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[(Ho)16.6(we)20.5(v)13.1(e)0(r)14.9(,)-230.5(t)15.4(h)0(e)-222.7(a)0(c)21.4(u)0(i)15.9(t)0(y)-218(o)13.1(f)-229.7(o)0(n)19.9(s)0(e)16.3(t)-224.8(an)17.5(d)-227.1(s)0(i)14.7(m)0(u)22.7(l)0(t)18.2(a)0(n)17.5(e)0(o)23.8(u)0(s)-221.5(p)13.1(re)14.9(se)22.7(nt)15.9(at)19.8(io)22.3(n)-227.1(o)0(f)-222.9(t)0(h)22.3(e)0(s)16.3(e)]TJ
0 -1.2203 TD
[(sy)18.8(mp)22.7(to)15.9(ms)-161.8(d)13.1(i)0(f)19.6(f)0(e)14.9(r)0(e)21.2(n)0(t)22.2(i)0(a)13.5(t)15.4(e)-172.6(P)0(A)18.1(N)0(S)-165.3(f)0(r)21.1(o)0(m)-160.6(t)0(h)15.9(e)0(s)22.7(e)-172.6(ps)18.8(yc)17.5(h)13.1(i)0(a)19.8(t)0(r)19.6(i)0(c)-163.5(c)0(o)17.5(n)0(d)19.9(i)0(t)18.2(i)0(o)22.2(n)0(s)18.8(.)-173.6(T)13.3(h)0(e)]TJ
T*
[(PA)18.1(NS)-481.5(d)13.1(i)0(a)19.8(g)0(n)19.9(o)0(s)18.8(i)0(s)-478.5(i)0(s)21.1(,)-489.8(th)15.9(er)21.2(ef)21.2(or)17.3(e,)-479.1(li)18.2(mi)18.7(te)19.8(d)-486.4(t)0(o)-483.6(c)0(a)21.4(s)0(e)16.3(s)-487.6(wi)18.9(th)-477.3(ac)15.1(u)13.1(t)0(e)19.8(-)0(o)17.3(n)0(s)18.8(e)0(t)]TJ
0 -1.2266 TD
[(sy)18.8(mp)22.7(to)15.9(ms)-395.8(in)-401.4(mu)16.4(lt)24.6(ip)15.9(le)-397.5(do)19.9(ma)20.3(in)15.9(s.)-402(In)-393.6(so)18.8(me)-403.3(in)22.2(st)14.7(an)23.9(ce)15.1(s,)-395.6(ch)17.5(il)18.2(d)13.1(r)0(e)14.9(n)-410.5(wi)18.9(th)]TJ
0 -1.2203 TD
[(PA)18.1(NS)-279.1(ex)17.5(p)13.1(e)0(r)14.9(i)0(e)19.8(n)13.1(ce)-282.1(vi)15.9(su)25.1(al)-283.7(o)13.1(r)-293(au)17.5(d)13.1(i)0(t)18.2(o)13.1(ry)-279.8(ha)17.5(ll)18.2(u)13.1(c)0(i)13.5(n)13.1(at)19.8(io)15.9(n)13.1(s)0(;)-282.4(t)0(h)22.2(e)0(s)16.3(e)-286.5(ca)15.1(se)22.7(s)-291.6(d)0(e)17.5(-)]TJ
T*
[(se)16.3(rv)23.7(e)-197.9(s)0(p)25.1(e)0(c)15.1(i)0(a)19.8(l)-193.2(n)13.1(o)0(t)15.9(e)0(,)-181.9(a)0(s)-186(s)0(y)25.1(m)0(p)16.4(t)0(o)22.2(m)0(s)-180.8(c)0(a)15.1(n)-189.2(ap)17.5(pe)17.5(ar)-181.1(id)15.9(en)23.9(ti)18.2(ca)15.1(l)-186.9(t)0(o)-186.4(t)0(h)22.2(e)-191.6(ps)18.8(yc)17.5(ho)19.9(ti)18.2(c)]TJ
0 -1.2266 TD
[(sy)18.8(mp)22.7(to)15.9(ms)-174.5(se)22.7(en)-172.2(in)-173.8(co)17.5(n)13.1(d)0(i)15.9(t)0(i)18.2(o)13.1(ns)-170.9(su)18.8(ch)-178.5(as)-173.3(sc)22.7(hi)15.9(zo)23.9(ph)19.9(re)14.9(n)13.1(i)0(a)19.8(,)-186.3(b)13.1(i)0(p)15.9(o)13.1(la)19.8(r)-185.5(d)13.1(is)14.7(o)13.1(r)0(d)17.3(e)0(r)21.3(,)]TJ
0 -1.2203 TD
[(an)17.5(d)-284(l)0(u)15.9(p)13.1(u)13.1(s)-291.5(ce)21.4(re)14.9(b)13.1(r)0(i)19.6(t)0(i)18.2(s)0(.)-275.5(A)0(g)16.6(a)0(i)19.8(n)13.1(,)-287.4(b)13.1(ec)15.1(au)17.5(se)-274.5(PA)18.1(NS)-272.8(is)-276.1(a)-292.8(d)13.1(ia)19.8(gn)19.9(os)18.8(is)-276.1(of)-279.8(ex)23.8(cl)19.8(u-)]TJ
T*
[(si)21.1(on)19.9(,)-357(a)-349.7(co)17.5(mp)22.7(re)14.9(h)13.1(e)0(n)17.5(s)0(i)21.1(v)0(e)-342.9(e)0(v)17.5(a)0(l)19.8(u)13.1(at)13.5(i)15.4(o)0(n)-346.8(i)0(s)-339.3(n)0(e)17.5(e)0(d)17.5(e)0(d)-342.9(t)0(o)-338.2(e)0(l)13.5(i)15.4(mi)18.7(na)17.5(te)-340.6(di)15.9(so)18.8(rd)23.7(er)14.9(s)]TJ
T*
[(pr)17.3(es)22.7(en)17.5(ti)18.2(n)13.1(g)-176.6(wi)18.9(t)15.4(h)-176.5(si)21.1(mi)18.7(la)19.8(r)-172.8(n)13.1(eu)17.5(ro)17.3(p)13.1(s)0(y)18.8(c)0(h)17.5(i)0(a)19.8(t)0(r)19.6(i)0(c)-163.5(s)0(y)18.8(m)15.9(pt)15.9(o)13.1(m)0(s)15.2(.)-167.3(He)14.2(re)-162.1(we)-162.8(p)13.1(r)0(o)17.3(v)13.1(id)15.9(e)]TJ
0 -1.2266 TD
[(co)17.5(n)13.1(s)0(e)16.3(n)13.1(su)18.8(s)-297.9(r)0(e)14.9(c)0(o)23.9(m)0(m)19.2(e)0(n)17.5(d)0(a)17.5(t)0(i)18.2(o)13.1(ns)-291.1(fo)23.7(r)-299.3(t)0(h)15.9(e)-299.1(cl)19.8(in)22.2(ic)19.8(al)-290(an)17.5(d)-296.7(l)0(a)19.8(b)0(o)19.9(r)0(a)14.9(t)15.4(or)17.3(y)-296.7(e)0(v)17.5(a)0(l)19.8(u)0(a)17.5(-)]TJ
0 -1.2203 TD
[(ti)18.2(o)13.1(n)-195.5(o)13.1(f)-198.1(y)13.1(o)0(u)19.9(t)0(h)-186.4(w)0(i)18.9(t)0(h)-180.1(p)0(o)19.9(t)0(e)19.8(n)0(t)15.9(i)0(a)19.8(l)-193.2(PA)18.1(NS)18.1(.)-192.6(T)13.3(re)14.9(at)19.8(me)20.3(n)13.1(t)-199.5(re)21.2(co)17.5(mm)19.2(en)23.9(da)17.5(ti)18.2(o)13.1(n)0(s)-183.6(w)0(i)18.9(l)0(l)]TJ
T*
[(be)-260.7(ad)17.5(d)13.1(r)0(e)14.9(s)0(s)23.9(e)0(d)-260.7(i)0(n)-262.3(a)-273.8(fu)23.7(tu)15.9(re)-257(re)14.9(p)13.1(o)0(r)17.3(t)0(.)]TJ
/F4 1 Tf
0 -3.1109 TD
[(Diagnostic)-339.4(Evaluation)]TJ
/F5 1 Tf
1.1128 -1.8336 TD
[(When)-356.5(PANS)-362.2(is)-358.3(suspected,)-366.3(it)-354.8(is)-364.6(important)-357.7(to)-357.1(obtain)-361.6(a)-362.3(compre-)]TJ
-1.1128 -1.2267 TD
[(hensive)-386(medical)-382.1(and)-380.3(psychiatric)-384.5(history)-381.5(and)-380.3(perform)-383.4(a)-381.3(thorough)]TJ
27.9978 56.1285 TD
[(physical)-351.6(examination.)-349.2(Table)-347.7(1)-347.3(provides)-347.8(an)-349.2(overview)-346(of)-349.4(the)-346.4(eval-)]TJ
0 -1.2203 TD
[(uation)-424.8(that)-425.8(should)-419.6(be)-425.1(conducted)-424.2(by)-416.3(the)-428.6(treating)-420.3(physician\(s\).)-428.5(If)]TJ
0 -1.2266 TD
[(ndings)-480.9(warrant,)-478.4(then)-478.7(relevant)-481.9(specialists)-476.8(should)-476.5(be)-482(consulted.)]TJ
0 -1.2203 TD
[(Table)-480.4(2)-473.7(provides)-474.2(an)-482(overview)-472.4(of)-475.8(the)-479.2(differential)-474.2(diagnosis)-476.3(for)]TJ
T*
[(PANS,)-314.6(reecting)-315.6(the)-314.8(need)-312.7(to)-312.9(assess)-316.5(multiple)-309(medical)-318.9(and)-310.8(psychi-)]TJ
0 -1.2266 TD
[(atric)-284.9(domains.)]TJ
/F10 1 Tf
0 -2.4406 TD
[(Family)-340.3(history)]TJ
/F5 1 Tf
1.1128 -1.8336 TD
[(The)-203.1(family)-197(history)-198.1(should)-198.3(include)-199.1(review)-201.5(of)-197.6(neurologic)-200.3(diseases,)]TJ
-1.1128 -1.2203 TD
[(psychiatric)-251.7(disorders,)-240.2(autoimmune)-249(and)-241.2(autoinammatory)-247.9(diseases,)]TJ
0 -1.2266 TD
[(immunodeciency)-370.1(syndromes,)-369.9(and)-367.7(frequent)-364.2(infections,)-366.5(including)]TJ
0 -1.2203 TD
[(recurrent)-286.6(streptococcal)-287.2(pharyngitis)-278.5(\(Table)-286.6(3\).)]TJ
1.1128 -1.2203 TD
-.0184 Tc
[(In)-213.9(o)7.4(n)1.1(e)-216.3(r)-1.5(e)5(port,)-211(rst-d)7.4(egre)5(e)-216.3(r)4.8(elative)5(s)-215.1(of)-210.2(children)-207.6(w)-2.2(ith)-207.6(P)2.5(AN)4.1(DA)4.1(S)-218.8(w)4.1(er)4.8(e)]TJ
-1.1128 -1.2266 TD
-.018 Tc
[(note)5.4(d)-308.4(to)-308.4(hav)7.8(e)-310.8(incr)5.2(eas)6.6(ed)-308.4(r)5.2(a)-1(tes)-309.6(o)1.5(f)-304.6(O)4.5(CD)4.5(,)-305.4(t)-2.6(ic)-304.5(dis)6.6(o)1.5(rde)5.4(r)-1.1(s,)-305.5(an)7.8(d)-308.4(acu)7.8(te)-304.5(rhe)5.4(u)1.5(-)]TJ
0 -1.2203 TD
-.0193 Tc
[(matic)-381.6(fev)6.5(e)-2.3(r,)-382.6(s)5.3(uggesting)-385.5(t)2.5(hat)-383.2(c)-2.3(hild)6.5(ren)-379.2(m)-3.4(ay)-385.5(have)-381.6(inh)6.5(e)-2.3(rited)-379.2(a)-388(s)5.3(p).2(ecic)]TJ
T*
-.0197 Tc
[(vulnerability)-189.9(t)2.1(o)-189.9(nonpyog)6.1(enic)-192.3(poststrep)]TJ
14.5806 0 TD
[(tococcal)-193.8(s)5(e)-2.6(quelae)-185.9(\()-2.7(Lougee)-192.3(e)-2.6(t)-193.8(a)3.8(l.)]TJ
-14.5806 -1.2266 TD
-.0194 Tc
[(2000\).)-205.7(M)5.7(aternal)-206.3(a)-2.4(utoimmune)-204.7(diseases)]TJ
14.6944 0 TD
-.019 Tc
[(are)-210.6(a)4.4(ls)5.6(o)-208.2(r)4.2(eported)-208.2(t)2.8(o)-208.2(b).5(e)-204.3(c)4.4(ommon)]TJ
-14.6944 -1.2203 TD
-.0193 Tc
[(amo)6.5(n).2(g)-372.9(p).2(atien)6.5(t)-3.9(s)-367.8(w)3.2(ho)-372.9(meet)-370.6(criter)]TJ
12.6142 0 TD
[(ia)-369(for)-369.2(P)1.6(ANDAS)-371.5(\()-84.6(M)5.8(u).2(rphy)-366.6(2010\).)-370(I)-2.4(t)]TJ
-12.6142 -1.2203 TD
-.0199 Tc
[(should)-379.8(b)-.4(e)-382.2(n)5.9(oted)-379.8(that)-377.5(neuropsychiat)]TJ
13.8978 0 TD
[(ric)-382.2(d)-.4(isorders)-374.7(among)-379.8(siblings)-381(are)]TJ
-13.8978 -1.2266 TD
-.0195 Tc
[(particularly)-297.2(common)-297.2(and)-297.2(i)2.3(mportant)]TJ
14.0874 0 TD
-.0189 Tc
[(to)-296.6(a)4.5(sse)4.5(ss)-297.8(fo)6.9(r)-299.2(a)-1.9(s)-291.5(w)-2.7(ell.)-300(Ps)5.7(ychiatric)]TJ
-14.0874 -1.2203 TD
