PANDAS, which stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, is a rare but complex medical condition that primarily affects children [1]. This syndrome is characterized by the sudden onset of neuropsychiatric symptoms following a streptococcal infection, such as strep throat. In this blog post, we will delve into what PANDAS syndrome is and explore the diagnostic process.
What is PANDAS Syndrome?
PANDAS syndrome is believed to be an autoimmune disorder where the body’s immune system mistakenly attacks the basal ganglia, a part of the brain responsible for controlling movement and regulating emotions [1]. This abnormal immune response is triggered by a streptococcal infection, which leads to an array of neuropsychiatric symptoms [1].
What are the Symptoms?
PANDAS can manifest with a range of symptoms, including:
- Obsessive-compulsive behaviors (OCD).
- Tics (motor and vocal).
- Anxiety and panic attacks.
- Mood swings and emotional lability.
- Regression in developmental milestones.
- Changes in handwriting and fine motor skills.
- Sensory sensitivities.
- Behavioral disturbances.
People do not directly transmit PANDAS from person to person. Instead, it is thought to result from an autoimmune response in which the body’s immune system mistakenly attacks the basal ganglia, a part of the brain [2].
Are PANS and PANDAS Syndrome the Same Thing?
PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) is a term for a set of sudden and severe neuropsychiatric symptoms in children, while PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) specifically links these symptoms to streptococcal infections [2]. Both involve abrupt onset of symptoms, but PANDAS has a narrower trigger (streptococcus), while PANS encompasses various triggers and infections [2].
How Common is PANDAS Syndrome and What are the Risk Groups?
PANDAS is considered rare, and its prevalence is not precisely known. It primarily affects children, typically between the ages of 3 and 12 [3]. Some children may be at a higher risk if they have a history of frequent streptococcal infections. However, not all children who have strep infections develop PANDAS.
Treatment Methods
If a child receives a diagnosis of PANDAS, healthcare providers typically implement a two-pronged treatment approach:
Antibiotics: To target the underlying streptococcal infection, antibiotics like penicillin or amoxicillin are prescribed to eradicate the bacteria and reduce the autoimmune response [3].
Immune Modulation: In some cases, healthcare providers may consider immune-modulating therapies such as intravenous immunoglobulin (IVIG) or plasmapheresis to help modulate the immune response and reduce symptoms.
In addition to medical treatment, behavioral therapy, cognitive-behavioral therapy (CBT), and other psychotherapeutic approaches may be recommended to manage neuropsychiatric symptoms [3].
Prevention Methods for PANDAS
Preventing streptococcal infections through good hygiene practices like handwashing and avoiding close contact with infected individuals can reduce the risk of strep-related complications, including PANDAS. However, it’s important to note that not all strep infections lead to PANDAS, and prevention measures may not entirely eliminate the risk.
Diagnosis Methods for PANDAS
Diagnosing PANDAS can be challenging because its symptoms overlap with other neuropsychiatric disorders, such as Tourette’s syndrome, obsessive-compulsive disorder, and general anxiety disorder. To diagnose PANDAS, healthcare providers typically follow a series of steps:
Medical History: The first step is to take a detailed medical history, including a history of streptococcal infections and the onset of neuropsychiatric symptoms. A thorough understanding of the patient’s symptoms and their timeline is crucial.
Clinical Evaluation: Medical professionals conduct a physical and neurological examination to assess the patient’s current state and to look for any signs of neuropsychiatric symptoms, motor abnormalities, or tics.
Blood Tests: Blood tests may be performed to check for streptococcal antibodies, specifically antistreptolysin O (ASO) and anti-DNase B [4]. Elevated levels of these antibodies may suggest recent streptococcal infections.
Throat Culture: Healthcare providers may take a throat culture to detect the presence of streptococcal bacteria, even if visible symptoms like a sore throat are absent.
Neuropsychological Assessment: We may conduct a neuropsychological evaluation to assess cognitive and emotional functioning, helping us identify specific neuropsychiatric symptoms.
Differential Diagnosis: It’s essential to rule out other conditions that might be causing the symptoms. A comprehensive evaluation helps differentiate PANDAS from other similar disorders.
Response to Treatment: A critical diagnostic criterion is observing whether the patient’s symptoms improve after treatment for streptococcal infections, such as antibiotics.
