Common Triggers of PANS/PANDAS

• PANS and PANDAS are conditions known to be triggered by infections and exposures, primarily bacterial, environmental, fungal, or viral.

 List of Pathogens and Environmental Triggers Associated with PANS and PANDAS:

 Primary Pathogen in PANDAS 

Group A β-hemolytic Streptococcus (GAS)

• Common illnesses: strep throat, scarlet fever, impetigo
• Strongest pathogen for triggering PANDAS specifically.

Infections Associated with PANS 

• Influenza (Flu A/B) – Can provoke a strong immune response, potentially affecting the brain.
• Epstein-Barr Virus (EBV) – Cause of mononucleosis ("mono").
• Herpes Simplex Virus (HSV-1, HSV-2) – Linked to herpes encephalitis.
• Varicella-Zoster Virus (VZV) – Causes chickenpox or shingles.
• Coxsackievirus – Cause of hand, foot, and mouth disease.
• Enteroviruses – Includes echovirus, enterovirus D68, and others.
• Cytomegalovirus (CMV) – Often asymptomatic but may reactivate and affect immunity.
• Human Herpesvirus 6 (HHV-6) – May trigger immune activation and encephalitis.
• COVID-19 (SARS-CoV-2) – Some cases of post-infectious neuropsychiatric symptoms, including PANS-like syndromes.

• Mycoplasma pneumoniae – Atypical pneumonia; known PANS trigger.
• Borrelia burgdorferi – Lyme disease; may mimic or worsen PANS symptoms.
• Babesia – Tick-borne parasite; Lyme coinfection; may contribute to inflammation.
• Bartonella henselae – Cause of cat scratch disease; associated with neuropsychiatric symptoms.
• Chlamydia pneumoniae – Respiratory infection; potential immune trigger.
• Clostridium difficile (C. diff) – GI infection; may impact the gut-brain axis.

• Candida albicans – Yeast overgrowth; some anecdotal reports of symptom flare-ups.
• Toxoplasma gondii – Possible chronic neuroinflammation link (limited evidence).
• Babesia (also listed under bacterial/co-infections) – Tick-borne protozoa affecting red blood cells.

Mold Exposure & Mold Sensitivity

• Chronic exposure to mycotoxins or damp environments may worsen immune dysregulation.
• Mold-related inflammation is being studied as a contributor to neuroimmune and psychiatric symptoms in sensitive individuals.

The common thread among these triggers is the potential for the immune system to mount an abnormal response. In PANS/PANDAS, the immune system's reaction to these infections becomes misdirected, where it produces antibodies that mistakenly attack healthy brain cells, particularly those in the basal ganglia, also known as Basal Ganglia Encephalitis. This autoimmune response within the central nervous system ultimately leads to the neuropsychiatric symptoms characteristic of these disorders.

It's important to note that not all individuals who experience these infections will develop PANS/PANDAS, and there may be additional genetic or environmental factors at play that determine who might become susceptible. Understanding these common triggers is essential for early recognition and intervention, as addressing the underlying infection and immune dysregulation can be key to managing PANS/PANDAS effectively. Additionally, ongoing research is shedding light on other potential triggers and contributing factors, further enhancing our understanding of these complex disorders.