[(family)-252.4(his)5.7(t)-3.5(ory)-258.7(m)3.3(ay)-258.7(provide)-261.1(imp)6.9(o).6(rtan)]TJ
14.2392 0 TD
-.0201 Tc
[(t)-257.6(c)-3.1(lues)-254.7(to)-259.9(genet)-4.7(i)1.7(c)-262.3(s)4.5(uscept)-4.7(ibili)-4.7(ties)]TJ
-14.2392 -1.2203 TD
-.0193 Tc
[(to)-189.5(OCD,)-192.9(anxiety)6.5(,)-192.9(or)-192.1(mood)-189.5(disorders,)]TJ
13.9231 0 TD
[(ADHD,)-192.9(p).2(ervasiv)6.5(e)-191.9(developmental)]TJ
-13.9231 -1.2203 TD
[(dis)5.4(o).3(rder)-267.9(\(PDD\),)-268.7(and)-271.6(o)6.6(thers.)-268.7(It)-269.3(shou)6.6(ld)-265.3(be)-267.7(noted)-265.3(that)-269.3(a)-267.7(positive)-267.7(ps)5.4(ychi-)]TJ
0 -1.2266 TD
[(atric)-160.3(f)3.9(amily)-157.9(h).2(istory)-151.6(does)-152.8(not)-155.6(precl)]TJ
12.5067 0 TD
-.0197 Tc
[(ude)-160.7(considering)-152(a)-160.7(diag)6.1(nosis)-159.5(of)-154.6(PANS.)]TJ
-12.5067 -1.2203 TD
-.0192 Tc
[(In)-278(fact,)-275(a)-274(National)-275.7(I)4(nstitute)-274(f)-2.3(or)-274.2(Me)]TJ
13.354 0 TD
-.0201 Tc
[(n)5.7(t)-4.7(al)-276.6(Health)-278.9(\(NIMH\))-281.5(study)-272.5(found)-272.5(a)]TJ
-13.354 -1.2203 TD
[(10-fol)-4.6(d)-253.5(increase)-255.9(in)-253.5(rates)-254.6(o)5.8(f)-256.1(O)-3.8(CD)-256.8(and)-253.5(t)-4.6(ic)-255.9(disorders)-254.6(a)-3(mong)-253.5(rst-degree)]TJ
0 -1.2266 TD
-.019 Tc
[(relatives)-247.3(of)-248.7(PANDAS)-251(probands)-247.3(\(Lo)6.8(ugee)-248.6(e)-2(t)-250.2(a)4.4(l.)-249.5(2)6.8(000\).)]TJ
/F10 1 Tf
0 -2.4406 TD
0 Tc
[(Medical)-337.2(history)-333(and)-335.7(physical)-334.5(examination)]TJ
/F5 1 Tf
1.1128 -1.8336 TD
[(The)-373.8(medical)-375.8(history)-368.8(and)-374(physical)-376.9(examination)-371.6(should)-375.3(address)]TJ
-1.1128 -1.2266 TD
[(not)-306.1(only)-299.2(the)-308.5(signs)-301.1(and)-304.5(symptoms)-300.4(characteristic)-308.4(of)-305.1(PANS)-305.3(\(such)-300.9(as)]TJ
ET
313.058 720.113 239.131 .22681 re
f
313.058 601.512 239.131 .22675 re
f
BT
/F7 1 Tf
8.9663 0 0 8.9663 349.6818 725.7825 Tm
(Table)Tj
/F5 1 Tf
2.9971 0 TD
(1.)Tj
/F7 1 Tf
1.2519 0 TD
[(Overview)-332.9(of)-335.1(PANS)-330.6(Evaluation)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 322.0724 708.7179 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 330.5196 707.4707 Tm
[(Family)-332.1(history)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 322.0724 698.7967 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 330.5196 697.4927 Tm
[(Medical)-335(history)-330.9(and)-336.1(physical)-339(examination)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 322.0724 688.8187 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 330.5196 687.5148 Tm
[(Psychiatric)-332.5(evaluation)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 322.0724 678.8408 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 330.5196 677.5369 Tm
[(Infectious)-336.9(disease)-332.7(evaluation)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 322.0724 668.9196 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 330.5196 667.6156 Tm
[(Assessment)-338(of)-330.4(symptoms)-332(and)-336.1(history)-337.2(that)-331(points)-335.1(to)-331.8(need)-338(for)]TJ
0 -1.1128 TD
[(further)-333.3(evaluation)-336.9(of)-330.4(immune)-339.4(dysregulation)-330.5(\(autoimmune)]TJ
T*
[(disease,)-335.6(inammatory)-331.9(disease,)-341.9(immunodeciency\))]TJ
/F11 1 Tf
7.9702 0 0 7.9702 322.0724 638.9857 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 330.5196 637.6817 Tm
[(Neurological)-335.5(assessment)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 322.0724 629.0644 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 330.5196 627.7605 Tm
[(Assessment)-338(of)-330.4(somatic)-336.6(symptoms,)-334.9(including)-332.6(possible)-337.7(sleep)]TJ
T*
(evaluation)Tj
/F11 1 Tf
7.9702 0 0 7.9702 322.0724 609.1085 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 330.5196 607.8046 Tm
[(Genetic)-337.7(evaluation)]TJ
7.9702 0 0 7.9702 321.0519 589.6628 Tm
[(PANS,)-325.6(pediatric)-331.2(acute-on)12.2(set)-338.1(neurop)13(sychiatric)-330.3(syndrom)13.5(e.)]TJ
ET
313.058 186.69 239.131 .22676 re
f
313.058 78.009 239.131 .28348 re
f
BT
/F7 1 Tf
8.9663 0 0 8.9663 319.2377 192.359 Tm
(Table)Tj
/F5 1 Tf
2.9971 0 TD
(2.)Tj
/F7 1 Tf
1.2519 0 TD
[(Differential)-337.5(Diagnosis)-333.7(for)-334.6(Youth)-334.2(with)-334.2(PANS)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 322.0724 175.2945 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 330.5196 174.0472 Tm
[(Obsessive)-333.8(compulsive)-335.2(disorder)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 322.0724 165.3732 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 330.5196 164.0692 Tm
[(Anorexia)-333.3(nervosa)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 322.0724 155.3952 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 330.5196 154.0913 Tm
[(Avoidant/restrictive)-334.9(food)-335.8(intake)-332.4(disorder)-337.7(\(ARFID\))]TJ
/F11 1 Tf
7.9702 0 0 7.9702 322.0724 145.4173 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 330.5196 144.1133 Tm
[(Tourette)-333.9(syndrome)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 322.0724 135.4393 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 330.5196 134.1921 Tm
[(Transient)-334.6(tic)-337.8(disorder)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 322.0724 125.5181 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 330.5196 124.2141 Tm
[(Bipolar)-336.8(disorder)]TJ
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(a)Tj
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[(CHANG)-336.8(ET)-338.7(AL.)]TJ
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[(Wilsons)-447.3(disease,)-443.1(among)-439.8(others\).)-442.3(Therefore,)-443.4(the)-441.3(comprehensive)]TJ
T*
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[(sentation)-304.5(and)-304.5(past)-302.8(medical)-306.3(history.)-302.2(Review)-311.1(of)-298.8(the)-302.1(childs)-308(medical)]TJ
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[(records)-267.1(can)-262.6(help)-263.7(construct)-265.2(a)-261.2(timeline)-267.1(of)-260.9(early)-261.9(behavioral)-265.9(problems)]TJ
T*
[(and)-336.1(childhood)-328.5(illnesses.)-335.1(The)-329.6(infection)-331.3(history)-330.9(of)-330.4(parents)-338(and)-329.7(sib-)]TJ
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[(lings)-304(is)-301.4(of)-298.8(particular)-304.2(interest,)-304.2(regarding)-300.5(both)-299.2(susceptibility)-302.7(to,)-303.1(and)]TJ
28.0042 74.5534 TD
[(potential)-199.9(sources)-208.7(of,)-200.6(PANS/PANDAS)-208.8(related)-204.2(infections)-205.5(\(especially)]TJ
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[(GAS)-281.9(infections\).)]TJ
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[(maciation)-246.1(s)-.7(eco)6.8(ndary)-252.5(to)-246.1(res)5.6(t)-3.6(ricted)]TJ
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[(gns)-367.9(of)-369.3(GAS)-371.6(i)2.4(nfection)-366.7(\(i.e.,)-376.4(p)6.4(h).1(ar-)]TJ
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[(be)-356.1(pu)-5.9(rsue)-8.3(d.)]TJ
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[(toms,)-180.4(a)-185.3(comprehensive)-185.4(review)-188.9(of)-178.7(systems)-187.2(and)-184.3(physical)-187.2(examination)]TJ
T*
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T*
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T*
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(litis,)Tj
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[(IX.)-501(Neurological:)]TJ
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(A.)Tj
