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.
