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[(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
/F11 1 Tf
7.9702 0 0 7.9702 322.0724 115.5401 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 330.5196 114.2362 Tm
[(Sydenham)-331.8(chorea)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 322.0724 105.5622 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 330.5196 104.2582 Tm
[(Autoimmune)-332.1(encephalitis)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 322.0724 95.6409 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 330.5196 94.337 Tm
[(Systemic)-334.7(autoimmune)-337.5(disease)]TJ
6.7246 0 0 5.9768 440.3904 98.3055 Tm
(a)Tj
/F11 1 Tf
7.9702 0 0 7.9702 322.0724 85.663 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 330.5196 84.359 Tm
[(Wilsons)-333.5(disease)]TJ
6.7246 0 0 5.9768 391.8613 88.3275 Tm
(a)Tj
5.9774 0 0 5.3127 321.0519 69.789 Tm
(a)Tj
7.9702 0 0 7.9702 323.7164 66.2173 Tm
[(Relatively)-329(rare)-332.1(condition)12.9(s.)]TJ
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[(PANS,)-325.6(pediatric)-331.2(acute-on)12.2(set)-338.1(neurop)13(sychiatric)-330.3(syndrom)13.5(e.)]TJ
/F4 1 Tf
8.9663 0 0 8.9663 62.022 749.6502 Tm
(4)Tj
47.4471 0 TD
[(CHANG)-336.8(ET)-338.7(AL.)]TJ
ET
endstream
endobj
71 0 obj
<>stream
/GS1 gs
BT
/F5 1 Tf
8.9663 0 0 8.9663 59.7543 134.0787 Tm
0 0 0 rg
0 Tc
0 Tw
[(sensory)-377(abnormalities)-384.7(or)-374.7(choreiform)-375.7(movements\),)-378.2(but)-375.6(also)-378.7(clini-)]TJ
0 -1.2266 TD
[(cal)-418.4(features)-412.1(of)-412.6(disorders)-414.3(that)-413.2(must)-411.5(be)-412.4(excluded)-418.4(\(SC,)-412(lupus,)-410.4(and)]TJ
0 -1.2203 TD
[(Wilsons)-447.3(disease,)-443.1(among)-439.8(others\).)-442.3(Therefore,)-443.4(the)-441.3(comprehensive)]TJ
T*
[(evaluation)-355.9(must)-348.2(be)-349.2(individualized)-355.6(according)-350.9(to)-350.8(the)-346.4(patients)-357.7(pre-)]TJ
0 -1.2266 TD
[(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
0 -1.2203 TD
[(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
0 -1.2266 TD
[(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(\(especially)]TJ
0 -1.2203 TD
[(GAS)-281.9(infections\).)]TJ
1.1128 -1.2266 TD
-.0193 Tc
[(PANS-related)-284.4(ab)6.5(normalities)-279.2(t)2.5(hat)-282.1(m)3(ig)6.5(ht)-282.1(be)-280.5(present)-282.1(o).2(n)-278.1(physical)-282.1(ex-)]TJ
-1.1128 -1.2203 TD
-.0195 Tc
[(amination)-253(i)2.3(nclude:)-250.7(D)3(ehydration)-246.6(o)0(r)-255.6(e)]TJ
13.9357 0 TD
-.019 Tc
[(maciation)-246.1(s)-.7(eco)6.8(ndary)-252.5(to)-246.1(res)5.6(t)-3.6(ricted)]TJ
-13.9357 -1.2203 TD
-.0196 Tc
[(intake)-325(o)6.2(f)-325.2(uids)-323.8(o)-.1(r)-325.2(f)3.6(ood;)-320.3(sequ)6.2(elae)-325(of)-318.9(compulsive)-325(behaviors)-323.8(\()3.6(e.g.,)-319.7(r)-2.7(ed)]TJ
0 -1.2266 TD
-.0199 Tc
[(ring)-196.5(around)-196.4(the)-198.9(m)-4(outh)-196.5(f)-3(rom)-200(e)-2.9(xcessive)]TJ
14.549 0 TD
-.0191 Tc
[(lip)6.7(-)-2.2(lickin)6.7(g,)-199.1(chapped)-195.6(h).4(ands)-196.8(from)]TJ
-14.549 -1.2203 TD
-.0205 Tc
[(excessi)-5.1(ve)-205.8(w)-4.3(a)2.9(shing)-203.4(o)-1(r)-199.7(i)-5.1(rritati)-5.1(on)-197(of)-206(the)-205.8(e)2.9(xternal)-207.4(g)5.3(enit)-5.1(al)-5.1(ia)-199.5(from)-206.9(e)2.9(xcessi)-5.1(ve)]TJ
T*
-.0196 Tc
[(wip)6.2(i)-4.2(ng\);)-219.1(m)2.7(oto)6.2(r)-217.7(and/or)-217.7(phonic)-217.5(t)-4.2(ics)5(;)-219.1(evid)]TJ
14.8968 0 TD
-.0187 Tc
[(en)7.1(ce)-216.6(of)-216.8(sinusitis,)-211.3(c)-1.7(hro)7.1(n).8(ic)-216.6(otitis,)]TJ
-14.8968 -1.2266 TD
-.0192 Tc
[(tonsillitis)5.4(,)-369.9(or)-369.1(phary)6.6(ngitis;)-370.5(a)-2.2(n)6.6(d).3(/or)-369.1(s)-.9(i)]TJ
13.6448 0 TD
-.0194 Tc
[(gns)-367.9(of)-369.3(GAS)-371.6(i)2.4(nfection)-366.7(\(i.e.,)-376.4(p)6.4(h).1(ar-)]TJ
-13.6448 -1.2203 TD
-.0197 Tc
[(yng)6.1(itis,)-281.9(a)-2.7(n)6.1(a)-2.7(l)-282.5(o)-.2(r)-274.7(vulv)6.1(a)-2.7(r)-281.1(r)-2.8(ednes)4.9(s)-1.4(,)-281.9(s)-1.4(kin)-278.5(l)2.1(esions\).)]TJ
1.1128 -1.2203 TD
.0153 Tc
[(Most)-405.5(youth)-401.5(with)-407.8(PANDAS)-406.4(have)-410.3(fairly)-401.5(normal)-405.5(neurologi)5.4(c)-5.6(al)]TJ
-1.1128 -1.2203 TD
.0172 Tc