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[(If)-314.1(more)-322.7(severe)-317.9(impairment)-325.2(in)-319.2(cognition)-319.9(or)-317.8(memory)-319(is)]TJ
ET
59.754 710.079 239.131 .28351 re
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59.754 174.047 239.131 .22681 re
f
BT
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(Table)Tj
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(3.)Tj
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[(for)-334.6(Youth)-334.2(with)-334.2(PANS)-330.6(\(Examples\))]TJ
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()Tj
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T*
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[(Juvenile)-339(idiopathic)-332.2(arthritis,)-339.6(rheumatoid)-336.6(arthritis)]TJ
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(B)Tj
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[(Connective)-337.6(tissue)-338.7(diseases)-333.4(including)-332.6(lupus,)-334.5(Sjo)]TJ
18.9245 .019 TD
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.4173 -.019 TD
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-19.3418 -1.1128 TD
[(syndrome,)-337.5(scleroderma)]TJ
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3.9849 0 0 3.9849 77.726 496.7999 Tm
(B)Tj
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T*
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(B)Tj
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[(Familial)-335.3(Mediterranean)-342.2(fever,)-333(other)-335.4(recurrent)-337.2(fever)]TJ
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[(Thyroiditis,)-339.7(Addisons)-330.4(disease,)-335.6(Type)-335.4(1)-334.6(diabetes)]TJ
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[(Idiopathic)-337.1(thrombocytopenia)-333.8(purpura)-339.3(\(ITP\),)-335.5(hemolytic)]TJ
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(GuillainBarre)Tj
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[(syndrome,)-337.5(transverse)-336.4(myelitis)]TJ
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(B)Tj
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[(Celiac)-339.6(disease)]TJ
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T*
(colitis\))Tj
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(B)Tj
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8.9663 0 0 8.9663 86.5134 295.937 Tm
[(Irritable)-336.5(bowel)-336.1(syndrome,)-337.5(food)-329.4(intolerances)-342.1(\(i.e.)-329.6(gluten,)]TJ
T*
(dairy\))Tj
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7.9702 0 0 7.9702 68.7685 277.3416 Tm
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8.9663 0 0 8.9663 86.5134 266.0598 Tm
[(Alopecia,)-340.1(vitiligo,)-335.3(psoriasis)]TJ
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[(Recurrent)-339.3(infections)-338.3(and)-329.7(immunodeciency)-338.5(syndromes)]TJ
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[(Recurrent)-333(infections:)-335.5(sinusitis,)-340.6(tonsilitis)-331.4(\(especially)-336.3(strep\),)]TJ
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[(pneumonia,)-333.4(skin)-332(infections)-338.3(\(i.e.)-335.9(staph\),)-332.7(other)-335.4(infections.)]TJ
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[(Chronic)-332.8(granulomatous)-336.3(diseases)-333.4(\(CGD\),)-339.5(common)-335.3(variable)]TJ
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[(immuno)5.7(decien)5.7(c)-3.1(y)-272.5(\()3.1(CVID\),)-269.6(othe)]TJ
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[(r)-274.8(i)2(mmu)6(nodeciency)-272.2(s)-1.5(yn)6(dro)6(m)2.4(es)]TJ
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[(Idiopathic)-337.1(diseases)]TJ
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[(Chronic)-332.8(fatigue)-334.5(syndrome,)-337.5(bromyalgia,)-331.3(and)-336.1(other)-335.4(pain)]TJ
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[(Cranial)-364.6(nerves:)]TJ
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[(PANS)-855.4(patients)-855.1(typically)-851.1(have)-856.5(normal)]TJ
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[(strength)-579.4(but)-577.9(may)-579.9(exhibit)-573.8(mildly)-581.7(reduced)-575.5(proximal)]TJ
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[(muscle)-339.4(weakness)-331.5(and)-336.1(slouched)-334.9(posture.)]TJ
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(D.)Tj
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[(Fine)-383.7(motor)-385.4(skills:)]TJ
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[(These)-382.8(can)-389.1(be)-380.8(normal)-389(or)-381(abnormal)]TJ
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[(depending)-415.5(upon)-409(presence)-414.2(or)-412.6(absence)-412.1(of)-412.6(adventitious)]TJ
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[(movements)-474.3(and)-468.8(developmental)-474.2(regression.)-476(Abnorm-)]TJ
T*
[(alities)-259(may)-263.7(be)-254.4(elicited)-259.7(by)-258.3(having)-262.7(the)-257.9(child)-254.6(write,)-263.4(draw,)]TJ
T*
[(or)-336.7(copy)-329.3(simple)-334.7(gures.)]TJ
-1.391 -1.2266 TD
(E.)Tj
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[(Motor)-340(or)-343.1(phonic)-344.9(tics)-344.8(are)-341.1(com-)]TJ
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[(mon)-394.1(in)-395.1(patients)-393.6(with)-401.4(PANS.)-390.4(Choreiform)-397(movements)]TJ
T*
[(\(piano)-360.2(playing)-361.1(ngers\))-364.4(may)-358.6(be)-361.8(present.)-366.2(These)-357.5(move-)]TJ
0 -1.2266 TD
[(ments)-242.7(can)-243.6(be)-241.7(elicited)-240.7(with)-243.3(a)-242.2(Romberg)-243.8(test)-237.3(in)-243.3(which)-241.2(the)]TJ
0 -1.2203 TD
[(child)-564.4(stands)-562.3(with)-565.8(the)-561.4(hands)-563.9(outstretched)-567.3(and)-563.7(eyes)]TJ
T*
[(closed)-405.5(for)-402.1(60)-403.7(seconds.)-398.7(Hand)-408.4(movements)-398.4(are)-404.3(consid-)]TJ
0 -1.2266 TD
[(ered)-334.3(abnormal)-333.6(in)-338.2(children)]TJ
/F9 1 Tf
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[(8)-334.6(years.)]TJ
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(F.)Tj
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[(These)-262.6(can)-256.3(be)-260.7(normal)-262.6(or)-260.9(minimally)-255.1(depressed)]TJ
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[(in)-331.8(the)-333.8(acute)-337.6(phase)-332.4(of)-336.7(PANS/PANDAS.)]TJ
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(G.)Tj
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[(Cerebellar)-517(examination:)]TJ
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[(This)-515.2(is)-516.4(normal)-515.5(in)-508.9(patients)]TJ
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[(with)-338.2(PANS.)]TJ
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(H.)Tj
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[(G)-5.6(a)-2.3(it:)]TJ
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[(This)-564(is)-564(normal)-566.8(i)-4.1(n)-562.8(p)0(atients)-570.3(w)3(ith)-562.8(P)1.4(ANS)-567.7(unless)]TJ
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[(compuls)5.1(i)-4.1(on)6.3(s)-418.5(o)0(r)-420(tics)-418.5(i)2.3(nterr)]TJ
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[(upt)-415.1(gait.)-414.4(C)1.6(horea)-419.8(may)-417.4(b)0(e)-419.8(e)3.9(li-)]TJ
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[(aluations)-538.6(and)-537.4(s)-1.1(hou)6.4(ld)-531.1(prompt)]TJ
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[(with)-331.9(the)-333.8(appropriate)-337.6(tests)-332.9(or)-336.7(referral)-333.9(to)-331.8(a)-337(neurologist.)]TJ
