Infection-Triggered Anorexia Nervosa (PANDAS AN)

by Mae Sokol, MD, Creighton Univ. School of Medicine, Omaha, NE
Reprinted from Eating Disorders Review
September/October 2001 Volume 12, Number 5
©2001 Gürze Books

Definition:

There is evidence of a rare type of anorexia nervosa (AN) in children that is triggered by infection. This may be one of the Pediatric Auto-immune Neuropsychiatric Disorders Associated with Streptococcus (PANDAS). Obsessive-compulsive disorder, tics, and Tourette’s disorder are also included in this group. This type of AN is sometimes called PANDAS AN.

Characteristics of PANDAS AN:

  1. This type of anorexia nervosa occurs before a child reaches puberty. (AN is a serious illness marked by refusal to eat, weight loss and obsessive fears of getting fat.)
  2. The child has a rapid onset of symptoms and/or worsening of disordered eating.
  3. The child may have signs of an previous or current streptococcal infection, which occurs at about the same time as the onset of eating disorder symptoms (Please note: Strep infections are common among youngsters; not all strep infections are PANDAS-related). With PANDAS, most children have the following:
    1. A history of streptococcal illness: pharyngitis, sinusitis, or a flu-like syndrome
    2. A positive throat culture
    3. Positive findings on blood tests:
      1. Anti-deoxyribonuclease B (anti-DNase B) titer
      2. Anti-streptolysin O (ASO) titer
  4. Increased symptoms do not occur exclusively during stress or illness.
  5. Neurologic (nerve) abnormalities, with restlessness and/or erratic movements

Laboratory Tests:

If the above clinical characteristics are present, the following laboratory tests may be helpful:

  1. Throat culture
  2. Anti-DNase B (anti-deoxyribonuclease B)
  3. ASO titer (anti-streptolysin O)
  4. ANA (anti-nuclear antibody)
  5. CRP (C-reactive protein)
  6. Sedimentation rate
  7. Immunologlobulin screen

Treatment:

A variety of antibiotics, including amoxicillin, have been helpful. Researchers are currently studying the effectiveness of plasma exchange or use of intravenous immunoglobulin.

For further information, contact Mae Sokol, MD, Eating Disorders Program, Children’s Hospital, 8200 Dodge Street, Omaha, Nebraska 68114; Telephone: (888)-216-1860; e-mail: sokolms@aol.com

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Mae S. Sokol, MD

Creighton Univ. School of Medicine, Omaha, NE

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