Paediatric Autoimmune Neuropsychiatric Disorder Associated with Group A Beta-Haemolytic Streptococcal Infection: An Indication for Tonsillectomy? A Review of the Literature
Table 2
Summary of Case Reports.
Author
Patient demographic
PANDAS Criteria Met (including confirmation of GABHS)
Neuropsychiatric symptoms
ASOT titre
Treatment provided prior to tonsillectomy
Follow-Up duration after tonsillectomy
Outcome at follow-up
Alexander et al. []
9-year-old, male
Yes
Oculofacial tics, agitation, hyperactivity
Positive Throat Culture No value reported
Cephalosporin, azithromycin and prophylactic penicillin Sertraline
1 year
Complete resolution
Fusco et al. []
11-year-old, male
Yes
Severe choreic movements of upper limbs Oculo-facial tics
Initial presentation: 694 U/ml 6 months postantibiotics (penicillin + diaminocillina): 782 U/ml 5 months after tetrabenazine: 658 U/ml 8 weeks post-tonsillectomy and 2 weeks after discontinuation of tetrabenazine: 156 U/ml NOTE: Normal range <200 U/ml
Penicillin with monthly diaminocillina Tetrabenazine
3 years
Complete resolution
Batuecas Caletrío et al. []
9-year-old, male
Yes
Oculo-facial tics Obstructive Sleep Apnoea (OSA)
550 μm/ml (elevated)
Not applicable as indication for tonsillectomy was OSA
Not reported
Complete resolution
Lynch et al. []
6-year-old, male
Yes
Facial tics, hemichorea
360
Numerous courses of penicillin
18 months
Complete resolution
Heubi and Shott
9-year-old, male
Yes
Motor and vocal tics
195 Units NOTE: Normal <160 units
Clonidine
2 months
Almost complete resolution
10-year-old, male
No
Obsessive-compulsive symptoms
Not reported
Sertraline
1 year
Complete resolution & discharge from psychiatrist
Orvidas and Slattery
12-year-old, female
Yes
Obsessive-compulsive symptoms
1 : 340 (raised) Positive RADT Test
Azithromycin (intermittent benefit)
11 months
Almost complete resolution (1 acute panic attack)
8-year-old, male
Yes
Intermittent motor tics, head jerking and ocular tics
Positive RADT Test on three occasions No value reported