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[(A)-388.5(comprehensive)-387.7(psychiatric)-390.8(evaluation)-387.5(is)-389.9(important)-389.3(in)-382.4(order)]TJ
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[(to)-338.2(understand)-336.6(the)-340.1(full)-337.5(range)-333.8(of)-336.7(psychiatric)-340.2(symptomatology,)-341.3(psy-)]TJ
T*
[(chiatric)-448(history,)-447.6(developmental)-442.6(history,)-447.6(response)-448.5(to)-439.3(previous)-448.9(or)]TJ
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[(current)-320.5(psychotropic)-314.3(medications,)-318.8(and)-317.1(response)-322.1(to)-312.9(past)-315.5(or)-317.8(current)]TJ
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T*
[(an)-418.8(experienced)-424.3(child)-419(psychiatrist)-424.7(or)-418.9(psychologist.)-418.6(At)-417.3(minimum,)]TJ
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[(however,)-294.8(primary)-290(care)-292.4(evaluation)-299(should)-286.8(include)-294(the)-295.8(full)-286.9(range)-295.9(of)]TJ
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[(psychiatric)-384.5(and)-380.3(behavioral)-379.7(symptoms)-376.3(associated)-381.9(with)-382.4(PANS,)-377.8(in-)]TJ
T*
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T*
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[(\(K)20.4(SA)18.1(DS)18.1(-P)18.8(L)13.3(\))-293(\(K)20.4(au)17.5(fm)20.1(an)-279.6(et)-283.7(al)19.8(.)-293.8(1)0(9)19.9(9)13.1(7\))-286.2(ma)20.3(y)-290.4(b)0(e)-279.6(u)0(s)18.8(e)0(f)14.9(u)13.1(l,)-284.7(al)19.8(th)22.2(ou)19.9(gh)-283.6(th)22.3(es)16.3(e)]TJ
T*
[(in)22.2(st)14.7(ru)23.7(me)14(n)13.1(t)0(s)-371(w)0(e)14.2(r)0(e)-370.8(d)0(e)17.5(s)0(i)21.1(g)0(n)19.9(e)0(d)-374.5(f)0(o)17.3(r)-381.5(re)21.2(se)16.3(ar)21.2(ch)-374.5(pu)19.9(rp)17.3(o)13.1(s)0(e)16.3(s)-380.1(an)17.5(d)-385.2(m)15.9(ay)-374.5(be)-374.5(to)15.9(o)]TJ
0 -1.2266 TD
[(cu)17.5(mb)22.7(er)14.9(so)25.1(me)-390.7(fo)17.3(r)-394.1(c)0(l)19.8(i)0(n)15.9(i)0(c)19.8(a)0(l)-391.2(p)13.1(ra)21.2(ct)13.5(i)15.4(c)0(e)15.1(.)-394.9(If)-389.9(a)-400.3(s)0(t)21.1(r)0(u)17.3(c)0(t)19.8(u)13.1(re)14.9(d)-397.9(i)0(n)22.2(t)0(e)19.8(r)0(v)17.3(i)0(e)19.8(w)-394.8(is)-389.9(no)20(t)]TJ
0 -1.2203 TD
[(us)18.8(ed)17.5(,)-350.7(i)0(t)-342.2(i)0(s)-339.3(p)0(a)17.5(r)0(t)19.6(i)0(c)19.8(u)0(l)22.2(a)0(r)14.9(l)0(y)-338.2(i)0(m)18.7(p)0(o)19.9(r)0(t)19.6(a)0(n)17.5(t)-351.3(to)-344.5(ex)23.9(pl)15.9(o)13.1(r)0(e)-345.5(a)0(r)21.2(e)0(a)15.1(s)-348.5(of)-343.1(p)13.1(o)0(t)15.9(e)0(n)17.5(t)15.4(ia)13.5(l)-351.3(e)0(m)20.3(-)]TJ
T*
[(ba)17.5(rr)21.1(as)16.3(sm)21.6(en)17.5(t)-351.3(o)0(r)-349.4(s)0(e)22.7(n)0(s)18.8(i)0(t)18.2(i)0(v)22.2(i)0(t)18.2(y)0(,)-343.9(i)0(n)15.9(c)0(l)19.8(u)13.1(di)15.9(n)13.1(g)-353.6(se)16.3(x)13.1(u)0(a)17.5(l)-357.6(o)13.1(r)-356.2(v)13.1(i)0(o)15.9(l)0(e)19.8(n)13.1(t)-357.6(i)0(m)18.7(a)0(g)17.5(e)0(s)-344.1(a)0(n)17.5(d)]TJ
0 -1.2266 TD
[(im)18.7(p)13.1(u)0(l)15.9(s)0(e)22.7(s)0(,)-667.5(a)0(s)-672.9(t)0(h)22.2(e)0(s)16.3(e)-672.2(ar)14.9(e)-678.5(c)0(o)23.9(m)0(m)19.2(o)0(n)-669.3(a)0(m)20.3(o)0(n)19.9(g)-676.1(pa)17.5(ti)18.2(en)17.5(t)15.4(s)-677.3(wi)18.9(th)-666.9(PA)18.1(NS)]TJ
0 -1.2203 TD
[(\(F)18.8(ra)21.2(nk)19.9(ov)19.9(ic)19.8(h)-309.3(e)0(t)-296.3(a)0(l)19.8(.)-306.4(20)19.9(15)19.9(a,)-295.7(in)-300.2(p)13.1(r)0(e)21.2(s)0(s)17.6(\))0(.)-295.9(S)0(e)18.9(l)0(f)19.6(-)0(i)19.6(n)0(j)15.9(u)13.1(ri)19.6(ou)19.9(s)-304.2(t)0(h)15.9(o)13.1(ug)19.9(ht)15.9(s)-304.2(a)0(n)17.5(d)-303(be)17.5(-)]TJ
T*
[(ha)17.5(v)13.1(i)0(o)15.9(r)0(s)-293.7(a)0(l)19.8(s)0(o)-291.1(o)0(c)17.5(c)0(u)17.5(r)-305.6(fr)21.1(eq)17.5(u)13.1(e)0(n)17.5(t)0(l)18.2(y)-303(an)23.9(d)-309.3(c)0(a)21.4(n)-303(be)-298.6(p)13.1(a)0(r)21.2(t)0(i)18.2(c)0(u)17.5(l)0(a)19.8(r)0(l)19.6(y)-303(wo)16.6(rr)21.1(is)21.1(om)16.4(e)-305.4(i)0(n)]TJ
T*
[(ch)17.5(il)18.2(d)13.1(r)0(e)21.2(n)-340.9(wi)18.9(th)-325.5(de)17.5(v)13.1(e)0(l)13.5(o)13.1(p)13.1(m)0(e)14(n)13.1(ta)19.8(l)-338.6(r)0(e)14.9(g)13.1(re)21.2(ss)17.6(io)22.2(n)-340.9(a)0(n)17.5(d)-334.6(in)22.3(cr)14.9(ea)21.4(se)16.3(d)-334.6(i)0(m)18.7(p)0(u)19.9(l)0(s)21.1(i)0(v)15.9(i)0(t)18.2(y)13.1(.)]TJ
0 -1.2266 TD
[(Fo)21.4(r)-324.6(e)0(x)23.9(a)0(m)14(p)13.1(le)19.8(,)-319.1(c)0(h)17.5(i)0(l)18.2(d)13.1(re)14.9(n)-315.7(w)0(i)18.9(t)0(h)-312.9(P)0(A)18.1(N)0(S)-310.7(h)13.1(av)17.5(e)-324.4(m)0(a)20.3(d)13.1(e)-324.4(a)0(t)19.8(t)0(e)19.8(m)0(p)22.7(t)0(s)-314.1(a)0(t)-309(j)0(u)15.9(m)0(p)22.7(i)0(n)15.9(g)]TJ
0 -1.2203 TD
[(ou)19.9(t)-231.2(o)0(f)-222.9(a)-229.6(mo)22.7(vi)15.9(n)13.1(g)-233.5(ca)21.4(r)-236.1(o)13.1(r)-229.7(a)-235.9(se)22.7(co)17.5(n)13.1(d)-233.5(st)21.1(or)17.3(y)-227.1(w)0(i)18.9(n)0(d)19.9(o)0(w)-223.6(\()-71.7(Mu)19.2(rp)17.3(h)13.1(y)-233.5(et)-220.4(al)19.8(.)-230.5(2)0(0)19.9(1)0(4)19.9(\))0(.)]TJ
/F10 1 Tf
0 -2.7758 TD
[(Mental)-337.9(status)-331.1(examination)]TJ
/F5 1 Tf
1.1128 -1.8336 TD
[(During)-203(an)-203.8(acute)-204.8(PANS)-204.2(episode,)-205.6(the)-207.3(child)-204(may)-206.8(appear)-202.9(hyperalert,)]TJ
-1.1128 -1.2267 TD
[(unsmiling,)-242.9(anxious,)-247.4(and)-241.2(in)-243.3(the)-245.2()54.8(ght)-243(or)-241.9(ight)56.9()-242.4(mode.)-247.2(Parents)-241.8(may)]TJ
27.9978 74.5598 TD
[(report)-255.3(that)-255.1(their)-250.9(child)-254.6(has)-248.7(a)-254.8()54.8(terror-stricken)-255.9(look,)56.1()-248.7(although)-253.2(this)-253.9(is)]TJ
0 -1.2203 TD
[(often)-417.6(present)-413.9(only)-413.1(in)-414(the)-416(rst)-415.4(few)-411.5(days)-412.6(of)-418.9(illness.)-414.7(Memory)-411(im-)]TJ
0 -1.2266 TD
[(pairments)-243.4(appear)-240.9(to)-237(be)-235.4(part)-241(of)-235.6(the)-238.9(PANS)-235.8(syndrome.)-236.4(Children)-241.5(often)]TJ
0 -1.2203 TD
[(cannot)-385.3(recall)-381.7(details)-387.7(of)-381(their)-377.4(symptoms)-382.6(or)-381(their)-383.7(impact)-380.2(on)-384.7(func-)]TJ
T*
[(tioning.)-289.8(Emotional)-291.6(lability)-290.5(\(emotional)-296.4(incontinence\))-289.9(is)-288.8(a)-292.8(hallmark)]TJ
0 -1.2266 TD
[(symptom)-331.3(of)-330.4(PANS)-324.3(and)-329.7(is)-333(characterized)-333.6(by)-327.8(involuntary)-327.9(and)-329.7(often)]TJ
0 -1.2203 TD
[(uncontrollable)-297.3(episodes)-285.5(of)-292.5(crying)-290.6(or)-286.2(laughing)-291.1(that)-286.7(are)-290.5(often)-291.1(mood)]TJ
T*
[(incongruent)-288.3(\(i.e.)-279(a)-286.5(patient)-285.4(might)-281(laugh)-282.2(uncontrollably)-282.2(when)-282(angry)]TJ
0 -1.2266 TD
[(or)-305.1(frustrated\).)-300.2(Depression)-303.1(is)-295.1(also)-302.8(common,)-300.3(particularly)-300.9(during)-300.9(the)]TJ
0 -1.2203 TD
[(later)-215.4(stages)-217(of)-210.3(the)-207.3(illness,)-218.7(so)-208.9(that)-210.8(the)-213.6(child)-210.4(may)-213.1(present)-211.6(with)-211.7(a)-210.6(at)-212.2(or)]TJ
T*
[(depressed)-513.7(affect.)-509.7(Agitation,)-507.2(irritability,)-507.1(aggression,)-511.4(and)-506.8(temper)]TJ
T*
[(tantrums/rage)-256.8(episodes)-247.6(are)-252.6(also)-245.9(common.)-249.7(Speech)-249.5(is)-250.8(often)-246.9(affected,)]TJ
0 -1.2266 TD
[(with)-515.2(a)-507.8(variety)-511.6(of)-507.5(notable)-515.3(observations,)-508.1(including)-509.6()54.8(baby)-514.7(talk)58.9()]TJ
0 -1.2203 TD
[(secondary)-360.7(to)-350.8(developmental)-360.4(regression,)-355.9(a)-349.7(paucity)-357.2(of)-355.7(speech,)-356.2(\(se-)]TJ
T*
[(lective\))-245.6(mutism,)-237.6(or)-241.9(new)-238.2(onset)-239.1(of)-241.9(stuttering.)-241.6(Severe)-239.5(impulsivity)-240.8(and)]TJ
0 -1.2266 TD
[(compulsive)-284.6(behavior)-279.4(may)-282.7(be)-279.7(present.)-284(Insight)-280.3(may)-282.7(be)-279.6(limited.)]TJ