[()6.5(n)-1.3(d)5(i)1(ng)5(s)3.9(,)-472.6(bu)5(t)-473.2(t)1(h)5(e)-477.9(freq)5(u)-1.3(en)5(cy)-469.2(of)-471.8(n)5(e)2.6(uro)5(l)1(og)5(ical)-473.2(n)5(di)7.3(ng)5(s)-476.7(i)1(n)-469.2(y)5(ou)5(th)]TJ
0 -1.2266 TD
.0145 Tc
[(with)-528.8(PANS)-527.4(is)-530(no)-4(t)-526.5(w)-1(ell)-526.5(e)-.1(s)-5.2(t)4.6(a)-6.4(b)2.3(lishe)-6.4(d.)-525.9(Ch)-4(oreifo)-4(rm)-526(mov)-4(e)-.1(men)-4(t)4.6(s)-5.2(,)]TJ
0 -1.2203 TD
[(den)-4.1(ed)-250.7(as)-251.9(ne)-253.1(p)-4.1(iano)-4.1(-play)-4.1(i)-1.8(ng)-250.7(mo)-4.1(vemen)-4.1(t)-1.8(s)-251.9(o)2.2(f)-253.3(t)-1.8(he)-253.1(ng)-4.1(e)-.2(rs)-251.9(wh)-4.1(en)-250.7(the)]TJ
T*
.0169 Tc
[(ch)4.7(ild)-494.8(h)4.7(a)2.3(s)-496(a)2.3(rms)-489.6(a)2.3(nd)-488.4(han)4.7(d)-1.6(s)-489.6(e)2.3(xt)7(en)4.7(d)4.7(e)-4(d)-488.4(a)2.3(nd)-488.4(eyes)-489.6(cl)7(os)3.6(ed)-494.8(\(Swed)4.7(o)]TJ
0 -1.2266 TD
.0143 Tc
[(et)-330.7(al.)-330.1(199)-4.2(8,)-330.1(T)-4(ouwe)-6.6(n)-326.7(19)-4.2(79)-4.2(\))-329.2(can)-326.6(b)-4.2(e)-329.1(see)-6.6(n)-326.6(in)-326.6(ch)-4.2(ild)-4.2(r)-.5(en)-326.6(with)-326.6(PANS,)]TJ
0 -1.2203 TD
.0138 Tc
[(bu)-4.7(t)-482.9(i)-2.4(f)-487.8(f)-1(u)-4.7(l)-2.4(l)-482.9(c)-7.1(ho)-4.7(rea)-487.6(i)-2.4(s)-486.4(n)-4.7(oted,)-488.6(w)-1.7(o)-4.7(r)-1(ku)-4.7(p)-485.2(f)-1(o)-4.7(r)-487.8(SC,)-488.6(a)-.8(n)-4.7(t)4(ip)-4.7(ho)-4.7(sph)-4.7(o)1.6(lipid)]TJ
T*
.0136 Tc
[(sy)-4.9(ndro)-4.9(m)-2.1(e)-317.1(\()-1.2(APL)-4.7(S)2.9(\),)-318.1(lu)-4.9(pus)-6.1(,)-318.1(a)-1(nd)-321(b)-4.9(a)-1(sal)-318.7(g)-4.9(ang)-4.9(l)-2.6(ia)-323.4(enc)-7.3(e)-1(ph)-4.9(alitis)-322.2(sh)-4.9(ould)]TJ
0 -1.2266 TD
.0126 Tc
[(be)-356.1(pu)-5.9(rsue)-8.3(d.)]TJ
1.1128 -1.2203 TD
0 Tc
[(In)-324.1(addition)-326.7(to)-331.8(documenting)-327.2(physical)-332.6(evidence)-332.3(of)-324.1(PANS)-330.6(symp-)]TJ
-1.1128 -1.2203 TD
[(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*
[(can)-199.4(help)-194.2(to)-199.1(exclude)-197.5(other)-196.3(medical)-198.8(conditions.)-197.1(The)-196.8(following)-203.3(is)-193.9(a)-197.9(list)]TJ
0 -1.2266 TD
[(of)-311.5(the)-314.8(most)-316.6(pertinent)-318.6(PANS)-311.6(ndings,)-313.1(signs)-320.1(of)-311.5(relevant)-317.5(rheumato-)]TJ
0 -1.2203 TD
[(genic)-423.7(strep)-418.8(infection)-426.1(\(known)-420.3(to)-420.4(trigger)-423.2(PANDAS)-418.4(and)-424.6(SC\),)-418.4(and)]TJ
T*
[(ndings)-278.6(that)-280.4(are)-284.2(suggestive)-282.3(of)-279.8(other)-278.5(related)-286.4(conditions.)]TJ
2.3901 -2.447 TD
[(I.)-498.2(Constitu)11.2(tional)-416.2(symptoms)-414.2(\(fevers,)-411.7(hair)-418.1(loss,)-418.4(weight)-415.5(loss,)]TJ
1.0812 -1.2203 TD
[(night)-486.1(sweats\))-487.9(that)-482.7(may)-491.3(indicate)-483.3(systemic)-489.1(autoimm)11.2(une/)]TJ
0 -1.2266 TD
[(inammat)10.7(ory)-405.8(disease,)-398.8(immunodecie)10.2(ncy,)-402.2(chronic)-406.4(infec-)]TJ
0 -1.2203 TD
[(tion,)-243(or)-248.2(thyroid)-241.2(disorder)]TJ
-1.4163 -1.2203 TD
.0203 Tc
[(I)20.3(I)20.3(.)-480(Skin:)-678.8(S)3.2(carlatiniform)-671.9(rash)-674.7(\(scarlet)-678.8(f)-.8(ever\))5.5(,)-678.1(erythem)4.6(a)]TJ
1.4163 -1.2266 TD
[(mar)5.5(g)-4.5(inatum)-893.2(\(acute)-892.1(rheumatic)-892.1(f)-.8(ever\),)-893.1(malar)-892.3(r)-.8(ash)]TJ
0 -1.2203 TD
[(\(lupus\),)-754(petechiae)-753(\()-.8(A)4.8(P)-3.1(LS\))5.5(,)-754(chr)5.5(o)-4.5(nic)-759.3(u)1.8(rticarial)-754.6(r)-.8(ash)]TJ
T*
.0211 Tc
[(\(vasculit)4.9(is,)-449.7(o)2.6(ther\),)-449.7(l)4.9(i)-1.4(vido)-446.3(reticul)4.9(aris)-447.5(\(pol)4.9(yarteri)4.9(tis)-447.5(no-)]TJ
T*
.0202 Tc
[(dosa)-746.8(a)-.7(nd)-738.1(other)-740.7(r)-.9(heu)-4.6(m)4.5(atologic)-740.5(d)1.7(isorders\),)-741.5(perianal)]TJ
0 -1.2266 TD
.0204 Tc
[(redness)-334.4(\(perianal)-330.9(s).7(trep\).)]TJ
-1.7262 -1.2203 TD
0 Tc
[(III.)-496.1(Eyes:)-390.7(Dilated)-383.5(pupils)-385.7(or)-381(slow)-385.9(pupillary)-385.7(response)-385.3(to)-388.7(light)]TJ
1.7451 -1.2203 TD
[(examination)-592.9(\(PANS)-585.6(and)-589(other)-588.3(neurological)-591.4(diseases\),)]TJ
0 -1.2266 TD
[(dark)-502.6(discoloration)-505.2(under)-502.1(eyes)-503.6(\(allergies)-507.7(or)-501.1(chronic)-501.2(si-)]TJ
0 -1.2203 TD
