In 2020, COVID-19 reminded us that acute infections could lead to long-term consequences. Physicians have documented the extensive set of symptoms that plague many survivors of the coronavirus, including brain fog, fatigue, shortness of breath, and even changes in mood (CDC, 2020; Marshall, 2021). While this sort of phenomena may seem foreign to many of us, it is actually quite common in the world of bacterial and viral infections. This brings me to the topic of today's article, Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections, or PANDAS.
Strep throat is a common bacterial infection that results in a sore throat accompanied by flu-like symptoms (Mayo Clinic, 2020). In the late 1990s, researchers at the National Institute of Mental Health noticed a troubling pattern of cases in which children with no prior history of OCD rapidly developed moderate to severe obsessive-compulsive symptoms. Notably, these kids all had one thing in common: they had recently recovered from a bad Strep infection (Orefici et al., 2016).
While we do not definitively understand why this occurs, many scientists believe that PANDAS is caused by an autoimmune reaction. The leading theory suggests that the proteins found on the surface of the streptococcus bacteria mimic the proteins found in the basal ganglia of the brain. This would mean that the antibodies we produce to fight off strep would also bind to cells of our basal ganglia leading to neuroinflammation and potential damage of this brain region (Macerollo & Martino, 2013).
I warn you of this potential complication in childhood strep in order to educate you, rather than scare you. PANDAS is a condition that is often improperly diagnosed, leading to unnecessary hardship. Compared to traditional OCD, PANDAS is usually more easily treated. A course of antibiotics in conjunction with cognitive-behavioral therapy is often enough to completely extinguish the condition (Pabst & Subasic, 2020).