1.1128 -1.2203 TD
[(However,)-215.9(children)-213.9(with)-218(PANS)-210.5(will)-215.7(often)-208.9(willingly)-215(acknowledge)]TJ
-1.1128 -1.2203 TD
[(the)-213.6(OCD)-205.9(thoughts)-207.7(once)-211.5(they)-206.8(are)-214.6(reassured)-206.5(that)-210.8(they)-206.8(will)-209.4(not)-211.2(have)-205.2(to)]TJ
0 -1.2266 TD
[(reveal)-377.7(their)-377.3(content.)-379.1(Children)-374.3(may)-377.5(experience)-374.2(auditory)-375.9(or)-374.7(visual)]TJ
0 -1.2203 TD
[(hallucinations,)-189(as)-179.7(well)-182.5(as)-186(violent)-181.8(imagery,)-178.9(and)-184.3(suicidal)-184.9(or)-178.7(homicidal)]TJ
T*
[(ideation.)-313.1(These)-313.2(experiences)-311.7(should)-312.1(be)-304.9(assessed)-311.6(specically.)-316.2(Chil-)]TJ
T*
[(dren)-230.7(with)-230.7(PANS)-235.8(are)-227.3(often)-234.2(highly)-226.4(aware)-232(of)-235.6(their)-225.6(unwanted)-235.9(thoughts)]TJ
0 -1.2266 TD
[(and)-487.8(actions,)-481.5(and)-487.8(may)-485(be)-482(embarrassed)-489.6(by)-479.6(them)-482.2(and)-487.8(apologetic)]TJ
0 -1.2203 TD
(afterward.)Tj
/F10 1 Tf
0 -2.6683 TD
[(General)-336(laboratory)-336.2(studies)]TJ
/F5 1 Tf
1.1128 -1.8336 TD
[(All)-281.8(patients)-286.1(meeting)-278.6(PANS)-280(criteria)-286.2(should)-280.5(have)-281.1(the)-283.2(following:)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 323.0361 418.2235 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 331.4834 416.9196 Tm
[(Complete)-339.7(blood)-330.4(cell)-339.7(count)-332.8(with)-331.9(manual)-338.3(differential)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 323.0361 407.2818 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 331.4834 405.9778 Tm
[(Erythrocyte)-297.1(sedimentation)-293.6(rate)-294(\(ESR\))-296.7(and)-291.8(C-reactive)-294.6(protein)]TJ
0 -1.2203 TD
(\(CRP\))Tj
/F11 1 Tf
7.9702 0 0 7.9702 323.0361 385.3416 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 331.4834 384.0377 Tm
[(Comprehensive)-339.4(metabolic)-334.6(panel)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 323.0361 374.3999 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 331.4834 373.0959 Tm
[(Urinalysis)-296.1(\(to)-296(assess)-297.5(hydration\))-295.3(and)-291.8(to)-293.9(rule)-291.6(out)-293.4(inammation)]TJ
T*
[(for)-370.5(children)-372(with)-369.8(urinary)-375(complaints;)-368(clean-catch)-373.9(urine)-373.3(cul-)]TJ
0 -1.2266 TD
[(ture)-335.9(for)-332.5(those)-334(with)-338.2(pyuria)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 323.0361 341.518 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 331.4834 340.2141 Tm
[(Throat)-296.8(culture,)-293.2(anti-streptolysin)-300.1(O)-293.7(\(ASO\))-298.8(and)-291.8(anti-DNAse)-299.9(B)]TJ
-.9421 -1.8906 TD
[(The)-285.3(following)-279.1(laboratory)-278.8(tests)-282.3(should)-280.5(also)-283.9(be)-279.6(considered.)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 323.0361 308.1259 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 331.4834 306.822 Tm
[(If)-383.6(there)-388.4(are)-385.3(elevated)-386.9(inammatory)-382.5(markers,)-387.3(fatigue,)-381.7(rashes,)]TJ
0 -1.2203 TD
[(or)-564.4(joint)-559.7(pain,)-563.8(antinuclear)-562.7(antibody)-563(\(ANA\))-562.8(or)-564.4(uorescent)]TJ
T*
[(antinuclear)-316.1(antibody)-310.1(\(FANA\))-308(should)-312.1(be)-311.3(obtained;)-309.7(if)-309.2(ANA)-311.9(is)]TJ
0 -1.2266 TD
[(elevated)-336.3(proceed)-341.6(with)-331.9(lupus)-331.6(workup.)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 323.0361 264.3023 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 331.4834 262.9984 Tm
[(Antiphospholipid)-238.1(antibody)-234.2(work)-231.6(up)-233(should)-236.2(only)-229.7(be)-235.4(pursued)-236.7(if)]TJ
0 -1.2203 TD
[(the)-390.7(patient)-386.5(has)-387.8(chorea,)-389.2(petechiae,)-385.4(migraines,)-391.8(stroke,)-383.3(throm-)]TJ
T*
[(bosis,)-436.8(thrombocytopenia,)-431.6(or)-437.9(levido)-431.2(rash.)-430.8(Workup)-437.9(includes:)]TJ
0 -1.2266 TD
[(anticardiolipin)-412.4(antibody,)-414.1(dilute)-403.6(Russells)-415.3(viper)-411.3(venom)-408.2(time)]TJ
0 -1.2203 TD
(\(dRVVT\),)Tj
/F13 1 Tf
4.4703 0 TD
(b)Tj
/F5 1 Tf
.8852 0 TD
[(2-glycoprotein)-337.7(I)-330.9(antibodies.)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 323.0361 209.5369 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 331.4834 208.233 Tm
[(If)-320.4(abnormal)-327.2(liver)-320.4(function)-319(tests)-326.5(or)-317.8(KayserFleisher)-329.7(rings)-321.5(are)]TJ
0 -1.2266 TD
[(present,)-290.4(there)-287.2(is)-288.8(a)-286.5(need)-287.4(to)-281.3(evaluate)-292(for)-288.3(Wilsons)-282.9(disease)-288.4(with)]TJ
0 -1.2203 TD
[(ceruloplasmin)-336.4(and)-336.1(24)-334.1(urine)-335.4(copper)-333.3(tests.)]TJ
/F10 1 Tf
-2.055 -2.9971 TD
[(Infectious)-340.4(disease)-329.8(evaluation)]TJ
/F2 1 Tf
1.1128 -1.6123 TD
(PANDAS.)Tj
/F5 1 Tf
5.3871 0 TD
[(The)-209.4(diagnosis)-210.8(of)-204(PANDAS)-209.8(is)-212.9(based)-205.9(on)-207.7(evidence)-212.1(of)]TJ
-6.5 -1.2266 TD
[(recent)-295.5(or)-292.5(current)-295.2(streptococcal)-299.8(infection)-293.3(with)-293.9(onset)-296(or)-286.2(acute)-299.7(exac-)]TJ
0 -1.2203 TD
[(erbations.)-350.3(Streptococcal)-347.8(pharyngitis)-348(is)-345.7(conrmed)-347.1(with)-344.5(a)-343.4(properly)]TJ
T*
[(performed)-309(throat)-301(culture)-309.2(or)-298.8(rapid)-303.8(antigen)-306.6(test.)-303.5(Rapid)-305.9(antigen)-300.3(tests)]TJ
T*
[(are)-252.6(insufciently)-250.9(sensitive;)-252.4(therefore,)-251.6(follow-up)-246.1(culture)-252.3(is)-244.5(required)]TJ
0 -1.2266 TD
[(if)-315.5(the)-314.8(test)-313.2(is)-314.1(negative.)-317.8(Culture-proven)-315.8(GAS)-313.5(infection)-312.3(may)-314.3(also)-315.5(be)]TJ
0 -1.2203 TD
[(documented)-490.5(at)-479.7(other)-487.1(symptomatic)-481.4(\(to)-485.7(distinguish)-481(from)-487.3(asymp-)]TJ
T*
[(tomatic)-257.3(sites)-250.7(in)-249.6(General)-254(laboratory)-253.5(studies)-256(section\))-253(sites,)-247.3(including)]TJ
0 -1.2267 TD
[(the)-371.7(nasal)-361.7(cavity,)-366.9(skin)-370(and)-361.4(skin)-370(structure,)-365.6(and)-367.7(perianal)-368.1(or)-362(vaginal)]TJ
/F4 1 Tf
-27.9978 77.2217 TD
(4)Tj
47.4471 0 TD
[(CHANG)-336.8(ET)-338.7(AL.)]TJ
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[(areas.)-428.8(Perianal)-417.2(streptococcal)-426.3(infection)-426.1(may)-421.8(accompany)-419.8(onset)-422.5(or)]TJ
0 -1.2203 TD
[(exacerbation)-250.8(of)-248.2(neuropsychiatric)-247.9(symptoms)-243.5(\(Toufexis)-248.5(et)-245.7(al.)-242.3(2014\).)]TJ
0 -1.2266 TD
[(A)-325.3(history)-318.2(of)-317.8(scarlatiniform)-326.2(rash,)-323.3(impetigo,)-320.5(and)-317.1(perianal)-323.8(or)-324.1(vulvar)]TJ
0 -1.2203 TD
[(dermatitis,)-399.3(or)-387.3(deep)-394.9(tissue)-395.6(GAS)-389.4(infection)-394.5(during)-395.7(the)-390.7(preceding)-395.2(6)]TJ
T*
[(months)-296.7(should)-293.1(also)-290.2(be)-292.3(obtained.)-296.4(Culture)-292.6(of)-292.5(nasal)-292.1(secretions)-299.9(is)-288.8(ad-)]TJ
0 -1.2266 TD
[(vised,)-185.1(as)-186(a)-185.3(small)-189.8(fraction)-184.9(of)-185(sinusitis)-186(is)-187.6(caused)-188.9(by)-182.4(GAS)-187.1(\(Cherry)-188.6(et)-182.5(al.)]TJ
0 -1.2203 TD
[(2014\).)-344.5(Serologic)-344.8(diagnosis)-343.6(of)-343.1(recent)-346.1(GAS)-345.2(infection)-350.2(can)-338.5(be)-349.2(made)]TJ
T*
[(by)-220.3(demonstrating)-220.2(a)-216.9(0.2)-223.2(log)]TJ
6.7246 0 0 5.9768 154.7149 647.5463 Tm
(10)Tj
8.9663 0 0 8.9663 163.4456 649.077 Tm
[(rise)-216.9(\(a)-219(58%)-215.6(increase\))-224.3(in)-218(either)-221.2(ASO)-218.7(or)]TJ
-11.5646 -1.2266 TD