[(nusitis\),)-332.2(sc)16.3(l)15.4(e)0(r)21.2(a)0(l)-309(i)0(n)22.3(j)0(e)19.8(c)0(t)19.8(i)0(o)22.3(n)-315.7(\(u)17.3(v)13.1(e)0(i)19.8(t)0(i)24.5(s)0(,)-313.4(e)0(p)23.9(i)0(s)21.1(c)0(l)19.8(e)0(r)21.3(i)15.4(ti)18.2(s,)-307.1(o)13.1(r)-318.3(sc)16.3(l)15.4(e)0(r)21.2(i)0(t)18.2(i)0(s)21.1(\))0(,)]TJ
T*
[(or)-311.5(Ka)20.5(ys)18.8(er)21.3()13.1(F)0(l)23.7(e)0(i)19.8(s)0(h)18.8(e)0(r)-307.5(r)0(i)19.6(n)13.1(gs)-316.4(\(W)21.7(i)15.4(l)0(s)21.1(o)0(n)19.9()0(s)-312.6(d)13.1(is)21.1(ea)21.4(se)22.7(\))]TJ
-1.8273 -1.2266 TD
[(IV.)-501(Ear,)-252.9(n)25.8(o)19.5(s)24.6(e)23.4(,)-224.2(a)17(n)25.8(d)-227.1(t)21.8(h)25.8(r)16.9(o)25.8(a)23.4(t)21.8(:)-224.8(R)21.1(e)17(c)23.4(u)25.8(r)16.9(r)23.2(e)23.4(n)19.5(t)21.8(,)-224.2(r)23.2(e)23.4(c)23.4(e)17(n)25.8(t)21.8(,)-224.2(o)19.5(r)-223.4(c)23.4(u)19.5(r)23.2(r)23.2(e)17(n)25.8(t)-224.8(t)21.8(o)19.5(n)25.8(s)18.3(i)21.8(l)]TJ
23.3505 0 TD
-.0211 Tc
(litis,)Tj
-21.5485 -1.2203 TD
-.0217 Tc
[(rhinosi)6.4(nusitis)-395.5(\(chronic)-390.4(nasal)-392(c)]TJ
11.8049 0 TD
-.0212 Tc
[(ongestion,)-390.8(nasal)-391.5(o)4.6(r)-396.4(p)4.6(ostnasal)]TJ
-11.8049 -1.2203 TD
-.0223 Tc
[(discharge,)-448.8(sinus)-446.6(p)3.5(ressure)-447.9(o)3.5(r)-448(t)]TJ
11.7922 0 TD
-.0214 Tc
[(enderness\),)-441.6(h)4.4(oarseness,)-441.6(ot)6.7(itis)]TJ
-11.7922 -1.2203 TD
-.0185 Tc
[(m)3.7(e)-1.5(d)7.3(i)3.3(a)4.9(,)-451.4(sw)4(o)7.3(llen)-448(n)7.3(as)6.1(al)-445.7(tur)4.7(b)1(i)9.6(n)1(a)4.9(t)3.3(es)]TJ
13.0378 0 TD
-.0221 Tc
[(or)-454.2()51.7()1.1(allergic)-454(salute)58()-454.2(sign,)]TJ
-13.0378 -1.2266 TD
-.019 Tc
[(pe)4.4(te)4.4(ch)6.8(iae)-571(o).5(n)-574.9(p)6.8(al)9.1(ate)-571(\()-2.1(A)3.5(P)1.9(L)7(S)]TJ
11.7985 0 TD
-.0205 Tc
[(or)-572.7(Gro)5.3(u)-1(p)-576.4(A)-573.4(beta-h)5.3(emolyt)7.6(ic)]TJ
-11.7985 -1.2203 TD
-.0235 Tc
[(s)-5.2(t)-1.7(rep)-4(t)-1.7(oc)-6.5(occ)-6.5(i)-311.6([)-6.6(GABHS])-316.5(i)-1.7(nfe)-6.5(c)-.1(tion)-4(\))-.3(,)-317.3(o)2.3(r)-316.5(u)-4(lcer)-316.5(o)-4(n)-313.9(p)-4(a)-.1(late)-316.3(\()-6.6(l)-1.7(up)-4(us)-5.2(\))]TJ
-1.4669 -1.2203 TD
0 Tc
[(V.)-498.9(Neck:)-363.8(Tymphadenopathy,)-364.3(thyromegaly,)-358(limited)-360(range)-365.4(of)]TJ
1.4669 -1.2267 TD
(motion)Tj
-1.7767 -1.2203 TD
-.0188 Tc
[(V)-18.8(I)-18.8(.)-519.8(Ches)5.8(t:)-427(Chest)-433.3(p)7(ain,)-432.7(coug)7(h,)-432.7(dysp)7(n).7(ea)-431.7(signs,)-426.4(r)-1.9(ales)-430.5(\(in)7(f)-1.9(ection,)]TJ
1.802 -1.2203 TD
-.0191 Tc
[(rheumatologic)-343.5(d).4(is)5.5(ease\),)-344.5(t)-3.7(achyc)]TJ
12.0388 0 TD
-.0188 Tc
[(ardia,)-344.2(mu)7(rmur)-349.7(or)-349.7(click,)-344.2(pro-)]TJ
-12.0388 -1.2266 TD
[(longed)-442(P)-4.4(R)-446.8(o).6(n)-448.4(e)4.5(lectrocard)6.9(iogr)]TJ
11.8744 0 TD
-.0198 Tc
[(am)-446.5(\(ECG\))-451.9(\()-2.9(acute)-451.7(r)3.4(heumatic)]TJ
-11.8744 -1.2203 TD
[(fever,)-332.4(in)6.1(fection,)-332.4(other)-331.6(i)2.1(nammatory)-335.4(disorder\))]TJ
-2.1561 -1.2203 TD
0 Tc
[(VII.)-496.8(Abdomen:)-515.2(Constipation,)-514.7(diarrhea,)-515(abdominal)-511.5(pain,)-513.2(ab-)]TJ
2.1308 -1.2266 TD
[(dominal)-257.2(tenderness,)-260.9(blood)-254.5(or)-254.5(mucous)-257.1(in)-256(stool,)-256.3(which)-260.2(may)]TJ
0 -1.2203 TD
[(suggest)-334.2(underlying)-337(bowel)-336.1(disease)]TJ
-2.4659 -1.2203 TD
[(VIII.)-498.9(Musculoskeletal:)-828(Pain,)-815.3(warmth,)-825.2(tenderness,)-817.3(redness,)]TJ
2.4659 -1.2203 TD
[(pseudoparalysis)-627.5(\(arthritis)-623.3(and)-620.6(acute)-628.5(rheumatic)-624(fever\),)]TJ
0 -1.2266 TD
[(myofascial)-340.2(tenderness)-333.8(or)-336.7(tender)-331(points)-335.1(\(bromyalgia\))]TJ
-1.802 -1.2203 TD
[(IX.)-501(Neurological:)]TJ
1.644 -1.2203 TD
(A.)Tj
/F8 1 Tf
1.4732 0 TD
(Cognition:)Tj
/F5 1 Tf
4.7485 0 TD
[(PANS)-406.5(patients)-406.2(are)-404.3(frequently)-411.6(inattentive.)]TJ
-4.7485 -1.2267 TD
[(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
f
59.754 174.047 239.131 .22681 re
f
BT
/F7 1 Tf
8.9663 0 0 8.9663 105.1086 725.7258 Tm
(Table)Tj
/F5 1 Tf
3.0034 0 TD
(3.)Tj
/F7 1 Tf
1.2519 0 TD
[(Family)-330.4(History)-337.4(Assessment)]TJ
-3.6926 -1.1128 TD
[(for)-334.6(Youth)-334.2(with)-334.2(PANS)-330.6(\(Examples\))]TJ
/F5 1 Tf
-5.6211 -2.0423 TD
(Neuro/Psychiatric)Tj
/F11 1 Tf
7.9702 0 0 7.9702 68.7685 688.762 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 77.2157 687.4581 Tm
