It’s hard to see your child suffer from strep throat, the most common complication of an infection of the Streptococcus pyogenes bacterium. What can be scarier, though, is watching the child recover from the high fever, the swollen tonsils, and the excessive fatigue, only to see them develop new symptoms soon after—symptoms that are unfamiliar and unexplained.
Strep infections can cause diseases far beyond painful, and some of them aren’t regularly diagnosed or even fully understood by medical professionals. This includes pediatric autoimmune neuropsychiatric disorders associated with Streptococcus, or PANDAS, a condition that’s only been recognized since the late 1990s, that most commonly affects kids between ages three and 12.
The First Signs of PANDAS
Part of PANDAS’ frightening nature is that its early signs don’t necessarily resemble a physical illness, nor do they appear until about four to six weeks after the initial strep infection. These first symptoms are similar to mental disorders such as obsessive-compulsive disorder (OCD) and Tourette syndrome, but they intensify in just a few days to a debilitating point. As a comparison, childhood mental disorders typically manifest gradually over weeks, months, or even longer.
A parent might first notice that their child is participating in repetitive or obsessive behaviors, regressing in their emotional development, starting to have separation anxiety or panic attacks, or even suffering from depression or suicidal thoughts. There are physical signs, too, including unusual movements or tics, sensitivity to light, sound, or touch, and trouble sleeping and focusing.
The Difficulty in Diagnosis
There’s a pearl of general wisdom in diagnosing diseases: When you hear hoofbeats, think horses, not zebras. It makes sense, really—99 times out of 100, the right diagnosis is going to be a common one. Of course, that makes it harder when the true condition is that one out of 100 disease, and nothing seems to be working as treatment. It’s harder when medical professionals don’t even know the exact cause of the disease, such is the case for PANDAS.
The prevailing theory is that PANDAS is the result of a faulty immune system response to that initial strep infection. It might be something totally different—because the disease wasn’t identified until 1998, and there aren’t any longterm studies yet. However, there’s no test for PANDAS beyond a typical blood test or throat culture that can confirm there’s a strep infection in the body, so doctors have to go on a bit of wisdom and a lot of faith.
The Two-Fold Treatment
Because PANDAS manifests as both physical and psychological symptoms, doctors must treat both physical and mental symptoms—which means it’s not an easy road to recovery. Without treatment, though, PANDAS can become a chronic autoimmune condition that could result in permanent cognitive damage.
First, that strep infection has got to go. Usually, antibiotics can take care of that, though some cases require immunoglobulin. Then, the psychiatric symptoms—which might start to lessen with the antibiotics—can be handled through, perhaps, a low dose of antidepressants, as well as therapy. Proper treatment of PANDAS is often an “It takes a village” scenario, which is true even in health care.
Continuing Controversy
Strep isn’t the only infection that can cause psychiatric problems. PANDAS is a subset of pediatric acute-onset neuropsychiatric syndrome (PANS), which results in the same type of symptoms but is caused by other infections, such as influenza.
However, because of PANDAS’ recent identification and lack of long-term research, there are still questions surrounding the syndrome—and that means it’s not as easily or as quickly diagnosed as other conditions. Although one in 200 children may have PANDAS or PANS, according to the PANDAS Network, the true prevalence of the disease has yet to be determined.
