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A Link Between Perianal Strep and Pediatric Autoimmune Neuropsychiatric Disorder Associated With Streptococcal Infection (PANDAS)
Megan Toufexis, D.O.; Caroline DeOleo, M.D.; Josephine Elia, M.D.; Tanya K. Murphy, M.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2014;26:164-168. doi:10.1176/appi.neuropsych.12050126
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From the Departments of Pediatrics (MT, TKM) and Psychiatry (CD, TKM), University of South Florida, St. Petersburg, FL; and the University of Pennsylvania, Philadelphia, and A.I. DuPont Hospital for Children (JE).

Send correspondence to Dr. Toufexis; e-mail: mtoufexi@health.usf.edu

Copyright © 2014 by the American Psychiatric Association

Received May 22, 2012; Revised January 22, 2013; Accepted March 18, 2013.


Perianal streptococcal dermatitis is an infection caused by group A streptococcus (GAS). Children with a pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) phenotype may have tics or obsessive compulsive symptoms secondary to a systemic immune activation by GAS infecting perianal areas. In this retrospective case series, the authors describe three children with symptoms consistent with PANDAS and a confirmed perianal streptococcal dermatitis as the likely infectious trigger. Concomitant perianal dermatitis and new-onset obsessive-compulsive symptoms and/or tics are strong indications for perianal culture and rapid antigen detection test in young children.

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TABLE 1.Characteristics of the Patients at the Time of Presentation
Table Footer Note

ASO: anti-streptolysin O; GAS: group A streptococcus; NM: not measured; OC: obsessive compulsive; OCD: obsessive-compulsive disorder; PSD: perianal streptococcal dermatitis; RADT: rapid antigen detection test.

Table Footer Note

Upper limit normal (ULN) ASO 5-year-old child: 160 Todd units/mL; 6-year-old child: 240 Todd units/mL; ULN Anti-DNase B 5-year-old child: 320 Todd units/mL; 6-year-old child: 480 Todd units.17



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