[(Movement)-331.7(disorders:)-335.6(Tics,)-337.2(Tourettes)-336.7(syndrome,)-331.2(chorea)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 68.7685 678.7841 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 77.2157 677.5369 Tm
[(Obsessive)-333.8(compulsive)-335.2(disorder,)-334.3(hoarding)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 68.7685 668.8628 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 77.2157 667.5588 Tm
[(Anxiety,)-335.7(panic)-328.9(disorder,)-340.6(social)-333.6(phobia)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 68.7685 658.8849 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 77.2157 657.5809 Tm
[(Eating)-329.8(disorder)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 68.7685 648.9069 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 77.2157 647.603 Tm
[(Alcoholism)-333.8(and)-336.1(other)-329.1(substance)-338(abuse)-338.7(or)-330.4(addiction)-335(problem)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 68.7685 638.9857 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 77.2157 637.6817 Tm
[(Mood)-333.9(disorders:)-335.6(Depression,)-331.3(manic/depressive)-341(episodes/)]TJ
0 -1.1128 TD
[(bipolar)-332.1(disorder,)-334.3(rages,)-337.9(emotional)-332.2(lability)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 68.7685 619.0298 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 77.2157 617.7258 Tm
[(Schizophrenia/psychotic)-335.6(disorders)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 68.7685 609.0518 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 77.2157 607.7479 Tm
[(Autism/pervasive)-337.2(developmental)-335.1(disorder)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 68.7685 599.1306 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 77.2157 597.8266 Tm
[(Attention-decit/hyperactivity)-342(disorder)-331.4(\(ADHD\),)-334.6(learning)]TJ
T*
[(disorders,)-335(intellectual)-337.8(disability)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 68.7685 579.1747 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 77.2157 577.8707 Tm
[(Personality)-336.4(disorders)]TJ
-1.9475 -1.4416 TD
[(Autoimmune)-338.4(or)-330.4(autoinammatory)-336.4(diseases)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 68.7685 556.2708 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 77.2157 554.9668 Tm
(Rheumatologic)Tj
/F12 1 Tf
3.9849 0 0 3.9849 77.726 546.5762 Tm
(B)Tj
/F5 1 Tf
8.9663 0 0 8.9663 86.5134 544.9888 Tm
-.0224 Tc
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(B)Tj
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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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(grens)Tj
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[(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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[(Kawasakis)-340.4(disease,)-335.6(HenochSchonlein)-340.6(purpura,)-329.6(other)]TJ
T*
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3.9849 0 0 3.9849 77.726 476.844 Tm
(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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7.9702 0 0 7.9702 68.7685 456.6613 Tm
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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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(B)Tj
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(GuillainBarre)Tj
5.64 .0379 TD
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[(syndrome,)-337.5(transverse)-336.4(myelitis)]TJ
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(B)Tj
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(B)Tj
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[(Acute)-338.5(disseminate)-336(encephalomyelitis)-338.4(\(ADEM\))]TJ
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(B)Tj
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8.9663 0 0 8.9663 86.5134 345.77 Tm
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(Gastroenterologic)Tj
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3.9849 0 0 3.9849 77.726 327.4015 Tm
(B)Tj
