PANDAS syndrome in children after purulent angina. Learn the symptoms and treatment

PANDAS syndrome in children after purulent angina.  Learn the symptoms and treatment

PANDAS is a set of symptoms that appears in children who have been infected with streptococcus. The most common symptoms include obsessive-compulsive disorder and nervous tics.

PANDAS syndrome (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) is a rare disease affecting children and adolescents. It is estimated that 1 in 2,000 children suffer from it. It is the result of infection with group A streptococcus. Streptococcus (Streptococcus), which is a type of Gram-positive bacteria. This bacterium can cause a number of infections – from relatively harmless (e.g. purulent sore throat, acute bacterial pharyngitis) to serious and life-threatening (e.g. pneumonia, meningitis, endocarditis, nephritis or even sepsis). .

The neuropsychiatric complication of streptococcal infection in the form of PANDAS syndrome usually appears within four to six weeks of streptococcal infection and rapidly worsens rapidly. The disease was first described in 1998 and is not yet well understood. It is indicated that PANDAS syndrome may have an autoimmune basis.

Purulent tonsillitis in a child and PANDAS syndrome

Disorders characteristic of PANDAS syndrome may occur after a history of purulent angina. It is a throat infection caused by group A streptococci. It often develops suddenly. It causes severe sore throat, enlarged lymph nodes, white coating on the tonsils, increased body temperature, and even abdominal pain and vomiting. During streptococcal infection, the child’s body begins to produce antibodies that are supposed to recognize and destroy the bacteria. This is how the natural human immune mechanism works. Unfortunately, in this case, an incorrect immune reaction may occur – antibodies not only fight bacteria, but also attack their own cells – neurons in the brain. This is due to the similarity between bacterial and human antigens.

Symptoms of PANDAS syndrome

Symptoms of PANDAS syndrome appear suddenly and may vary in severity. The most characteristic are: obsessive-compulsive neurosis, which manifests itself, among others, repetition of actions or persistent recurrence of certain thoughts and tics, i.e. short, involuntary body movements or facial grimaces. Other symptoms that should make parents watch out include:

  • sudden mood changes in a child,

  • irritability,

  • medicines,

  • tearfulness,

  • aggression, sadness,

  • problems with concentration, problems with motor coordination,

  • insomnia, difficulty falling asleep, and nightmares,

  • eating disorders,

  • bedwetting.

How to diagnose and treat children with PANDAS?

Diagnosis in PANDAS syndrome is difficult. The basis for its diagnosis is correlating the occurrence of neuropsychiatric symptoms with a history of streptococcal infection. PANDAS syndrome most often occurs in children between 3 and 12 years of age, before puberty. It is characterized by the sudden appearance and disappearance of neuropsychiatric symptoms (tics/obsessions).

Treatment involves silencing or eliminating neuropsychic symptoms. In such cases, anti-anxiety and antidepressant drugs are most often administered. Cognitive-behavioral therapy and nervous tics therapy are also part of the treatment.

Since prevention is better than cure, it is worth remembering that in the event of streptococcal angina, effective antibiotic treatment is very important. It helps prevent the occurrence of PANDAS syndrome.


  • C. Wilbur, A. Bitnun, S. Kronenberg, RM Laxer, DM Levy, WJ Logan, M. Shouldice, EA Yeh “Paediatrics & Child Health”



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