PANDAS is an acronym for a sudden onset mental disorder in children, which develops after an acute strep infection. Children may develop sudden onset obsessions, compulsions, OCD, anxiety, lability, motor or vocal tics, enuresis, deterioration in handwriting, etc. It is reasonable to believe adults can also get acute strep, and similarly develop PANDAS, although little research has been done on adults with problem behaviors or a mental health diagnosis.

Strep has as many as 75 variants, some more virulent than others, and different variants may have a predilection for particular types of tissue or organs. Chronic strep can hide from the immune system and attack the nervous system over time. The strain originating in Turkey can cause heart disease (rheumatic fever), kidney disease (glomerulonephritis and HSP), and chronic skin disease (Bechet’s disease). Some variants attack the intestine or reproductive organs. Strep pneumonia can cause death, and intraocular strep can cause blindness.

We proposed in “The Origin of Disease” that chronic strep may cause multiple myeloma, when a chain of events carried out by the immune system results in strep being carried by an immune cell back to the bone marrow. Patients with multiple myeloma are thought to have frequent strep infections, perhaps not because of an increased susceptibility to strep but rather because the patient harbors strep in their immune cells, which periodically erupts into an acute strep infection.

Doctors know acute strep infection requires prompt and appropriate treatment, and acute strep can cause PANDAS in children. It is difficult to know how and when to diagnose a chronic or indolent strep infection, how to treat children with PANDAS, how to diagnose and treat adults with chronic strep and a mental illness, and how to diagnose chronic strep when it has already evolved into another named disease.