Pediatric autoimmune neuropsychiatric disorders and streptococcal infections: role of otolaryngologist

Laryngoscope. 2001 Sep;111(9):1515-9. doi: 10.1097/00005537-200109000-00005.


Objective: To increase awareness and understanding of the putative role of streptococcal infection in the development of neuropsychiatric disorders in children and to discuss therapeutic options in this group of patients.

Methods: Case illustration and literature review.

Results: Two siblings, one with obsessive-compulsive disorder (OCD) and one with a tic disorder, had tonsillectomy for recurrent streptococcal pharyngitis. At the latest follow-up visit (11 mo postoperatively), both patients exhibited significant improvement in their psychiatric illnesses. We discuss these cases as well as the diagnosis, pathophysiology, and treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).

Conclusion: PANDAS is an active area of research investigating the relationship between streptococcal infections and the development of obsessive-compulsive disorder or tic disorders (or both) in children. The etiopathogenesis of PANDAS is thought to reflect autoimmune mechanisms and involvement of the basal ganglia of susceptible hosts. Because otolaryngologists evaluate a large portion of pediatric patients with recurrent streptococcal pharyngitis, it is important to be aware of this association and to manage these patients appropriately.

Publication types

  • Case Reports

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Autoimmune Diseases / microbiology*
  • Basal Ganglia / microbiology
  • Child
  • Combined Modality Therapy
  • Female
  • Humans
  • Male
  • Obsessive-Compulsive Disorder / microbiology*
  • Otolaryngology*
  • Patient Selection
  • Pharyngitis / complications*
  • Pharyngitis / diagnosis
  • Pharyngitis / therapy
  • Physician's Role*
  • Practice Guidelines as Topic
  • Primary Prevention / methods
  • Recurrence
  • Referral and Consultation
  • Rheumatic Fever / prevention & control
  • Streptococcal Infections / complications*
  • Streptococcal Infections / diagnosis
  • Streptococcal Infections / therapy
  • Streptococcus pyogenes*
  • Tic Disorders / microbiology*
  • Tonsillectomy


  • Anti-Bacterial Agents