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[(Celiac)-339.6(disease)]TJ
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3.9849 0 0 3.9849 77.726 317.4802 Tm
(B)Tj
/F5 1 Tf
8.9663 0 0 8.9663 86.5134 315.8928 Tm
[(Inammatory)-336.8(bowel)-336.1(disease)-339(\(Crohns)-332.3(disease,)-335.6(ulcerative)]TJ
T*
(colitis\))Tj
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(B)Tj
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[(Irritable)-336.5(bowel)-336.1(syndrome,)-337.5(food)-329.4(intolerances)-342.1(\(i.e.)-329.6(gluten,)]TJ
T*
(dairy\))Tj
/F11 1 Tf
7.9702 0 0 7.9702 68.7685 277.3416 Tm
()Tj
/F5 1 Tf
8.9663 0 0 8.9663 77.2157 276.0378 Tm
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(B)Tj
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[(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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7.9702 0 0 7.9702 68.7685 244.4597 Tm
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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
12.5447 0 TD
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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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(disorders)Tj
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[(PANS,)-325.6(pediatric)-331.2(acute-on)12.2(set)-331(neuropsychiatri)11(c)-335.4(syndrom)13.5(e.)]TJ
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[(PANS)-336.6(CLINICAL)-339.4(EVALUATION)-334.8(CONSENSUS)-341.1(RECOMMENDATIONS)-22096.1(5)]TJ
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[(matory)-332.1(brain)-335.4(disease/autoimmune)-338.6(encephalitis.)]TJ
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(B.)Tj
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[(Cranial)-364.6(nerves:)]TJ
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[(These)-363.8(are)-366.4(typically)-364.3(normal)-370.1(in)-363.4(PANS)]TJ
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(patients.)Tj
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(C.)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
/F5 1 Tf
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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
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(E.)Tj
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[(Abnormal)-345.9(movements:)]TJ
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9.4654 0 TD
[(Motor)-340(or)-343.1(phonic)-344.9(tics)-344.8(are)-341.1(com-)]TJ
-9.4654 -1.2203 TD
[(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
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[(ered)-334.3(abnormal)-333.6(in)-338.2(children)]TJ
/F9 1 Tf
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/F5 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
/F5 1 Tf
10.6604 0 TD
[(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
/F8 1 Tf
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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
10.2621 0 TD
[(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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[(ci)4.7(te)6.3(d)-535.1(b)2.4(y)-535.1(s)7.5(tr)6.1(esse)6.3(d-ga)6.3(it)-532.8(e)6.3(v)]TJ
10.085 0 TD
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[(aluations)-538.6(and)-537.4(s)-1.1(hou)6.4(ld)-531.1(prompt)]TJ
-10.085 -1.2203 TD
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[(evaluation)-334.9(f)4(or)-331.1(SC.)]TJ
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0 Tc
[(Other)-351.3(positive)-353.2(neurological)-357.5(signs)-351.7(should)-350(be)-355.5(followed)-347.6(up)]TJ
0 -1.2266 TD
[(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
/F10 1 Tf
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[(Psychiatric)-333.2(evaluation)]TJ
/F5 1 Tf
1.1128 -1.8336 TD
[(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
0 -1.2266 TD
[(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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[(psychotherapy.)-258.2(Ideally,)-255.3(a)-254.8(child)-254.6(with)-256(PANS)-254.7(should)-255.2(be)-254.4(evaluated)-253.6(by)]TJ
