Lyme disease and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): an overview

Abstract

Lyme disease (LD) is a complex, multisystemic illness. As the most common vector- borne disease in the United States, LD is caused by bacterial spirochete Borrelia burgdorferi sensu stricto, with potential coinfections from agents of anaplasmosis, babesiosis, and ehrlichiosis. Persistent symptoms and clinical signs reflect multiorgan involvement with episodes of active disease and periods of remission, not sparing the coveted central nervous system. The capability of microorganisms to cause and exacerbate various neuropsychiatric pathology is also seen in pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), a recently described disorder attributed to bacterium Streptococcus pyogenes of group A beta-hemolytic streptococcus in which neurologic tics and obsessive-compulsive disorders are sequelae of the infection. In the current overview, LD and PANDAS are juxtaposed through a review of their respective infectious etiologies, clinical presentations, mechanisms of disease development, courses of illness, and treatment options. Future directions related to immunoneuropsychiatry are also discussed.

Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis

“…Lyme disease, a complex multisystemic illness, is the most common vector-borne disease in the USA and is caused by bacterial spirochete Borrelia. 73 Lyme disease has been reported as presenting as TS; 74 in the UK, 75 it is spread to humans by infected ticks and named after the city of Lyme in Connecticut. If the tick bites an infected animal, the tick becomes infected and can pass the disease to humans; most bites occur in late spring and early summer and it is estimated that there are 3000 new cases in UK per year.…”

Evaluation of the Cunningham Panel™ in pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS): Changes in antineuronal antibody titers parallel changes in patient symptoms

“…The biology behind many neuropsychiatric conditions remains elusive, but recent studies implicate immune dysregulation in some cases, particularly the presence of autoantibodies targeting neural tissue. Numerous studies have linked movement, behavior, and neuropsychiatric disorders to infections and the production of anti-neuronal autoantibodies (Kirvan et al, 2003;Cox et al, 2013;Kirvan et al, 2006aKirvan et al, , 2006bKirvan et al, 2007;Singer et al, 2015;Brimberg et al, 2012;Cunningham, 2012Cunningham, , 2014Garvey et al, 1998;Garvey et al, 1999;Gause et al, 2009;Greenberg, 2017;Murphy et al, 2007;Perlmutter et al, 1998;Taranta and Stollerman, 1956;Taranta, 1959;Swedo, 1994;Cox et al, 2015;Rhee and Cameron, 2012). Infectious triggers such as streptococcal and other infections, along with antineuronal autoantibodies similar to those associated with Sydenham chorea have been linked to childhood obsessive-compulsive disorder (OCD) and/or tics (Kirvan et al, 2003;Kirvan et al, 2006aKirvan et al, , 2006bSwedo, 1994;Swedo et al, 1997;Swedo et al, 1993;Swedo et al, 1989).…”

Implications for Advanced Practice Nurses When Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS) Is Suspected: A Qualitative Study

“…Some researchers agree that a link exists between the sudden onset of symptoms and a recent group A beta-hemolytic streptococcus (GABHS) infection in the child, as well as family members being carriers of GABHS (Macerollo & Martino, 2013;Rhee & Cameron, 2012;Vitaliti et al, 2014). However, other researchers have claimed that not enough evidence exists to support a correlation between neuropsychiatric syndromes and streptococcal infections (Morris-Berry et al, 2013;Schrag et al, 2009).…”

“…Some authors have described very specific diagnostic criteria for PANDAS but argued that Lyme disease, OCD, Tourette's syndrome, and tic disorders can also present with similar diagnostic criteria, including streptococcal infections, thus leading to misdiagnosis (Mell, Davis, & Owens, 2005;Rhee & Cameron, 2012). However, recently, Murphy, Storch, Lewin, Edge, and Goodman (2012) presented findings suggesting that diagnostic criteria should include the following findings: dramatic onset, definite remissions, improvement of neuropsychiatric symptoms during antibiotic therapy, surgical history positive for tonsillectomy/adenoidectomy, evidence of group A streptococcal infection, and clumsiness when combined with a parent history of PANDAS-like symptoms.…”