'Unbelievable pain and suffering': How a common throat infection can rewire children's brains

Strep throat is a common illness among children, usually causing a sore throat and fever. Most kids recover quickly with antibiotics, but for a small number, the infection can trigger dramatic changes in their behavior and mental health. Scientists are now investigating how strep throat can sometimes lead to lasting changes in the brain, resulting in a condition called Pandas, which stands for 'paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. '

Charlie Drury was a typical, active eight-year-old until his birthday in November 2012. That day, he started showing strange symptoms like an eye twitch and sniffing his hands. He soon developed a fever and was diagnosed with strep throat. However, instead of getting better, Charlie's behavior changed drastically. He became extremely sensitive to smells, couldn't stand being touched, and developed severe anxiety. He stopped eating, refused to bathe, and had trouble sleeping. He even started hallucinating and struggled with reading and writing. His mother, Kate Drury, said it was as if she lost her child overnight. After weeks of confusion, doctors finally diagnosed Charlie with Pandas.

Pandas is a rare condition that can cause sudden onset of obsessive-compulsive disorder (OCD) and other symptoms like mood swings, aggression, pain, and sleep problems. It is believed that in some children, the immune system overreacts to strep bacteria and mistakenly attacks healthy brain tissue, especially in the basal ganglia, which controls movement, learning, and emotions. This misdirected immune response can lead to severe behavioral and developmental problems.

The exact number of children affected by Pandas is unclear, but it is considered uncommon and seems to affect boys more than girls, usually before puberty. Other infections, such as the flu or Covid-19, can also trigger similar symptoms, which are then called Pans. Children with Pandas or Pans may experience periods of remission, but symptoms can return if they get sick again.

Treating Pandas and Pans can be challenging. Many doctors are unfamiliar with the conditions or skeptical about their existence. Some children are given psychiatric medications, which may help some but can cause side effects or be ineffective for others. The best approach is to treat both the infection and the immune response. Early treatment with antibiotics, steroids, or immune therapies like intravenous immunoglobulin (IVIG) and plasma exchange can make a big difference.

Charlie Drury still needs regular plasma exchange treatments to manage his symptoms. His mother has become an advocate for better access to treatment, even helping pass a law to require insurance coverage for Pandas therapies. Another child, Lulu Johnson, developed Pandas at age eleven and suffered for two years before passing away. Her family struggled to get proper care and now works to raise awareness and support research.

Scientists continue to study Pandas and Pans, hoping to understand why some children are affected and to find better ways to diagnose and treat them. Lulu's family donated her blood and brain tissue to help researchers learn more. The goal is to prevent other children from suffering as she did.

While strep throat is usually a minor illness, for some children it can have life-changing consequences. Families, doctors, and researchers are working together to improve care and find answers, so that children with Pandas and Pans can get the help they need and live healthier lives.