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*
[(cluding)-418(not)-419.9(only)-413.1(OCD)-420.8(and)-418.3(eating)-420.9(disorders,)-417.2(but)-419.9(also)-416.7(emotional)]TJ
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[(lability,)-350.3(mood)-349.3(disorders,)-354(ADHD,)-349.3(anxiety)-350.9(disorders,)-347.7(tic)-350.4(disorders,)]TJ
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[(psychosis,)-552.3(and)-551(neurodevelopmental)-559(disorders)-553.4(including)-547.5(autism)]TJ
T*
[(spectrum)-284.2(disorder.)]TJ
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[(A)-382.2(s)0(t)21.1(r)0(u)17.3(c)0(t)19.8(u)13.1(re)14.9(d)-378.9(d)0(i)22.2(a)0(g)17.5(n)0(o)19.9(s)0(t)21.1(i)0(c)-372.2(i)0(n)15.9(t)0(e)19.8(r)0(v)17.3(i)15.4(ew)-377.8(su)18.8(ch)-368.2(as)-375.7(th)22.3(e)-381.3(K)0(i)18.9(d)0(d)19.9(i)0(e)-372.2(S)0(c)18.9(h)0(e)17.5(d)13.1(ul)15.9(e)]TJ
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[(fo)17.3(r)-489(A)0(f)20.4(f)0(e)21.2(c)0(t)19.8(i)0(v)15.9(e)-488.8(Di)18.9(so)18.8(rd)23.7(er)14.9(s)-487.6(a)0(n)17.5(d)-486.4(Sc)18.9(h)13.1(i)0(z)13.5(o)13.1(ph)19.9(re)21.2(ni)15.9(a-)21.2(Pr)18.8(es)16.3(en)23.9(t)-490.4(a)0(n)17.5(d)-486.4(Li)16.1(fe)21.3(ti)18.2(me)]TJ
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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*
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[(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
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[(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
(6)Tj
47.4471 0 TD
[(CHANG)-336.8(ET)-338.7(AL.)]TJ
ET
endstream
endobj
86 0 obj
<>stream
/GS1 gs
BT
/F5 1 Tf
8.9663 0 0 8.9663 59.7543 725.7825 Tm
0 0 0 rg
0 Tc
0 Tw
[(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
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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*
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T*
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T*
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T*
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T*
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[(arthritis)-336.6(\(but)-333.5(not)-337.7(SC\))]TJ
0 -1.1128 TD
[(erythrocyte)-337.6(sedimentation)]TJ
T*
[(rate)-338.3(\(ESR\),)-331.3(anti-)]TJ
0 -1.1065 TD
[(streptolysin)-340.1(O)-331.6(\(ASO\),)]TJ
0 -1.1128 TD
[(DNAseB)-337.8(are)-334.8(all)-337.8(highly)]TJ
T*
(elevated.)Tj
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(Electrocardiogram)Tj
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[(\(tachycardia,)-338.5(prolonged)]TJ
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(PR\))Tj
-.9737 -1.1128 TD
[(Joint)-329.3(imaging)-339.4(typically)]TJ
.9737 -1.1128 TD
[(normal)-338.4(or)-330.4(small)-335.2(effusion)]TJ
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[(can)-338.5(be)-330.2(seen.)]TJ
12.1906 13.3287 TD
[(Refer)-334.8(back)-331.7(to)-338.2(PMD)-329.9(and/or)]TJ
.999 -1.1065 TD
[(pediatric)-333.7(rheumatologist)]TJ
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[(for)-332.5(full)-331.2(work)-339.1(up)-327.8(and)]TJ
T*
[(determination)-333(of)-336.7(antibiotic)]TJ
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(prophylaxis.)Tj
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[(Order)-337.3(echocardiogram)]TJ
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[(if)-334.4(patient)-335.9(has)-330.9(pathologic)]TJ
T*
[(heart)-331.5(murmur.)]TJ
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[(Juven)5.2(ile)-337.8(arthritis)-336.7(\(including)]TJ
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(spondyloarthropathy,)Tj
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[(enthesitis-related)-338.5(arthritis,)]TJ
T*
[(reactive)-332.6(arthritis,)-339.6(psoriatic)]TJ
T*
[(arthritis,)-333.2(and)-336.1(idiopathic)]TJ
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(arthritis\))Tj
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[(Arthritis)-337.5(can)-332.2(also)-334.5(be)-336.6(seen)-332.9(in)]TJ
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[(lupus,)-334.5(mixed)-330(connective)]TJ
