Tonsils and Adenoids

The immune mechanism underlying PANDAS also occurs in adults, who present with the same range of neuropsychiatric symptoms. PANDAS is characterized by sudden-onset psychiatric symptoms including OCD, severe behavioral dysregulation, pseudo-seizures, and emotional lability following streptococcal infection. The PANDAS mechanism involves repeated strep exposure provoking antibodies that cross-react with dopamine receptors in the limbic system via molecular mimicry. Tonsils can harbor Group A strep as a hidden reservoir even when throat cultures test negative, which is clinically relevant for children with PANDAS. Tonsils are lymphatic tissue and part of the immune system, so the first clinical question when they are enlarged is to identify the underlying cause. PANDAS-like neuropsychiatric syndromes can also be triggered by COVID-19, Lyme disease, and influenza. Mold exposure is the leading environmental cause of recurrent strep throat in children because mold toxins stress bacteria into forming more aggressive biofilms. The Cunningham Panel is the diagnostic tool used to identify brain receptor antibodies in PANDAS. Dietary intervention removing gluten, dairy, and confirmed allerge…