Streptococcal Seroreactivity and Neuropsychiatric Symptom Patterns Relevant to PANS/PANDAS in Young Adults

Abstract

PANDAS and PANS are paediatric neuropsychiatric constructs, with limited evidence for related patterns in adulthood. We examined whether current antistreptolysin O (ASO) titres covaried with PANS/PANDAS-relevant symptoms in 50 psychiatric patients aged 18–34 years selected using a pragmatic history consistent with previous streptococcal exposure. Participants completed an investigator-adapted Romanian PANS 31-item symptom rating scale; routine EEG and clinical covariates were recorded. Continuous ASO was analysed against the total score and ten study-defined domains using Spearman correlations, bootstrap confidence intervals and Benjamini–Hochberg correction; item-level and clinical-context analyses were exploratory. ASO showed a modest association with the total score (rho=0.305, p=0.031), whereas the ≥200-IU/mL contrast was nonsignificant and the association attenuated after adjustment for paediatric psychiatric history. The strongest multiplicity-robust associations involved tics (rho=0.496, q=0.0025) and cognitive/motor symptoms (rho=0.421, q=0.0117); vocal tics were the only item surviving correction across 31 items. Higher ASO was also associated with paediatric psychiatric history and recorded autoimmune pathology, while routine EEG did not independently converge with symptom findings. Total-scale internal consistency was low (alpha=0.535). These cross-sectional findings support a narrow, hypothesis-generating association between streptococcal seroreactivity and selected PANS/PANDAS-relevant symptom dimensions in young adults, but do not establish adult PANDAS, active neuroinflammation, or ASO as a diagnostic biomarker.