T*
[(tissue)-332.4(disease,)-335.6(and)]TJ
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(Sjo)Tj
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()Tj
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[(grens)-334.7(syndrome.)]TJ
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[(Pain)-331.9(and)-336.1(stiffness)-337.3(in)-331.8(one)-336.1(or)]TJ
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[(more)-335.4(joints)-332.8(including)-332.6(the)]TJ
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[(feet,)-334.9(heels,)-339.3(buttocks,)-333.1(neck,)]TJ
T*
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T*
[(morning)-335.5(and)-329.7(with)]TJ
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[(prolonged)-333.4(stationary)]TJ
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[(positions,)-335.4(may)-333.3(get)-333.8(better)]TJ
T*
[(with)-331.9(movement)-340.8(and)]TJ
T*
(NSAIDS)Tj
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[(Finger)-270.3(pain)-270(and)-272.8(stiffness)-267.8(with)]TJ
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(writing)Tj
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[(TMJ)-335.4(pain)-333.3(with)-338.2(chewing)]TJ
13.1643 12.2222 TD
[(Red)-309.2(painful)-313.1(eye)-306.9(may)-308(indicate)]TJ
1.0053 -1.1065 TD
[(acute)-331.3(\(symptomatic\))]TJ
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-.0002 Tc
(uveitis/iritis.)Tj
T*
0 Tc
[(Asymptomatic)-294.5(uveitis/iritis)]TJ
T*
[(will)-329.6(present)-338(with)-331.9(blurry)]TJ
0 -1.1065 TD
[(vision)-328.8(only.)]TJ
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[(TMJ)-335.3(pain)-333.3(may)-333.3(indicate)-337.9(pain)]TJ
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[(processing)-334.8(disorder)-337.9(or)]TJ
T*
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[(of)-330.4(TMJ)-335.4(joint.)]TJ
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[(Quadriceps)-336(muscle)-333.1(weakness)]TJ
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[(is)-282.4(common)-284.8(in)-281.3(patients)-292.4(with)]TJ
0 -1.1065 TD
-.0002 Tc
(spondyloarthropathy.)Tj
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0 Tc
[(Psoriasis)-333.3(would)-333.7(indicate)-337.9(dry)]TJ
0 8.9663 -8.9663 -0 520.0439 302.7968 Tm
[(arthritis)-330.3(\(swelling)-339.6(may)-333.3(not)]TJ
T*
[(be)-330.2(apparent\).)]TJ
12.1842 16.6672 TD
[(Warmth,)-337(swelling,)-334.1(and/or)]TJ
.999 -1.1065 TD
[(limited)-334.8(range)-333.8(of)-336.7(motion)]TJ
0 -1.1128 TD
[(including)-332.6(neck)-338(and)-329.7(low)]TJ
T*
[(back)-331.7(\(forward)-341(bending\))]TJ
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[(Tenderness)-336(at)-334.3(insertion)-336.3(sites)]TJ
.98 -1.1065 TD
[(of)-330.4(tendons)-339.3(and)-329.7(ligaments)]TJ
0 -1.1128 TD
[(\(plantar)-336.6(fascia,)-337.5(Achilles)]TJ
T*
[(tendon,)-335.2(patellar)-334.2(insertion)]TJ
T*
[(sites,)-253.6(sacroiliac)-254.6([SI])-251(joints\).)]TJ
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[(Psoriasis)-339.6(\(look)-333(behind)-332.3(ears,)]TJ
.98 -1.1128 TD
[(umbilicus,)-333.9(intergluteal)]TJ
T*
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12.1842 12.2222 TD
[(Ultrasound)-335.1(\(if)-336.6(expertise)]TJ
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[(available\))-341.9(or)-330.4(MRI)-335.4(to)-331.8(look)]TJ
0 -1.1128 TD
[(for)-338.9(evidence)-332.3(of)-336.7(active)]TJ
T*
(inammation.)Tj
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[(Radiographs)-302.8(show)-306(damage)-305(in)]TJ
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[(cases)-336(of)-336.8(long-standing)]TJ
0 -1.1128 TD
[(arthritis)-336.6(or)-336.7(destructive)]TJ
T*
[(arthritis.)-339.6(Osteopenia)-337.4(and)]TJ
T*
[(sclerosis)-337.1(can)-338.5(be)-330.2(present)]TJ
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[(before)-335.9(erosive)-338(changes)]TJ
0 -1.1128 TD
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[(ESR)-330.4(and)-336.1(C-reactive)-338.9(protein)]TJ
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[(\(CRP\))-244.7(are)-246.2(elevated)-247.7(in)-243.3(some)]TJ
