◽  
Thalma Hendler ◽  
Iulian Ianco ◽  
Yehuda Sasson
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Clinical Symptoms ◽  
Epidemiological Studies ◽  
Obsessive Compulsive ◽  
Genetic Studies ◽  
Compulsive Disorder ◽  
Everyday Activities ◽  
Research Fields ◽  
Patterns Of Behavior

Obsessive-compulsive disorder (OCD) is a psychiatric disorder in which the patient suffers from recurrent intrusive ideas, impulses, thoughts (obsessions), and/or patterns of behavior (compulsions) that are ego-alien and produce anxiety if resisted. The ego-dystonic nature of OCD is one of the hallmarks of this disorder. OCD can be a disabling condition because the obsessions and compulsions are time-consuming and interfere with patients' everyday activities and their relationships with friends and family. In severe cases, OCD conflicts even with the simplest tasks of daily living.Research interest in OCD has been growing steadily in the past decade. A search on MEDLINE reveals an over 300% increase in citations on OCD from 1986 to 1998. These range across the spectrum of research fields, from genetic studies, brain imaging, and neurobiological research examining the underlying pathogenesis of OCD to epidemiological studies evaluating the course of clinical symptoms, comorbidities, and outcomes. Each area represents an important piece in the complex jigsaw puzzle of OCD.

scholarly journals Neuropsychiatric symptoms following sore throat in a young boy

2019 ◽  
Vol 12 (1) ◽  
pp. e227540 ◽  
Author(s):  
Raafat Hammad Seroor Jadah ◽  
Athar Abdul Mujeeb
Keyword(s):  
Physical Examination ◽  
Sleep Disturbance ◽  
Symptom Onset ◽  
Normal State ◽  
Neuropsychiatric Symptoms ◽  
Sudden Onset ◽  
Metabolic Abnormalities ◽  
Streptococcal Infections ◽  
History Of ◽  
Patient’S History

A previously healthy 6-year-old boy was referred to us by his primary provider, with a history of sudden onset behavioural abnormalities including irritability, sleep disturbance and anxiety. Physical examination revealed no significant findings; further analyses were not suggestive of meningitis, encephalitis, metabolic abnormalities, toxicity or any other obvious cause. On rechecking the patient’s history, an episode of throat pain 1 week prior to the symptom onset was noted. Therefore, the possibility of paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) was considered. The antistreptolysin O titre was high (1078 IU/mL), and it increased to 1194 IU/mL 4 weeks later, leading to a diagnosis of PANDAS. He was started on ampicillin and administered one dose of intravenous immunoglobulin. His abnormal behaviours subsided and he returned to a normal state within 48 hours of treatment. This report aims to provide insights into the symptomology and diagnosis of PANDAS in children.

Cognitive Behavioral Therapy and Acceptance and Commitment Therapy as Augmentation Treatment for Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS): A Case Report

2017 ◽  
Vol 41 (S1) ◽  
pp. s781-s782
Author(s):  
A. Pozza
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Antibiotic Prophylaxis ◽  
Test Score ◽  
Behavioral Therapy ◽  
Neuropsychiatric Disorders ◽  
Tic Disorders ◽  
Cognitive Behavioral ◽  
Symptom Improvement ◽  
Streptococcal Infections ◽  
Compulsive Disorder

IntroductionPaediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are a subgroup of conditions including obsessive-compulsive disorder (OCD), tic disorders, pre-pubertal and sudden onset, temporal association between streptococcal infections and associated neurological abnormalities. Some strategies were developed, including the use of antibiotic prophylaxis to prevent streptococcal-triggered exacerbations, and immunomodulatory interventions for the management of acute symptoms. Cognitive-behavioral therapy (CBT), which has been demonstrated to be the first-line treatment for OCD, can be a valid adjuvant during the difficult course of PANDAS to target acute symptoms and prevent exacerbations.ObjectivesThe study presented a case of a patient with PANDAS treated with antibiotic medication and CBT as augmentation.MethodsThe 11-year-old patient (Y-BOCS pre-test score = 32), had been hospitalized for three weeks for acute onset of PANDAS. The clinical picture consisted of asthenia, contamination fears and washing compulsions, separation anxiety, severe depression and anxiety. Pharmacotherapy involved risperidone 2 mg/die and sertraline 250 mg/die for five months combined with antibiotic prophylaxis for two years. The CBT intervention started at discharge from hospital and included psycho-education on anxiety, intensive exposure and response prevention (2 hour sessions three times a week) for twelve months, cognitive restructuring, diffusion and mindfulness for the subsequent twelve months.ResultsAnxiety and OCD symptoms substantially improved. The patient gradually started school again. Post-test score was 11 on the Y-BOCS.ConclusionsAlong with psychiatric and antibiotic medications, CBT may be a valid augmentation strategy for PANDAS to reduce risk of exacerbations and enhance symptom improvement. Limitations are discussed.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

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