[(ADB,)-310(ordinarily)-299.3(obtained)-306.1(48)-302(weeks)-304.1(apart,)-309.1(although)-303.7(only)-299.2(62)19.9(%)-292.5(o)13.1(f)]TJ
0 -1.2203 TD
[(ne)17.5(w)-274.7(G)0(A)19.7(S)-270(ac)21.4(qu)19.9(is)21.1(it)24.6(io)22.2(ns)-265.8(we)20.5(re)-263.3(fo)23.7(ll)18.2(o)13.1(w)0(e)20.5(d)-271.4(by)-264.6(su)25.1(ch)-267(a)-273.8(r)0(i)19.6(s)0(e)-261.9(\()-115.9(Jo)25.1(hn)19.9(so)25.1(n)-277.7(e)0(t)-264.7(a)0(l)26.1(.)]TJ
T*
[(20)19.9(1)13.1(0)0(\))17.3(.)-281.1(A)-287.3(s)0(i)27.4(n)0(g)19.9(l)0(e)-277.3(h)13.1(ig)22.2(h)-284(t)0(i)24.6(t)0(e)19.8(r)0(,)-270.6(r)0(a)14.9(t)15.4(he)17.5(r)-280.3(t)0(h)22.2(a)0(n)-273.3(s)0(e)16.3(r)0(i)26(a)0(l)-277.3(a)0(c)21.4(u)13.1(te)-277.3(an)23.9(d)-284(c)0(o)23.9(n)0(v)19.9(a)0(l)19.8(e)0(s)22.7(c)0(e)21.4(n)13.1(t)]TJ
T*
[(ti)18.2(te)19.8(rs)22.5(,)-293.8(i)15.4(s)-297.9(n)13.1(o)13.1(t)-294.4(di)22.2(ag)17.5(n)13.1(o)13.1(s)0(t)21.1(i)0(c)19.8(a)0(l)19.8(l)0(y)-281.3(r)0(e)21.2(l)0(i)18.2(a)0(b)23.9(l)0(e)19.8(,)-293.8(b)13.1(u)13.1(t)-294.4(ma)20.3(y)-296.7(b)13.1(e)-292.8(c)0(o)17.5(n)13.1(si)21.1(d)13.1(e)0(r)21.2(e)0(d)-286(c)0(o)23.9(n)13.1(tr)19.6(ib)22.2(-)]TJ
0 -1.2266 TD
[(ut)22.2(or)17.3(y)-416.8(i)0(f)-410.3(l)0(e)19.8(v)13.1(el)19.8(s)-418(e)0(x)17.5(c)0(e)21.4(e)0(d)-412.4(t)15.4(wo)16.6(fo)23.7(ld)-407.7(\(0)23.7(.3)-413.4(l)15.4(o)0(g)]TJ
6.7246 0 0 5.9768 203.811 592.7809 Tm
(10)Tj
8.9663 0 0 8.9663 210.3306 594.2549 Tm
[(\))-425.8(a)0(b)23.9(o)13.1(ve)-412.4(th)22.2(e)-419.2(l)0(a)19.8(b)13.1(or)17.3(at)26.2(or)17.3(y)13.1()0(s)]TJ
-16.7937 -1.2203 TD
[(st)21.1(at)19.8(ed)-387.1(up)19.9(p)13.1(e)0(r)-389.7(l)0(i)18.2(m)15.9(it)-392.8(o)13.1(f)-400.5(n)13.1(o)0(r)17.3(m)15.9(al)19.8(,)-401.3(b)13.1(ec)21.4(au)17.5(se)-388.3(t)15.4(h)0(e)17.5(s)0(e)-388.3(h)13.1(ig)22.2(he)17.5(r)-400.5(l)15.4(ev)17.5(el)26.2(s)-405.4(a)0(r)21.2(e)-400.3(u)13.1(n)13.1(-)]TJ
T*
[(co)17.5(mm)25.5(on)-258.3(in)-262.3(ch)23.9(il)24.6(dr)17.3(en)-254.4(wi)18.9(th)22.2(o)13.1(u)0(t)-262.3(r)16.9(ec)15.1(en)23.9(t)-269.1(s)0(t)21.1(r)0(e)21.2(p)13.1(to)22.2(co)17.5(cc)21.4(al)-258.4(in)22.2(fe)21.2(ct)19.8(i)15.4(o)0(n)19.9(.)]TJ
1.1128 -1.2266 TD
[(Asymptomatic)-275.5(acquisition)-276(of)-273.5(GAS)-275.6(can)-275.3(initiate)-273.9(a)-273.8(rise)-273.8(in)-268.6(ASO)-275.6(or)]TJ
-1.1128 -1.2203 TD
[(ADB)-452.5(\()-122.2(Johnson)-447.9(et)-448.1(al.)-444.7(2010\).)-445.7(It)-448.3(is)-446.8(not)-445.2(established)-452.6(whether)-447.6(such)]TJ
T*
[(acquisition)-345.5(can)-338.5(initiate)-337.2(PANDAS)-342.6(in)-338.2(the)-340.1(absence)-336.2(of)-343.1(antimicrobial)]TJ
0 -1.2266 TD
[(treatment,)-479.2(although)-468.1(analogous)-473.6(experience)-475.4(with)-471(rheumatic)-478.6(fever)]TJ
0 -1.2203 TD
[(\(Garvey)-376.7(et)-378.5(al.)-375.1(1998\),)-376.1(a)-375(prospective)-374.1(school-based)-377.1(study)-375.8(\()-84.3(Murphy)]TJ
T*
[(et)-283.7(al.)-280.3(2007\))-278.4(and)-285.5(our)-279.3(anecdotal)-278.9(experience)-285.7(support)-282.6(this)-279.2(potential.)]TJ
1.1128 -1.2203 TD
[(Children)-260.5(with)-262.3(PANDAS,)-257(their)-263.5(family)-260.3(members,)-261.8(and)-260.2(other)-259.5(close)]TJ
-1.1128 -1.2266 TD
[(contacts)-214.9(should)-210.9(be)-210.1(vigilantly)-207.3(observed)-213.4(for)-206.1(symptoms)-211.9(of)-210.3(pharyngitis)]TJ
0 -1.2203 TD
[(and)-228.6(other)-221.6(streptococcal)-223.9(infections,)-227.4(with)-224.4(prompt)-222.2(clinical)-228.1(assessment)]TJ
T*
[(and)-285.5(diagnostic)-278.8(testing)-284.1(when)-282(appropriate.)]TJ
/F2 1 Tf
1.1128 -2.447 TD
(PANS.)Tj
/F5 1 Tf
4.0024 0 TD
[(Most)-446.6(instances)-455.9(of)-450.6(PANS)-450.7(are)-454.9(suspected)-451.9(to)-452(be)-450.4(post-)]TJ
-5.1152 -1.2203 TD
[(infectious)-205.5(in)-192.7(origin,)-200.3(although)-196.2(no)-201.4(single)-198.4(microbe)-194.9(other)-202.6(than)-194.2(GAS)-199.7(has)]TJ
0 -1.2266 TD
[(yet)-188.3(been)-186.2(consistently)-188.2(associated)-192.2(with)-186.4(the)-188.3(onset)-188.6(of)-185(PANS.)-181.8(Therefore,)]TJ
0 -1.2203 TD
[(a)-482.5(detailed)-489.6(review)-486(and)-481.5(documentation)-484.4(of)-482.2(associated)-489.4(febrile)-482.6(and)]TJ
T*
[(nonfebrile)-304.1(infectious)-300.3(illnesses,)-303.5(including)-294.6(signs)-301.1(and)-298.1(symptoms)-300.4(and)]TJ
0 -1.2266 TD
[(diagnostic)-373.6(testing,)-369.2(is)-364.6(advised.)-370(The)-373.8(most)-367.2(commonly)-370(observed)-365.1(an-)]TJ
0 -1.2203 TD
[(tecedent)-292(infection)-287(seems)-286.5(to)-281.3(be)-286(upper)-287.1(respiratory)-288.4(infection,)-283.6(includ-)]TJ
T*
[(ing)-192.2(rhinosinusitis,)-193.1(pharyngitis,)-186.5(or)-191.3(bronchitis.)-187(It)-189(is)-193.9(not)-185.9(yet)-188.3(clear)-194.8(if)-189(any)]TJ
T*
[(one)-234.9(of)-235.6(those)-239.1(three)-236.6(presentations)-239.3(is)-231.9(more)-240.5(likely)-232.9(than)-238.4(the)-232.6(others)-234.9(to)-237(be)]TJ
0 -1.2266 TD
[(associated)-287.1(with)-281.3(the)-283.2(initiation)-280.9(of)-279.8(PANS.)]TJ
/F8 1 Tf
1.1128 -1.2203 TD
[(My)15.4(co)23.9(pl)15.9(a)13.1(s)0(m)15.5(a)-309.3(p)13.1(n)0(e)17.5(u)13.1(mo)16.6(n)13.1(i)0(a)15.9(e)]TJ
/F5 1 Tf
10.4518 0 TD
[(h)13.1(a)0(s)-299.8(b)0(e)17.5(e)0(n)-298.6(a)0(s)16.3(s)0(o)18.8(c)0(i)19.8(a)0(t)19.8(e)0(d)-298.6(w)0(i)18.9(t)0(h)-300.2(a)-311.8(nu)19.9(mb)16.4(er)-301.2(o)13.1(f)]TJ
-11.5646 -1.2203 TD
[(po)19.9(st)14.7(in)22.3(fe)21.2(ct)13.5(i)15.4(o)0(u)19.9(s)-228.3(n)13.1(e)0(u)17.5(r)0(o)17.3(l)15.4(og)19.9(ic)-220.4(d)13.1(i)0(s)21.1(o)0(r)17.3(d)13.1(er)14.9(s)-222(\()-71.7(Mu)19.2(ll)18.2(er)-212.7(et)-220.4(al)19.8(.)-224.2(2)13.1(00)19.9(4;)-211.7(Wa)15.6(lt)18.2(er)-212.7(et)-214.1(al)19.8(.)]TJ
0 -1.2266 TD
[(20)19.9(08)19.9(\),)-289.6(in)22.2(cl)19.8(ud)19.9(in)15.9(g)-296.7(a)-292.8(se)16.3(ro)17.3(lo)22.2(gi)22.2(ca)15.1(ll)18.2(y)-296.7(d)13.1(ia)19.8(gn)19.9(os)18.8(ed)-286(ca)15.1(se)-287.2(cl)19.8(os)18.8(el)19.8(y)-296.7(r)0(e)21.2(s)0(e)16.3(m)0(b)16.4(l)15.4(in)15.9(g)]TJ
0 -1.2203 TD
[(PA)18.1(NS)-253.8(\(E)23.9(rc)14.9(an)-248(et)-252.1(al)19.8(.)-262.2(2)13.1(00)19.9(8\))17.3(.)-262.2(I)0(t)-245.9(h)0(a)17.5(s)-259.9(al)19.8(so)-253.1(b)13.1(e)0(e)15.1(n)-258.7(d)13.1(o)0(c)17.5(u)0(m)16.4(e)0(n)23.9(t)0(e)13.5(d)-258.8(an)23.8(ec)15.1(d)13.1(o)0(t)15.9(a)0(l)19.8(l)0(y)]TJ
T*
[(in)-293.9(a)-299.1(f)0(e)21.2(w)-300(ca)21.4(se)16.3(s)-297.9(b)13.1(y)-303(o)13.1(ur)-292.5(g)13.1(r)0(o)17.3(u)13.1(p,)-287(an)17.5(d)-296.7(i)0(s)-288.8(t)0(h)15.9(e)0(r)21.2(e)0(f)21.2(o)0(r)17.3(e)-299.1(st)21.1(ro)17.3(n)13.1(g)0(l)15.9(y)-296.7(su)18.8(sp)18.8(ec)21.4(te)19.8(d)-303(o)13.1(f)]TJ
0 -1.2266 TD
[(be)17.5(in)22.2(g)-233.5(a)-229.6(st)21.1(im)18.7(u)13.1(l)0(u)15.9(s)-228.3(fo)23.7(r)-229.7(P)0(A)18.1(N)0(S)18.1(.)-230.5(B)14.7(e)0(c)15.1(a)0(u)17.5(s)0(e)-217.6(t)0(h)22.2(i)0(s)-219.2(o)0(r)17.3(g)0(a)17.5(n)13.1(is)14.7(m)-224.3(i)0(s)-219.2(b)0(o)19.9(t)0(h)-218(p)0(e)17.5(r)0(s)16.2(i)15.4(st)14.7(en)23.9(t)]TJ
0 -1.2203 TD
[(an)17.5(d)-195.5(t)0(r)19.6(e)0(a)21.4(t)0(a)19.8(b)0(l)15.9(e)0(,)-181.9(t)0(h)15.9(e)-191.6(di)15.9(ag)23.9(no)19.9(si)14.7(s)-190.4(m)0(a)20.3(y)-195.5(be)-184.8(p)13.1(u)0(r)17.3(s)0(u)18.8(e)0(d)-184.8(w)0(h)23(e)0(n)-184.8(a)-197.9(ch)17.5(il)24.6(d)-195.5(w)0(i)18.9(t)0(h)-186.4(P)14.6(AN)13.3(S)]TJ
T*
[(or)-178.7(a)-191.6(f)0(a)14.9(m)0(i)25(l)0(y)-180.1(m)0(e)20.3(m)0(b)16.4(e)0(r)-181.1(h)13.1(as)-179.7(a)-191.6(h)0(i)22.2(s)0(t)14.7(o)13.1(ry)-178.7(of)-178.7(co)17.5(ug)19.9(h,)-179.5(p)13.1(a)0(r)14.9(t)0(i)18.2(c)0(u)23.9(l)0(a)19.8(r)0(l)19.6(y)-189.2(co)17.5(ug)19.9(h)-189.2(l)0(a)19.8(s)0(t)21.1(i)0(n)15.9(g)]TJ
