Group A Streptococcal Infections, PANDAS, and PANS

For over two decades, researchers have explored the connection between microbial infections and mental health, particularly in the context of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). This condition typically follows a group A streptococcal (GAS) infection, such as strep throat, scarlet fever or anal streptococcal infection, also known as perianal streptococcal dermatitis.

Children with PANDAS experience a sudden onset of obsessive-compulsive behaviors, tic disorders, or both. Additional symptoms may include hyperactivity, involuntary jerky movements, mood changes, irritability, sleep issues, separation anxiety, increased urination, joint pain, and motor skill impairments like difficulty with handwriting.

The proposed cause of PANDAS involves molecular mimicry and autoimmunity, mechanisms also seen in post-streptococcal conditions like rheumatic fever and Sydenham’s chorea. In PANDAS, antibodies that target streptococcal bacteria are thought to cross-react with components of the basal ganglia, triggering an immune-mediated encephalitis.

PANDAS has since been recognised as part of a broader category called pediatric acute-onset neuropsychiatric syndrome (PANS). Unlike PANDAS, PANS encompasses neuropsychiatric symptoms triggered not only by streptococcal infections but also by other infectious agents (e.g., Mycoplasma, Lyme disease, Bartonella, and SARS-CoV-2) and possibly non-infectious factors like environmental toxins. Key features of PANS include a sudden onset of obsessive-compulsive behaviors or restricted eating, along with symptoms like depression, anxiety, aggression, cognitive impairments, ADHD-like behaviors, sleep disturbances, and urinary issues.

Anna Pinnock Dr Suparna Chakrabarti Dr Lorene Amet Sarah Cranage

Diagnosis Criteria used in Functional Medicine

  • A sudden onset of neuropsychiatric symptoms is essential.

  • Identification of triggers (infectious, environmental, or other).

  • Evidence of immune dysfunction or inflammation.

  • Rule out other medical causes (e.g., primary psychiatric disorders or neurological conditions).

Frequently asked questions by our clients

  • It is a condition caused by group A Streptococcus (GAS) bacteria, the same pathogen responsible for strep throat. It is characterised by redness, pain, and irritation in the perianal region. While more commonly associated with localized symptoms, evidence suggests that it may act as a trigger for neuropsychiatric conditions like PANDAS .

    A 2009 study published in the Journal of Child Neurology documented cases of children who developed PANDAS symptoms, including obsessive-compulsive disorder and tics, following anal streptococcal infections. Treatment of the infection with antibiotics often resulted in symptom improvement, suggesting a causal link.

    Anecdotal evidence from clinicians has further supported the association between perianal GAS infections and the onset or exacerbation of PANDAS symptoms.

  • GAS infections, regardless of location, can activate the immune system and cause systemic inflammation. The presence of circulating antibodies and inflammatory mediators may contribute to neuroinflammation, triggering or worsening PANDAS-related symptoms.

  • Primary Symptoms:

    • Sudden onset of obsessive-compulsive symptoms or restricted eating.

    • Associated Symptoms:
      Neuropsychiatric and somatic symptoms, including:

      Anxiety, irritability, or aggression.

      Emotional instability or depression.

      Cognitive difficulties (e.g., memory, focus).

      Sleep disturbances.

      Tics or motor abnormalities.

      Urinary frequency or enuresis.

    • The abrupt nature of symptom onset and the presence of multiple associated symptoms strongly indicate PANS.

    Detailed Medical History

    • Recent Illnesses: Look for infections (e.g., streptococcal, Mycoplasma, Lyme disease, or viral infections).

    • Environmental Exposures: Assess for toxins, mold, or other inflammatory triggers.

    • Family History: Check for autoimmune or psychiatric conditions.

    • Dietary Patterns: Identify potential nutritional deficiencies or food intolerances.

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