ABSTRACT
The past five years have seen an increased interest in the association between Streptococcus pyogenes infections and a constellation of neuropsychiatric diseases including Sydenham's chorea (SC), obsessive compulsive disorder (OCD), Tourette syndrome (TS), and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS). With the landmark publication of the first 50 PANDAS cases in 1998, Swedo and colleagues expanded the landscape of pediatric psychiatry from genetic and environmental factors to bacterial pathogens in the origin of neuropsychiatric disease. 1 This inclusion continues to incite considerable controversy. While numerous studies have supported the association between group A 13-hemolytic streptococcus (GABHS) infection and neuropsychiatric sequelae, few investigators have identified reliable streptococcal virulence factors or accepted disease markers; moreover no studies have identified a genetic locus candidate, and the PANDAS phenotype remains debatable.2-s
The difficulties in elucidating the pathogenesis of PANDAS are reflective of the complexity of the organism in question and the ubiquity of childhood exposure to GABHS. Streptococcus pyogenes is a diverse organism capable of initiating an array of clinical diseases, from uncomplicated pharyngitis to toxic shock syndrome with or without necrotizing fasciitis, and delayed sequelae, including acute rheumatic fever (ARF), Sydenham's chorea, and acute glomerulonephritis. A comprehensive review of streptococcal disease, however, is beyond the scope of this chapter.6