It’s crucial for parents and caregivers to consult with healthcare professionals who specialize in pediatric neuropsychiatric disorders if they suspect a child may have PANDAS. Early diagnosis and appropriate treatment are essential for managing the condition effectively.
How to Use Strep A Rapid Test Kit?
Strep A Rapid Test Kit is one of the valuable tools for helping diagnosis of PANDAS. Using a Strep A Rapid Test Kit typically involves a series of steps, and it’s important to follow the manufacturer’s instructions included with the kit carefully. Below are general guidelines on how to use a Strep A Rapid Test Kit:
- Gather Materials: Ensure you have all the necessary materials included in the kit, including the test cassette, swabs, reagent solutions, and any required disposables (e.g., gloves).
- Preparations Ensure the test kit is at room temperature before use, as extreme temperatures can affect the accuracy of the test.
- Sample Collection: Wash your hands thoroughly and put on disposable gloves if provided in the kit. Open the swab package and carefully collect an oropharyngeal (throat) swab sample. Tilt the patient’s head back, open the mouth, and gently swab the back of the throat and tonsils. Avoid touching the tongue or cheeks. Place the swab back into its container or any provided transport medium, following the manufacturer’s instructions.
- Test Preparation Open the test cassette package, ensuring you don’t touch the testing area. Dispense the required number of drops of reagent solution (provided in the kit) into the sample well on the test cassette, following the kit’s instructions.
- Sample Application: Transfer the swab into the test cassette’s sample well, ensuring the sample contacts the reagent solution. Rotate the swab in the sample well for a few seconds to ensure adequate mixing.
- Test Development: Allow the test to develop according to the recommended time frame specified in the kit’s instructions. This is typically a few minutes.
- Interpretation: After the specified development time, observe the test cassette for the presence or absence of colored lines in the result window. Most Strep A Rapid Test Kits will have two lines:
- Control Line: This line should appear regardless of whether the test is positive or negative, indicating that the test has worked correctly.
- Test Line: This line will appear only if the test is positive for Streptococcus A antigen. Interpret the results according to the manufacturer’s guidelines. A positive result shows both the control and test lines, while a negative result shows only the control line.
- Record and Report: Record the results as instructed in the kit’s manual. Report the results to the appropriate healthcare provider for further evaluation and treatment if necessary.
- Dispose: Dispose of used materials, including gloves and the test cassette, according to local regulations and biohazard disposal guidelines.
It’s crucial to note that the specific instructions for each Strep A Rapid Test Kit may vary slightly, so always follow the manufacturer’s instructions provided with the kit for the most accurate and reliable results. Additionally, confirm the expiration date of the kit before use, as using an expired kit may yield inaccurate results.
What is the Most Common and Effective Strep A Rapid Test Kit for PANDAS?
The Strep A Rapid Test Kit is a crucial diagnostic tool for the rapid detection of group A Streptococcal antigen from oropharyngeal swab samples. It aids in diagnosing upper respiratory infections like scarlet fever, pharyngitis, and tonsillitis, ensuring timely treatment and reducing infection spread. Its less-invasive swab sampling makes it patient-friendly, especially for sensitive or pediatric patients. The kit offers a safe and straightforward testing procedure, minimizing errors and expediting clinical testing. With rapid results typically available within minutes, it facilitates immediate treatment decisions, crucial for contagious diseases. Furthermore, the kit provides easily interpretable results, reducing the risk of misdiagnosis. Overall, the Strep A Rapid Test Kit significantly enhances patient care, early detection, and effective management of streptococcal infections, benefiting both patients and healthcare providers in combating these contagious diseases.
REFERENCES
[1] Pichichero, M. E. (2009). The PANDAS syndrome. Hot Topics in Infection and Immunity in Children V, 205-216.
[2] Macerollo, A., & Martino, D. (2013). Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): an evolving concept. Tremor and other hyperkinetic movements, 3.
[3] Shulman, S. T. (2009). Pediatric autoimmune neuropsychiatric disorders associated with streptococci (PANDAS): update. Current Opinion in Pediatrics, 21(1), 127-130.
[4] Prato, A., Gulisano, M., Scerbo, M., Barone, R., Vicario, C. M., & Rizzo, R. (2021). Diagnostic approach to pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): a narrative review of literature data. Frontiers in Pediatrics, 9, 746639.
