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Group A Streptococcus intranasal infection promotes CNS infiltration by streptococcal-specific Th17 cells

Thamotharampillai Dileepan, Erica D. Smith, Daniel Knowland, Martin Hsu, Maryann Platt, Peter Bittner-Eddy, Brenda Cohen, Peter Southern, Elizabeth Latimer, Earl Harley Dritan Agalliu. and P. Patrick Cleary
Journal of Clinical Investigation-2015
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Our results establish what we believe to be evidence of a novel crosstalk between the CNS and cellular immunity to infections, which may contribute to understanding the pathogenesis of many other CNS autoimmune diseases. Flare-ups associated with several chronic autoimmune conditions may be produced by the expansion of Th17 cells and the activation of cytokines induced by relatively common bacterial or viral infections. Aberrant cytokine expression could then disrupt the BBB to permit preexisting circulating autoantibodies to enter the brain, engage neural targets, and trigger the sudden onset of clinical symptoms.

Clinical Evaluation of Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): Recommendations from the 2013 PANS Consensus Conference

Kiki Chang, Jennifer Frankovich, Michael Cooperstock, Madeleine W. Cunningham, M. Elizabeth Latimer, Tanya K. Murphy, Mark Pasternack, Margo Thienemann, Kyle Williams, Jolan Walter, and Susan E. Swedo, From the PANS Collaborative Consortium
Journal of Child and Adolescent Psychopharmacology-2015
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On May 23 and 24, 2013, the First PANS Consensus Conference was convened at Stanford University, calling together a geographically diverse group of clinicians and researchers from complementary fields of pediatrics: General and developmental pediatrics, infectious diseases, immunology, rheumatology, neurology, and child psychiatry. Participants were academicians with clinical and research interests in pediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS) in youth, and the larger category of pediatric acute-onset neuropsychiatric syndrome (PANS). The goals were to clarify the diagnostic boundaries of PANS, to develop systematic strategies for evaluation of suspected PANS cases, and to set forth the most urgently needed studies in this field. Presented here is a consensus statement proposing recommendations for the diagnostic evaluation of youth presenting with PANS.

Multidisciplinary Clinic Dedicated to Treating Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome: Presenting Characteristics of the First 47 Consecutive Patients

Jennifer Frankovich, Margo Thienemann, Jennifer Pearlstein, Amber Crable, Kayla Brown, Kiki Chang
JCAP-2015

In our PANS clinic, 40% of patients had acute onset of symptoms. However, those with and without acute onset of symptoms had similar symptom presentation, rates of inflammatory conditions, somatic symptoms, and violent thoughts and behaviors. GAS infections were the most commonly identified infection at onset and at symptom flares. Because of the wide variety of medical and psychiatric symptoms, youth with PANS may require a multidisciplinary team for adequate care management.

Clinical Presentation of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections in Research and Community Settings

Susan E. Swedo, Jakob Seidlitz, Miro Kovacevic, M. Elizabeth Latimer, Rebecca Hommer, Lorraine Lougee, Paul Grant
JCAP-2015

The diagnostic criteria for PANDAS can be used by clinicians to accurately identify patients with common clinical features and shared etiology of symptoms. Although difficulties in documenting an association between GAS infection and symptom onset/exacerbations may preclude a diagnosis of PANDAS in some children with acute-onset OCD, they do appear to meet criteria for pediatric acute-onset neuropsychiatric syndrome (PANS).