Spotlight: Pandas not cute as panda

Yousuf Ali Al Mulla

A year ago, I received a call from a friend of mine to say that he is worried that his son who had fever was behaving indifferently. Although I am not a paediatrician, I went to see the eight-year-old.

The symptoms were found to be similar to Obsessive-Compulsive Disorder (OCD). The child, according to his parents, wanted to wash his hands several times and change his dress frequently. In fact, this Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal (PANDAS) infections, an autoimmune reaction to fight off an infection.

The antibodies the body manufactures to fight the infections like sore throat or fever find their way into the basal ganglia of the brain. Those antibodies are seen by the immune system itself as foreign particles and it attempts to remove them. In the process, the brain becomes inflamed, causing a host of neuropsychological disorders and deficits. More interestingly, PANDAS is commonly found in boys aged 5 to 10 years. According to PANDAS Network research, 1 in 200 children are affected with this rare syndrome. More precisely, the disease begins with an infection of bacteria that was not treated in time

with antibiotics. A child with a sinus infection and ear infection or sore throat need a bacterial test to determine whether antibiotics should be prescribed.

So, looking to different research mostly concluded that a delay can result in PANDAS, for which there is no cure. It can be treated, but another strep infection will trigger the return of PANDAS. There is another treatment, more aggressive, that removes the plasma from the blood and replaces it with plasma from other people. This treatment seems to make the PANDAS sort of dormant, but if another strep infection occurs and it is not treated immediately, PANDAS returns in all its fury.

I do understand the challenges that the parents face, especially when they are faced with a rational diagnosis that their child might be having a psychiatric disorder or he might be autistic. It’s a huge struggle because for many doctors the symptoms look like other conditions for which there are already treatment guidelines.

I believe that is critical to some points, as there are children who have ended up in psychiatric institutions as a result of many of the symptoms associated with Pandas were mistaken for signs of other medical or psychiatric disorders. However, lately preliminary research shows a genetic marker that causes PANDAS, which appears to be a unique form of encephalitis.

So, if your child has a history of fever and in few days, developed sudden onset of OSD or restricted food intake combined with anxiety, sudden mood changes and/or depression, it might be PANDAS.
I do recognise that this condition may have impact on the social interactions of the whole family as parents may be afraid to take PANDAS kid anywhere because of such behaviour.

At the end, we need to raise awareness of about PANDAS among the community as well as medical professionals. Actually, it is not a rare condition, it’s just rarely diagnosed and may need more research on it.

By Dr Yousuf Ali Al mulla –  a medical innovator and educator. dryusufalmulla@gmail.com