Several inflammatory disorders have been associated with preceding streptococcal infections
•acute rheumatic fever (ARF),
•post-streptococcal glomerulonephritis
•post- streptococcal reactive arthritis,
•erythema nodosum,
•cutaneous polyarteritis nodosa (PAN).
•Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection (PANDAS).

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection
  1. Obsessive-Compulsive Disorder (OCD),
  2. Tic disorders,
  3. Tourette’s syndrome (TS) and
  4. Sydenham’s chorea (SC)
  5. A number of additional manifestations including attention-deficit/hyperactivity disorder, myoclonus, dystonia, paroxysmal dyskinesias, anorexia nervosa , and acute disseminated encephalomyelitis.
The major distinguishing feature of the PANDAS
Is the temporal association between neuropsychiatric symptom exacerbations and GAS infections—that is :
Positive (or rising) antistreptococcal antibody titers or a positive throat culture during neuropsychiatric symptom relapses and
Evidence of GAS negativity during periods of remission.

Criteria for PANDAS
  • Tourette Syndrome (TS) is a neurological disorder characterized by tics -- involuntary, rapid, sudden movements or vocalizations that occur repeatedly in the same way.
  • Diagnostic criteria include:
  • Both multiple motor and one or more vocal tics present at some time, although not necessarily simultaneously .
  • The occurrence of tics many times a day (usually in bouts) nearly every day or intermittently throughout the span of more than one year;
  • Periodic changes in the number, frequency, type and location of the tics, and in the waxing and waning of their severity.
  • Symptoms can sometimes disappear for weeks or months at a time;
  • Onset before the age of 18.

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