From Tonsils to Basal Ganglia: Diagnosis and Treatment of Pandas
Dragica Severinac
PANDAS syndrome (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) is a neuroimmunological disorder in children, linked to autoimmune reactions following an infection with group A beta-hemolytic streptococcus. Symptoms include anxiety, irritability, aggression, sleep disturbances, sudden food selectivity, obsessive-compulsive behavior, and tics. Parents are often confused by the abrupt behavioral changes, failing to associate them with streptococcal infections such as pharyngitis and tonsillitis, which can act as triggers for this syndrome. Diagnosis is based on clinical presentation, history of streptococcal infections, and laboratory tests (throat swab, ASO titers). An otorhinolaryngologist conducts treatment with antibiotics, and for children with recurrent infections or tonsillar hypertrophy, tonsillectomy may be recommended according to ISKRA guidelines. Post-tonsillectomy care focuses on parental education, postoperative pain management, and early recognition of complications. Nursing interventions are essential in postoperative care, pain relief, infection prevention, and the management of postoperative complications, as well as providing emotional support to the family. PANDAS syndrome requires a multidisciplinary approach, involving otorhinolaryngologists, pediatricians, immunologists, psychiatrists, nurses and medical technicians. Timely diagnosis and treatment are essential for reducing neuropsychiatric symptoms and improving the child’s quality of life.
