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Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part III-Treatment and Prevention of
Michael S Cooperstock1, Susan E Swedo2, Mark S Pasternack3
1Division of Infectious Diseases, University of Missouri School of Medicine, Columbia, Missouri.
Insights
This guideline provides practical infection management for pediatric autoimmune neuropsychiatric disorders (PANS) and PANDAS, emphasizing prompt diagnosis and treatment of infections like streptococcus. It offers strategies for antimicrobial use and monitoring for all PANS/PANDAS cases.
Area of Science:
- Pediatric Neurology
- Autoimmune Encephalopathy
- Infectious Disease Management
Background:
- Pediatric acute-onset neuropsychiatric syndrome (PANS) and its subset, PANDAS, are increasingly recognized autoimmune conditions in children.
- Current management guidelines for the infection components of PANS/PANDAS are lacking.
- This consensus guideline addresses the critical role of infections in PANS/PANDAS.
Purpose of the Study:
- To establish a consensus management guideline for the infection components of PANS and PANDAS.
- To provide practical, evidence-based recommendations for diagnosing and treating infections in affected children.
- To integrate literature review with clinical expertise for comprehensive infection management.
Main Methods:
- Literature review and integration of clinical experience from the PANS/PANDAS Consortium.
- Development of practical guidelines submitted for review and comment by all Consortium members.
- Proposal of diagnostic approaches and treatment strategies for streptococcal and other infections.
Main Results:
- A retrospective diagnostic approach for group A streptococcal infection in PANDAS is proposed.
- Initial anti-streptococcal treatment is recommended for all new PANS cases.
- Guidelines include chronic antimicrobial prophylaxis for severe PANDAS, vigilance for non-streptococcal PANS, and monitoring for intercurrent infections.
Conclusions:
- This guideline offers a framework for managing infection issues in PANS and PANDAS.
- Prompt diagnosis and treatment of infections are crucial for managing these pediatric autoimmune disorders.
- Recommendations cover initial treatment, prophylaxis, and monitoring for various infections relevant to PANS/PANDAS.
Abstract:
Pediatric acute-onset neuropsychiatric syndrome (PANS) and its subset, pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS), are emerging autoimmune encephalopathies of childhood. Management guidelines are needed. This article, from the PANS/PANDAS Consortium, presents a consensus management guideline for the infection components. Accompanying papers from the Consortium discuss psychiatric and immunomodulatory management. Literature was reviewed and integrated with the clinical experience of the authors to provide a set of practical guidelines. This article was submitted to all members of the PANS/PANDAS Consortium, and their additional comments were added. The relationships between PANS and infections are reviewed. An approach to the retrospective diagnosis of group A streptococcal infection for an operational definition of PANDAS is proposed. An initial course of anti-streptococcal treatment is proposed for all newly diagnosed PANS cases. Chronic secondary antimicrobial prophylaxis is suggested for children with PANDAS who have severe neuropsychiatric symptoms or recurrent group A Streptococcus-associated exacerbations. Guidelines for children with non-streptococcal PANS include vigilance for streptococcal pharyngitis or dermatitis in the patient and close contacts. All patients with PANS or PANDAS should also be closely monitored for other intercurrent infections, including sinusitis and influenza. Intercurrent infections should be diagnosed and treated promptly according to current standard guidelines. A guideline for the assessment of infection at initial onset or during neuropsychiatric exacerbations is also presented. Standard immunizations and attention to vitamin D are encouraged. Data indicating limited utility of adenotonsillectomy and probiotics are presented. A working guideline for the management of infection issues in PANS and PANDAS, based on literature and expert opinion, is provided.
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