T*
[(1)-315.7(w)0(e)20.6(e)0(k)-304.9(o)13.1(r)-311.9(m)0(o)16.4(r)0(e)21.2(,)-312.7(wi)18.9(th)-300.2(u)13.1(p)-315.7(to)]TJ
/F9 1 Tf
11.5393 0 TD
()Tj
/F5 1 Tf
.7145 0 TD
.0254 Tc
[(4)-283.9(w)25.4(e)45.9(e)25.4(k)42.9(s)-285.1(be)4.5(tw)3.6(ee)4.5(n)-315.5(c)-1.8(a)4.5(s)5.7(es)-316.7(\()4.3(A)-2.7(m)3.4(e)4.5(r)4.3(i)2.9(c)4.5(a)-1.8(n)]TJ
-12.2538 -1.2266 TD
.0224 Tc
[(A)-5.7(cademy)-198.4(o)-2.4(f)-201(P)5.3(ediatrics)-199.6(2)-2.4(012\).)]TJ
/F8 1 Tf
12.5699 0 TD
0 Tc
[(M)-20.6(.)-224.2(pneumoniae)]TJ
/F5 1 Tf
6.4241 0 TD
.0226 Tc
[(causes)-199.4(p)4.1(haryngitis)]TJ
-18.994 -1.2203 TD
.0224 Tc
[(and)-223.7(t)-.1(racheobronchitis)]TJ
9.301 0 TD
[(more)-219.9(often)-217.5(t)-.2(han)-217.5(p)-2.5(neumonia,)-214.6(a)-4.9(lthough)-217.5(i)-.2(t)-221.5(i)-.2(s)]TJ
-9.301 -1.2203 TD
.0226 Tc
[(unusual)-214.9(in)-210.9(rhinosinusitis.)-214.3(B)-.6(oth)-217.2(s)-3.4(er)]TJ
14.2076 0 TD
.0222 Tc
[(ologic)-213.7(testing)-211.3(a)-5(nd)-217.6(polymerase)]TJ
-14.2076 -1.2267 TD
.022 Tc
[(c)-5.2(h)3.5(a)-5.2(i)-.5(n)-394.8(r).9(ea)-5.2(ction)-394.8(\().9(PCR\))-397.4(are)-397.2(c)-5.2(omm)-6.3(e)]TJ
14.3214 0 TD
.0229 Tc
[(rcially)-393.9(available.)-391(Like)-396.3(strep-)]TJ
-14.3214 -1.2203 TD
.0234 Tc
[(tococcal)-188.8(serolo)4.9(gy,)-188.2(s)3.7(e)-3.8(rol)7.2(ogic)-187.2(d)-1.4(iagn)4.9(os)3.7(is)-192.3(of)]TJ
/F8 1 Tf
17.1224 0 TD
.0245 Tc
[(M.)-187.1(pn)6(eumon)6(i)2(ae)]TJ
/F5 1 Tf
6.6327 0 TD
.0219 Tc
[(is)-187.5(most)]TJ
-23.7552 -1.2203 TD
.023 Tc
[(accurate)-288.7(w)-5.1(h)4.5(en)-299(rising)-292.7(titers)-293.8(are)-295.1(d)4.5(em)]TJ
14.9094 0 TD
[(onst)6.9(rated)-298.9(i)6.9(n)-298.9(s)3.4(erial)-290.3(s)-2.9(era.)-289.6(A)-5(n)4.6(-)]TJ
-14.9094 -1.2266 TD
.0228 Tc
[(tibodies)-268.8(p)-2(eak)-267.6(i).3(n)-267.6(3)4.3(6)-267.6(weeks.)-271(S)5.7(i)]TJ
12.8355 0 TD
.0226 Tc
[(ngle)-263.9(titer)-264(i).1(mm)-5.7(unoglobulin)-267.8(\(Ig\)M)]TJ
-12.8355 -1.2203 TD
.0232 Tc
[(serolog)4.7(y)-1.6(,)-574.1(u)-1.6(s)3.5(u)-1.6(ally)-577(available)-579.4(a)2.3(s)-578.2(a)2.3(n)-577(e)2.3(nzyme)-579.4(i).7(mmu)4.7(no)4.7(as)3.5(say,)-574.1(is)]TJ
T*
.0223 Tc
[(convenient,)-347.3(b)-2.5(ut)-348(subject)-348(to)-343.9(both)-343.9(f)]TJ
14.0305 0 TD
.0228 Tc
[(alse)-345.9(positives)-344.6(and)-343.4(f)1.7(alse)-345.9(nega-)]TJ
-14.0305 -1.2266 TD
.0225 Tc
[(tives.)-258.6(P)-.9(CR)-259.9(is)-256.4(highly)-261.5(sensitive,)]TJ
12.924 0 TD
.0212 Tc
[(and)-256.5(c)-6(an)-262.8(be)-265.3(performed)-262.8(on)-262.8(sputum)]TJ
-12.924 -1.2203 TD
.0231 Tc
[(or)-276.2(a)-282.3(t).6(hroat)-277.6(s)-2.9(wab.)-277(It)-283.9(is)-274.8(mos)3.4(t)-283.9(s)3.4(e)2.2(nsi)6.9(tive)-282.3(d)4.6(uring)-279.9(t).6(h)4.6(e)-282.3(rs)3.4(t)-283.9(3)-273.6(w)-5(eeks)-281.1(o)4.6(f)]TJ
T*
.0226 Tc
[(illness,)-226.9(but)-221.2(m).6(ay)-223.5(also)-223.5(detect)-221.2(a)-225.9(c)1.7(arri)]TJ
14.1444 0 TD
.0233 Tc
[(er)-219.1(state)-225.2(f)2.2(or)-219.1(prolonged)-222.8(p)4.8(eriods.)]TJ
-14.1444 -1.2203 TD
.0207 Tc
[(A)-203.4(c)-6.5(omb)-4.1(i)-1.8(na)-6.5(tion)-206.4(o)2.2(f)-202.7(b)-4.1(oth)-206.4(P)3.6(CR)-204.8(fo)-4.1(r)-202.7(ear)-6.7(ly)-200.1(dia)-6.5(g)2.2(n)-4.1(o)2.2(s)-5.3(i)-1.8(s,)-203.5(an)-4.1(d)-200.1(s)-5.3(ero)-4.1(l)-1.8(o)-4.1(g)2.2(y)-200.1(f)-6.7(or)]TJ
0 -1.2266 TD
.0234 Tc
[(later)-193.7(d)-1.4(iagn)4.9(os)3.7(is,)-194.5(m)1.4(ay,)-194.5(t).9(herefo)4.9(re,)-194.5(h)-1.4(ave)-193.5(t).9(h)4.9(e)-199.8(h)4.9(i).9(ghes)3.7(t)-195.1(diagno)4.9(stic)-193.5(yield)]TJ
0 -1.2203 TD
.0226 Tc
[(\(Waites)-446(e)-4.6(t)-448.8(a)1.7(l.)-454.5(2008\).)-454.5(Both)-451.1(test)]TJ
13.5943 0 TD
.0218 Tc
[(s)-453.1(m)-.2(ay)-451.9(be)-454.3(positive)-454.3(i)-.7(n)-451.9(c).9(hildren)]TJ
-13.5943 -1.2203 TD
.0245 Tc
[(with)6(ou)6(t)-409(a)3.6(pp)6(arent)-402.7(s)-1.5(y)6(m)2.5(pto)6(m)2.5(s.)-402.1(It)-402.7(is)-406.2(no)6(t)-409(k)6(no)6(wn)-405(wh)6(eth)6(e)3.6(r)-407.6(a)3.6(symp)6(-)]TJ
0 -1.2267 TD
.0226 Tc
[(tomatic)-282.8(colonization)-280.4(a)1.7(lone)-276.5(is)-281.6(sufcient)-284.4(t).1(o)-274.1(i).1(nitiate)-282.8(PANS.)]TJ
/F8 1 Tf
29.117 74.5598 TD
0 Tc
(Inuenza)Tj
/F5 1 Tf
3.9076 0 TD
[(is)-244.5(associated)-249.1(with)-243.3(a)-242.2(number)-245.9(of)-248.2(PANS)-242.1(cases)-247.5(associated)]TJ
-5.0204 -1.2203 TD
[(with)-287.6(well-documented)-289.4(acute)-287(inuenza,)-287.1(including)-288.3(inuenza)-284.2(H1N1.)]TJ
0 -1.2266 TD
[(A)-205.1(characteristic)-213.5(syndrome)-214.5(in)-205.4(the)-207.3(patient)-209.5(or)-210.3(family)-209.7(member)-207.6(during)-206(a)]TJ
0 -1.2203 TD
[(recognized)-352.9(epidemic)-356.4(period)-353.9(may)-358.6(be)-355.5(considered)-351.6(presumptive)-356.3(evi-)]TJ
T*
[(dence)-289.3(of)-286.2(this)-285.5(disease;)-292(rapid)-284.8(testing)-290.5(during)-281.9(the)-289.5(acute)-287(illness)-291.6(is)-288.8(only)]TJ
/F14 1 Tf
-.1707 -1.2266 TD
(*)Tj
/F5 1 Tf
1.3088 0 TD
[(75%)-304.1(sensitive,)-308.6(whereas)-308.1(PCR)-310.1(testing)-303.1(is)]TJ
/F9 1 Tf
16.1045 0 TD
(>)Tj
/F5 1 Tf
.7145 0 TD
[(90%)-304.1(sensitive)-312.1(for)-307.2(de-)]TJ
-17.9571 -1.2203 TD
[(tection)-279(of)-279.8(this)-285.5(disease.)]TJ
/F8 1 Tf
1.1128 -1.2203 TD
[(Epstein)-298.9(Barr)-303.7(virus)]TJ
/F5 1 Tf
7.7962 0 TD
[(infection)-306(has)-299.3(been)-306.4(reported)-301(to)-306.5(precede)-299.7(vari-)]TJ
-8.909 -1.2266 TD
[(ous)-372.8(neuropsychological)-383.5(disorders)-376.4(\(Caruso)-383.2(et)-378.5(al.)-375.1(2000\).)-376.1(We)-376.4(have)]TJ
0 -1.2203 TD
[(observed)-301.9(several)-302.5(children)-302.4(with)-300.2(an)-298.6(acute)-306(neuropsychiatric)-298.5(disorder)]TJ
T*
[(associated)-344(with)-338.2(serologically)-343.3(diagnosed)-340.8(Epstein)-343.2(Barr)-345.5(virus)-340.5(infec-)]TJ
T*
[(tion.)-394.7(These)-401.7(examples)-397.8(seem)-399.6(to)-395.1(be)-393.5(somewhat)-398.7(more)-398.6(complex)-401(than)]TJ
0 -1.2266 TD
[(typical)-279(cases)-285.4(of)-279.8(PANS.)]TJ
/F8 1 Tf
1.1128 -1.2203 TD
[(B)13.3(o)0(r)18.8(r)0(e)16.3(l)15.4(ia)-192.7(bu)19.9(rg)18.8(d)13.1(o)0(r)18.8(f)0(e)19.8(r)0(i)]TJ
/F5 1 Tf
8.2893 0 TD
[(\(L)17.5(y)13.1(m)0(e)-194.7(d)13.1(is)21.1(ea)15.1(se)22.7(\))-204.4(i)0(s)-187.6(u)0(n)19.9(d)0(e)17.5(r)-198.1(su)18.8(sp)18.8(ic)19.8(io)15.9(n)-195.5(b)0(e)17.5(c)0(a)15.1(u)13.1(se)-192.3(it)]TJ
-9.4022 -1.2203 TD
[(h)13.1(a)0(s)-318.8(b)13.1(ee)15.1(n)-322(a)0(s)22.7(s)0(o)18.8(c)0(i)19.8(a)0(t)13.5(e)0(d)-311.3(w)0(i)18.9(t)0(h)-312.9(a)-324.4(wi)18.9(de)-317.6(ra)21.2(n)13.1(g)0(e)-317.6(o)13.1(f)-324.6(p)0(o)19.9(s)0(t)14.7(i)15.4(nf)17.3(ec)15.1(t)15.4(i)0(o)15.9(u)13.1(s)-323.2(n)0(e)17.5(u)0(r)17.3(o)13.1(ps)18.8(y-)]TJ
0 -1.2266 TD
[(ch)17.5(i)15.4(a)0(t)13.5(r)0(i)19.6(c)-204.3(di)22.2(so)18.8(rd)17.3(er)21.2(s,)-199.6(in)22.3(cl)19.8(ud)19.9(in)15.9(g)-201.8(a)-210.6(sm)21.5(al)19.8(l)-205.9(n)0(u)19.9(m)0(b)16.4(e)0(r)-200.1(o)13.1(f)-204.4(c)0(a)15.1(s)0(e)22.7(s)-209.4(wi)18.9(th)-199.1(o)13.1(b)0(s)18.8(e)0(s)16.3(s)0(i)21.1(v)13.1(e-)]TJ
0 -1.2203 TD
[(co)17.5(m)15.9(p)0(u)19.9(l)0(s)14.7(i)0(v)22.2(e)-172.6(d)13.1(i)0(s)14.7(o)13.1(rd)17.3(er)-162.1(\(F)25.1(al)13.5(l)15.4(o)0(n)-163.4(e)0(t)-163.5(a)0(l)19.8(.)-167.3(19)19.9(98)19.9(\).)-163.1(Ho)23(we)14.2(v)13.1(e)0(r)-162.1(n)0(o)-163.4(k)13.1(no)19.9(wn)-160.4(ca)15.1(se)22.7(s)-171.4(o)0(f)]TJ
T*
[(p)13.1(o)0(s)18.8(t)0(-)19.6(L)0(y)20.1(m)0(e)-352.7(d)13.1(is)14.7(ea)21.4(se)-350.4(PA)18.1(NS)-348.7(ha)17.5(ve)-349.2(be)17.5(en)-349.2(no)19.9(te)13.5(d)13.1(.)-363.3(Di)18.9(ag)23.9(no)20(st)21.1(ic)-353.2(te)19.8(st)14.7(i)15.4(n)0(g)-353.1(f)0(o)17.3(r)]TJ
