Alterations in the Nervous System and Gut Microbiota after β-Hemolytic Streptococcus Group A Infection—Characteristics and Diagnostic Criteria of PANDAS Recognition

Abstract

The objective of this paper is to review and summarize conclusions from the available literature regarding Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). The authors have independently reviewed articles from 1977 onwards, primarily focusing on the etiopathology, symptoms, differentiation between similar psychiatric conditions, immunological reactions, alterations in the nervous system and gut microbiota, genetics, and the available treatment for PANDAS. Recent research indicates that PANDAS patients show noticeable alterations within the structures of the central nervous system, including caudate, putamen, globus pallidus, and striatum, as well as bilateral and lentiform nuclei. Likewise, the presence of autoantibodies that interact with basal ganglia was observed in PANDAS patients. Several studies also suggest a relationship between the presence of obsessive-compulsive disorders like PANDAS and alterations to the gut microbiota. Further, genetic predispositions—including variations in the MBL gene and TNF-α—seem to be relevant regarding PANDAS syndrome. Even though the literature is still scarce, the authors have attempted to provide a thorough insight into the PANDAS syndrome, bearing in mind the diagnostic difficulties of this condition.

Early childhood Group-A streptococcal infections and basal ganglia antibodies in adult ADHD: A preliminary study

“…Even more emerged about basal ganglia autoimmunity as over a fifth of the sample had positive ABGA titer, consistently with a previous report regarding Italian ADHD children (25%, [28]). This rate was also in line with that found in adults affected by obsessive-compulsive disorder (19.8%, [35]), which represents one of the most known neuropsychiatric manifestation of post-streptococcal autoimmune basal ganglia disorders [36]. ADHD seems to be even more prevalent than obsessivecompulsive disorder in adult populations (2.8% vs. 1.2%, [4,37]) and, as mentioned above, the implication of structural and functional anomalies of basal ganglia in its pathophysiology has been well-recognized by neuroimaging studies [5,6,8,9].…”

Early childhood infections, antistreptococcal and basal ganglia antibodies in adult ADHD: A preliminary study

“…Even more emerged about basal ganglia autoimmunity as over a fth of the sample had positive ABGA titer, consistently with a previous report regarding Italian children with ADHD (25%, [28]). This rate was also in line with that found in adults affected by obsessive-compulsive disorder (19.8%, [35]), which represents one of the most known neuropsychiatric manifestation of post-streptococcal autoimmune basal ganglia disorders [36]. ADHD seems to be even more prevalent than obsessive-compulsive disorder in adult populations (2.8% vs. 1.2%, [4,37]) and, as mentioned above, the implication of structural and functional anomalies of basal ganglia in its pathophysiology has been well-recognized by neuroimaging studies [5,6,8,9].…”

Early childhood infections, antistreptococcal and basal ganglia antibodies in adult ADHD: A preliminary study

“…Even more emerged about basal ganglia autoimmunity as over a fth of the sample had positive ABGA titers, consistently with a previous report regarding Italian children with ADHD (25%, [28]). This rate was also in line with that found in adults affected by obsessive-compulsive disorder (19.8%, [35]), which represents one of the most known neuropsychiatric manifestation of post-streptococcal autoimmune basal ganglia disorders [36]. ADHD seems to be even more prevalent than obsessive-compulsive disorder in adult populations (2.8% vs. 1.2%, [4,37]) and, as mentioned above, the implication of structural and functional anomalies of basal ganglia in its pathophysiology has been well-recognized by neuroimaging studies [5,6,8,9].…”