Doctors: strep infection could cause mental illness

Parents should beware. Some doctors believe, if left untreated, a common infection in kids could lead to mental illness.

Madeline Greenstein is back to being a happy, outgoing six-year-old.

"She's kind of like the life of the party," said mother Megan Greenstein

However, just a year ago, three strep infections in three months, led to some strange behavior.

"She would start asking me questions, and I would have to answer them in a specific way,” said Greenstein.

Her anxiety turned into constant fear.

"I think about scary stuff and then I get scared," said Madeline.

Within two months, she was "crying hysterically over nothing. High pitch laughing like what you would hear in a mental institute," said her mother.

Madeline was suffering what is called PANDAS, believed to be caused by a strep infection.

"The key is, the psychiatric symptoms just start overnight," said Michael A. Jenike, MD Professor of Psychiatry at Harvard Medical School

Dr. Jenike said that the body's immune system usually makes antibodies to attack the infection, but with PANDAS, the antibodies seem to attack part of the brain. That can lead to the sudden onset of OCD, separation anxiety, anorexia, bed-wetting, tics, or the worsening of motor skills and handwriting.

"I now hear and see patients all the time who have these kinds of sudden onset illnesses. We put them on antibiotics and the illnesses clear up in a week or two," said Dr. Jenike.

He also said that without antibiotics, it could be a trouble throughout their whole life.

Madeline started taking antibiotics and the results were immediate.

"I feel like we're on our path to recovery," said her mother.

Because PANDAS is just starting to be understood, it is not known how many children have developed psychiatric illnesses because of it. For more information on PANDAS, visit the link below.


STREP THROAT: Strep throat is extremely common and almost all school-age children get strep throat at some point in their lives. Up to 30% of children will show evidence by blood test of a recent streptococcal infection. It is characterized by a sore, red throat and when gone untreated, can sometimes lead to rheumatic fever. Rheumatic fever is a disease in which the heart and joints become inflamed and a type of this fever with the most neurological symptoms is Sydenham's chorea which may include poor muscle control, poor coordination, and awkward movements of the face, arms, and legs. However, these symptoms normally go away after a few weeks but parents should notify doctors if their child has a history of multiple strep throat infections or rheumatic fever so they can prevent relapses with a daily dose of antibiotics. (Source:

PANDAS: PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus and causes a range of behavioral and emotional problems. The bacteria associated with PANDAS is called Group A Beta-Haemolytic Streptococcus, which is the same bacteria associated with rheumatic fever hence the relation to strep throat. The disorder is categorized as one that affects children, but this does not mean that it is impossible for an adolescent or adult to develop the disorder. PANDAS is also rare so if a child gets strep throat that does not mean the disorder will definitely follow. Some of the behaviors caused by PANDAS are also normal behaviors for some children. The behaviors should become a concern when the child has a very episodic course of the behaviors (dramatic ups and downs) and seems to have strep throat shortly before or during the worsening behaviors. Children with PANDAS should take antibiotics for a short time as well as nutrient supplements that target brain structures. If PANDAS goes untreated and the child gets more strep infections, the recovery of the damage to the brain by attacking antibodies may not be complete and the child could develop a chronic psychiatric disorder. (Source:

BEHAVIORS TO LOOK OUT FOR: Since there is no definite test for PANDAS, parents should watch out for certain behaviors in their children that are odd or out of character, especially if they have experienced strep throat recently. Here are a few to look out for.
* Clinginess
* Hyperactivity
* Repetitive noises or vocalizations
* New onset bedwetting


For More Information, Contact:

Michael A. Jenike, MD
Professor of Psychiatry
Harvard Medical School

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