0 -1.2266 TD
[(L)13.3(y)0(m)16.4(e)-375(d)13.1(i)0(s)21.1(e)0(a)15.1(s)0(e)16.3(,)-369.6(ac)15.1(co)23.9(rd)17.3(in)22.2(g)-372.6(t)0(o)-363.4(g)0(u)19.9(i)0(d)15.9(e)0(l)19.8(i)0(n)22.2(e)0(s)-369.4(o)13.1(f)-375.2(t)0(h)22.2(e)-375(Ce)19.1(nt)15.9(er)21.2(s)-373.8(f)0(o)17.3(r)-368.9(Di)18.9(se)16.3(as)22.7(e)]TJ
0 -1.2203 TD
[(Co)21.5(nt)22.2(ro)17.3(l)-281.7(\()0(C)18.9(e)0(n)23.9(t)0(e)13.5(r)0(s)-268.4(f)0(o)17.3(r)-274(Di)18.9(se)16.3(as)16.3(e)-280.1(C)0(o)21.6(n)13.1(tr)13.3(o)13.1(l)-281.7(an)23.8(d)-284(P)14.6(re)14.9(v)13.1(e)0(n)17.5(t)0(i)18.2(o)13.1(n)-284.1(2)13.1(01)20(1\))-267.2(ma)14(y)-277.7(b)13.1(e)]TJ
T*
[(co)17.5(n)13.1(s)0(i)21.1(d)0(e)17.5(r)0(e)21.2(d)-366.2(fo)23.7(r)-362.5(c)0(h)17.5(i)0(l)18.2(d)13.1(re)21.2(n)-366.2(w)0(i)18.9(t)0(h)-350.8(P)0(A)18.1(N)0(S)-348.7(w)0(h)16.6(o)13.1(:)-363.9(1)13.1(\))-362.5(H)0(a)14.2(v)13.1(e)-362.3(a)-362.3(h)0(i)22.2(s)0(t)14.7(o)13.1(ry)-355.7(o)13.1(f)-362.5(an)]TJ
T*
[(il)18.2(l)15.4(n)0(e)17.5(s)0(s)-323.9(c)0(o)17.5(m)0(p)22.7(a)0(t)13.5(i)0(b)22.3(l)0(e)-327.9(w)0(i)25.3(t)0(h)-325.5(p)0(r)17.3(i)0(o)22.3(r)-337.2(cl)19.8(in)22.2(ic)19.8(al)-327.9(Ly)20.1(me)-327.4(d)13.1(i)0(s)21.1(e)0(a)15.1(s)0(e)22.7(,)-338(an)17.5(d)-328.3(2)0(\))-324.1(l)0(i)18.2(v)0(e)-323.9(i)0(n)]TJ
0 -1.2266 TD
[(re)21.3(gi)15.9(o)13.1(n)13.1(s)-247.3(in)-237(wh)23(ic)13.5(h)-239.8(t)0(h)15.9(e)-242.2(pr)17.3(es)16.3(en)23.9(ce)-237.8(of)-235.6(Ly)20.1(me)-238.9(d)13.1(i)0(s)21.1(e)0(a)15.1(s)0(e)-236.6(i)0(s)-231.9(e)0(s)16.3(t)0(a)19.8(b)0(l)22.2(i)0(s)14.7(h)13.1(ed)17.5(.)-243.2(I)0(n)-235.6(t)0(h)15.9(e)]TJ
0 -1.2203 TD
[(Un)23(it)18.2(ed)-437.7(S)14.5(t)0(a)13.5(t)15.4(es)16.3(,)-445.5(t)0(h)22.3(i)0(s)-434.2(i)0(s)-440.5(a)0(l)19.8(m)0(o)22.7(s)0(t)-434.2(e)0(x)17.5(c)0(l)19.8(u)0(s)18.8(i)0(v)22.3(e)0(l)19.8(y)-448.4(li)18.2(mi)25(te)13.5(d)-442.1(t)0(o)-433(t)0(h)15.9(e)-444.5(si)21.1(x)-442.1(N)0(e)14.2(w)]TJ
T*
-.0179 Tc
[(En)-17.9(gl)-17.9(an)-17.9(d)-402.6(s)-17.9(ta)-17.9(te)-17.9(s,)-412.8(N)-17.9(e)2.6(w)-412.7(Y)-17.9(o)5.1(r)-17.9(k,)-406.5(N)-17.9(e)-3.7(w)-406.4(J)-17.9(er)-17.9(se)-17.9(y,)-412.8(Pe)-17.9(nn)-17.9(sy)-17.9(lv)-17.9(an)-17.9(ia)-17.9(,)-395.8(M)-17.9(ar)-17.9(yl)-17.9(and)-17.9(,)]TJ
0 -1.2266 TD
0 Tc
[(Vi)18.9(rg)23.7(in)15.9(ia)19.8(,)-224.2(M)12.4(in)15.9(n)13.1(e)0(s)16.3(o)13.1(ta)19.8(,)-224.2(a)0(n)17.5(d)-227.1(Wi)20.3(sc)22.7(on)19.9(si)14.7(n)13.1(.)-224.2(Fo)21.4(ca)15.1(l)-224.8(r)0(e)21.2(g)13.1(io)15.9(n)13.1(s)-228.3(ar)21.2(e)-223.2(a)0(l)19.8(s)0(o)-215.2(f)0(o)17.3(u)13.1(nd)-214(in)]TJ
0 -1.2203 TD
[(No)23(rt)19.6(h)-239.8(D)0(a)14.2(k)13.1(ot)15.9(a,)-226.1(Io)17.3(wa)20.5(,)-243.2(I)0(n)23.7(d)0(i)15.9(a)0(n)23.9(a)0(,)-232.5(W)0(e)15.6(s)0(t)-231.9(V)0(i)18.9(r)0(g)23.7(i)0(n)15.9(i)15.4(a,)-232.5(Il)19.6(li)18.2(n)13.1(o)0(i)15.9(s)0(,)-231.2(a)0(n)23.8(d)-239.8(Ca)12.8(l)15.4(i)0(f)19.7(o)0(r)17.3(n)0(i)22.3(a)]TJ
T*
[(\(C)19(en)23.9(te)13.5(rs)-255.7(fo)17.3(r)-267.7(D)0(i)18.9(s)0(e)16.3(a)0(s)16.3(e)-267.5(Co)21.5(nt)15.9(ro)23.7(l)-275.4(a)0(n)23.9(d)-271.4(Pr)18.8(ev)17.5(en)23.8(ti)18.2(on)-258.3(20)19.9(13)19.9(\).)]TJ
1.1128 -1.2266 TD
[(As)-420.8(for)-421.1(other)-423.9(infectious)-420.5(disorders,)-423.5(we)-422.1(have)-426.5(anecdotally)-427.4(docu-)]TJ
-1.1128 -1.2203 TD
[(mented)-331.9(a)-330.7(few)-329.3(instances)-335.7(of)-330.4(herpes)-334.5(simplex)-327.9(infection)-337.6(and)-329.7(varicella)]TJ
T*
[(related)-343.3(to)-344.5(PANS)-343.3(onset)-340.3(or)-343.1(ares.)-342.8(We)-344.8(believe)-347(that)-343.6(numerous)-341(other)]TJ
0 -1.2266 TD
[(infectious)-471.1(agents,)-471.6(particularly)-477.9(those)-473.1(with)-471(characteristically)-481.3(pro-)]TJ
0 -1.2203 TD
[(longed)-313.3(colonization,)-311.3(have)-312.7(the)-314.8(potential)-313.7(to)-312.9(activate)-315(PANS)-311.6(as)-312.4(well.)]TJ
T*
[(Appropriate)-294.2(documentation)-294.7(of)-298.8(such)-292.5(infections)-294(is)-295.1(warranted)-299.9(when-)]TJ
T*
[(ever)-277.4(suggested)-285(clinically.)]TJ
/F10 1 Tf
0 -3.0603 TD
[(Evaluation)-333.2(for)-332.5(autoimmune)]TJ
0 -1.2203 TD
[(and)-329.4(autoinammatory)-336.6(diseases)]TJ
/F5 1 Tf
1.1128 -1.8336 TD
[(Neuropsychiatric)-308.2(symptoms)-313.1(can)-313.2(be)-304.9(caused)-315.3(by)-308.8(autoimmune)-312.2(en-)]TJ
-1.1128 -1.2203 TD
[(cephalitis,)-332.4(systemic)-331(autoimmune)-331.2(disease,)-329.3(and)-329.7(other)-329.1(inammatory)]TJ
0 -1.2266 TD
[(diseases.)-424.8(Therefore,)-430.7(it)-424.4(is)-427.9(important)-427.2(to)-426.7(consider)-426.1(these)-424.9(etiologies.)]TJ
0 -1.2203 TD
[(However,)-614.2(workup)-610(for)-610.7(these)-614.6(conditions)-611.5(should)-615.6(be)-608.4(done)-613.8(in)-610(a)]TJ
T*
[(thoughtful)-452.4(manner,)-459.9(and)-456.2(only)-451(pursued)-458(if)-454.6(relevant)-456.6(symptoms)-458.5(are)]TJ
T*
[(present.)-309.3(False)-309.7(positive)-308.9(antibody)-303.7(tests)-313.9(are)-309.5(common,)-306.7(and)-304.5(are)-309.5(mean-)]TJ
0 -1.2266 TD
[(ingless)-312.9(if)-309.1(criteria)-317.8(for)-313.6(a)-311.7(clinical)-316.6(syndrome)-309.3(are)-315.8(not)-312.4(met.)-314.9(The)-310.6(identi-)]TJ
0 -1.2203 TD
[(cation)-583.4(of)-577(antibodies)-582.3(in)-578.4(patients)-583.2(can)-585.1(be)-583.1(very)-578.5(distressing)-584.3(for)]TJ
T*
[(families,)-181.3(because)-184.5(the)-182(concept)-184.9(of)-185(false)-180.9(positivity)-180.8(can)-186.7(be)-178.5(difcult)-182.5(for)-180.8(a)]TJ
0 -1.2267 TD
[(layperson)-394(to)-401.4(understand,)-396.4(especially)-403.7(where)-394(there)-401(is)-396.3(a)-393.9(severely)-403.2(ill)]TJ
0 -1.2203 TD
(child.)Tj
1.1128 -1.2203 TD
[(The)-443.4(diagnostic)-449.5(guidelines)-443.2(and)-449.9(indications)-446.7(for)-446.3(workup)-445.6(of)-444.2(au-)]TJ
-1.1128 -1.2266 TD
[(toimmune)-298.1(encephalitis)-299.3(are)-296.8(broad,)-296.4(and)-291.8(not)-299.7(within)-290.6(the)-295.8(scope)-300.8(of)-292.5(this)]TJ
0 -1.2203 TD
[(article)-442.1(to)-445.6(discuss,)-439.5(but)-445.2(these)-443.9(conditions)-440.8(should)-438.6(be)-444(considered)-446.5(in)]TJ
T*
[(cases)-392.9(in)-388.7(which)-393(one)-386.7(of)-393.7(the)-390.7(following)-392.9(symptoms)-388.9(is)-389.9(prominent:)-395.1(1\))]TJ
0 -1.2266 TD
[(Delirium,)-345.4(psychosis,)-343.6(and/or)-341.2(diffuse)-344.5(encephalopathy;)-351.9(2\))-343.1(pervasive)]TJ
0 -1.2203 TD
[(cognitive)-303.4(decline;)-306.3(3\))-305.1(persistent)-307.8(memory)-306.3(impairment;)-309.7(4\))-298.8(pervasive)]TJ
T*
[(behavior)-292.1(deterioration;)-291.3(5\))-286.2(seizures;)-294.1(and)-291.8(6\))-292.5(movement)-290.2(abnormality)]TJ
T*
[(not)-350.3(consistent)-362.2(with)-357.1(tics.)-354(The)-354.9(evaluation)-355.9(for)-357.8(autoimmune)-356.5(enceph-)]TJ
0 -1.2266 TD
[(alitis)-408.8(includes)-402.2(neuroimaging,)-408.1(electroencephalogram)-416.1(\(EEG\),)-407(neu-)]TJ
0 -1.2203 TD
[(ronal)-797(antibody)-803.2(testing)-796.3(\(e.g.,)]TJ
/F8 1 Tf
8.9663 0 0 8.9663 431.6597 79.2 Tm
(N)Tj
/F5 1 Tf
.6639 0 TD
(-Methyl-)Tj
/F7 1 Tf
3.5661 0 TD
(d)Tj
/F5 1 Tf
.5501 0 TD
[(-aspartate)-803.3([NMDA])]TJ
-18.2542 -1.2203 TD
[(receptor)-373(antibodies,)-370.2(voltage)-376.2(gated)-373.1(potassium)-372.4(channel)-368.3(antibodies\))]TJ
0 -1.2267 TD
[(in)-717.5(serum)-721.8(and)-721.8(cerebrospinal)-725.9(uid)-721.5(\(CSF\),)-722.1(thyroid)-721.7(antibodies)]TJ
/F4 1 Tf
-28.0042 77.228 TD
[(PANS)-336.6(CLINICAL)-339.4(EVALUATION)-334.8(CONSENSUS)-341.1(RECOMMENDATIONS)-22096.1(5)]TJ
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