40 possible signs and symptoms of ongoing/post-streptococcal immune-mediated disease; the manifestations can be neurologic/psychiatric, musculoskeletal, cardiac, renal, skin, or systemic. Established post-streptococcal immune diseases include acute rheumatic fever, Sydenham chorea, and post-streptococcal glomerulonephritis; PANDAS is a proposed strep-associated pediatric neuropsychiatric syndrome with more diagnostic uncertainty.
40 signs and symptoms
| # | Sign/symptom | System / association |
|---|---|---|
| 1 | Sudden-onset obsessive thoughts | PANDAS/PANS |
| 2 | Compulsive behaviors/rituals | PANDAS/PANS |
| 3 | New motor tics | PANDAS/PANS |
| 4 | New vocal tics | PANDAS/PANS |
| 5 | Severe separation anxiety | PANDAS/PANS |
| 6 | Generalized or intense anxiety | PANDAS/PANS |
| 7 | Emotional lability | PANDAS/PANS; Sydenham chorea |
| 8 | Irritability | PANDAS/PANS |
| 9 | Aggressive behavior | PANDAS/PANS |
| 10 | Severe oppositional behavior | PANDAS/PANS |
| 11 | Depressed mood/sadness | PANDAS/PANS |
| 12 | Behavioral/developmental regression | PANDAS/PANS |
| 13 | Sudden deterioration in school performance | PANDAS/PANS |
| 14 | Hyperactivity | PANDAS/PANS |
| 15 | Inattention/concentration problems | PANDAS/PANS |
| 16 | New handwriting deterioration | Motor dysfunction/PANDAS |
| 17 | Fine-motor deterioration | Neuro/motor involvement |
| 18 | Sensory abnormalities | PANDAS/PANS |
| 19 | Sleep disturbance | PANDAS/PANS |
| 20 | Nighttime bed-wetting after previous continence | PANDAS/PANS |
| 21 | New urinary frequency | PANDAS/PANS |
| 22 | Sudden food restriction/refusal | PANS |
| 23 | Uncontrolled choreiform movements | Sydenham chorea |
| 24 | Clumsiness/motor instability | Sydenham chorea/neuro involvement |
| 25 | Muscle weakness/hypotonia | Sydenham chorea |
| 26 | Joint pain (arthralgia) | Rheumatic fever/post-strep arthritis |
| 27 | Joint swelling | Inflammatory arthritis |
| 28 | Migratory arthritis | Classic acute rheumatic fever |
| 29 | Painful/tender large joints | Rheumatic fever |
| 30 | Fever | Rheumatic fever/systemic inflammation |
| 31 | Fatigue/lethargy | Rheumatic fever/PSGN |
| 32 | New heart murmur | Rheumatic carditis |
| 33 | Fast heartbeat/palpitations | Cardiac involvement |
| 34 | Chest pain | Carditis/pericardial involvement |
| 35 | Shortness of breath | Carditis/heart failure |
| 36 | Painless subcutaneous nodules | Rheumatic fever |
| 37 | Erythema marginatum (ring-like rash) | Rheumatic fever |
| 38 | Dark/red-brown or cola-colored urine | PSGN |
| 39 | Facial/periorbital, hand or foot swelling | PSGN |
| 40 | Hypertension and/or decreased urine output | PSGN |
The neurologic/psychiatric cluster—particularly abrupt OCD, tics, anxiety, emotional changes, regression, handwriting deterioration, urinary symptoms and sleep disturbance—is described by NIMH for PANS/PANDAS. Symptoms characteristically have a very abrupt onset and may follow a relapsing-remitting course.