Dr. Rosario Trifiletti PANDAS and Related Illnesses: No Longer Black and White

PANDAS refers to the acute onset of tics and/or obsessive-compulsive symptoms in temporal correlation with a group A strep infection. However, PANDAS is but one of a larger group of post-infectious neuropsychiatric disorders known by the acronym PITANDS. Dr. Trifiletti will draw on his 15 years of experience treating almost 1000 cases of PITANDS to survey how complex things have become. He will discuss the range of possible infectious triggers that can produce PITANDS, which include not only GABHS but also Mycoplasma pneumoniae infection and Lyme-like illness, especially an anti-flagellin (p41) syndrome. He will also discuss why the range of clinical manifestations of PITANDS should be expanded to include symptoms beyond tics and OCD. This will be illustrated by four case histories: 1) a child with acute onset of tics following a streptococcal infection; 2) a child with acute onset of intractable sneezing following a Mycoplasma pneumoniae infection; 3) a child with an autistic spectrum disorder who undergoes sudden behavioral and language regression following a streptococcal infection (PDD-PANDAS); and 4) a hyperacute acute onset of ballistic tics, falsetto vocal change and episodic rage following severe streptococcal infection suggestive of demonic possession ("Exorcist syndrome"). All of these patients improved rapidly with the clinically appropriate antibiotics alone. PITANDS is thus seen to be a condition with a broad range of triggers and clinical manifestations that should be considered in the differential diagnosis of many acute and chronic neuropsychiatric conditions in children.

Rosario Trifiletti, MD, PhD received his degrees from the Johns Hopkins School of Medicine, with a PhD in neuropharmacology. After completing his training at Babies Hospital and the Neurological Institute of New York at Columbia-Presbyterian Medical Center, he was an assistant professor at Columbia and then Cornell Medical School. Subsequently, he was chief of child neurology at St. Vincent's (Manhattan) and UMNDJ-Newark. He is currently in private practice in Ramsey, NJ

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