0 -1.1128 TD
(patients.)Tj
12.1906 14.4415 TD
[(Refer)-334.8(to)-331.8(pediatric)]TJ
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[(rheumatologist)-337.6(for)-332.5(formal)]TJ
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T*
[(interpretation)-335.6(of)-336.7(physical)]TJ
T*
[(examnation,)-333(and)-336.1(imaging,)]TJ
0 -1.1065 TD
[(and)-329.8(to)-338.2(order)-334(blood)-330.4(work)]TJ
0 -1.1128 TD
[(for)-332.5(categorization)-340.1(of)]TJ
T*
[(arthritis.)-333.2(There)-339.9(are)-334.8(no)]TJ
T*
[(laboratory)-335.7(tests)-332.9(that)-337.3(are)]TJ
0 -1.1065 TD
[(diagnostic)-335.7(or)-330.4(are)-334.8(used)-336.8(to)]TJ
0 -1.1128 TD
[()54.8(screen)50.9()-330.9(for)-332.5(arthritis.)]TJ
T*
[(Diagnosis)-334.2(is)-333(based)-338.7(on)]TJ
0 -1.1065 TD
[(physical)-332.6(examination)-339.9(and)]TJ
0 -1.1128 TD
(imaging.)Tj
6.3735 -4.1099 TD
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3.9581 0 TD
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1.5871 0 TD
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/F8 1 Tf
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[(Condition/disease)-7971.6(Description)-339.7(of)-331.8(pain)]TJ
28.2887 1.1128 TD
[(Important)-339.5(comorbid)]TJ
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[(symptoms)-334(to)-331.8(consider)-4401.8(Physical)-332.4(examination)]TJ
26.2148 1.1128 TD
[(Objective)-336.8(data)-330.9(to)-338.2(help)]TJ
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[(conrm)-339.1(diagnosis)-7296.3(What)-333(to)-331.8(do)]TJ
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-28.7376 -2.0929 TD
[(Patients)-322.6(with)-319.2(neck,)-321.9(back,)-321.9(and)]TJ
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[(buttock)-260(pain)-257.4(may)-257.4(also)-252.3(have)]TJ
T*
[(abdominal)-334.5(symptoms)-338.4(and/)]TJ
T*
[(or)-336.7(tenderness)-333.8(with)]TJ
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[(abdominal)-334.5(examination.)]TJ
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[(Celiac)-339.6(disease)-332.7(or)-336.7(abdominal)]TJ
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[(bowel)-336.1(disease)]TJ
12.1906 1.1065 TD
[(Recurrent)-333(abdominal)-334.5(pain,)]TJ
.999 -1.1065 TD
[(gaseousness)-335.4(\(burping,)]TJ
0 -1.1128 TD
[(atulence\),)-339.4(diarrhea,)]TJ
T*
[(growth)-335.8(impairment)]TJ
12.1843 3.3322 TD
[(Sideropenic)-339.9(anemia,)]TJ
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[(arthralgias,)-339.4(arthritis,)]TJ
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[(enthesitis,)-337.5(fatigue)-334.5(and)]TJ
T*
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T*
[(migraines,)-334.9(seizures,)]TJ
0 -1.1065 TD
[(myelitis,)-338.4(stance)-338.3(and)-329.7(gait)]TJ
0 -1.1128 TD
[(problems)-338.7(\(afferent)-333.4(ataxia,)]TJ
T*
[(vestibular)-338.3(dysfunction,)]TJ
T*
[(cerebellar)-342.9(ataxia\))]TJ
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[(Thyroiditis,)-333.4(type)-333.3(1)-334.6(diabetes,)]TJ
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[(osteopenia,)-337(alopecia,)]TJ
T*
[(hepatic)-340.7(steatosis,)-335.1(dental)]TJ
0 -1.1065 TD
[(enamel)-340.7(hypoplasia)]TJ
12.1906 13.3287 TD
[(Abdominal)-335.4(tenderness)-333.8(and/or)]TJ
.999 -1.1065 TD
(distension.)Tj
-.98 -1.1128 TD
[(Dermatitis)-336.5(herpetiformis)]TJ
13.1643 2.2193 TD
[(Elevated)-333.7(tissue)]TJ
.999 -1.1065 TD
(transglutaminase)Tj
0 -1.1128 TD
(antibodies)Tj
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[(Small)-332.6(bowel)-336.1(biopsy)-331.1(shows)]TJ
.9737 -1.1128 TD
[(villous)-332.3(blunting.)]TJ
12.1843 4.445 TD
[(Refer)-341.1(to)-331.8(gastroenterologist)]TJ
1.0053 -1.1065 TD
[(for)-332.5(formal)-334.7(evaluation.)]TJ
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[(Inammatory)-336.8(bowel)-336.1(disease)]TJ
.999 -1.1128 TD
(\(IBD\))Tj
12.1906 1.1128 TD
[(Abdominal)-335.4(pain)-333.3(or)]TJ
.999 -1.1128 TD
[(tenderness,)-336.8(diarrhea,)]TJ
0 -1.1065 TD
[(constipation,)-335.3(mucus)-333.5(or)]TJ
0 -1.1128 TD
[(blood)-330.4(in)-338.2(stool,)-332.2(growth)]TJ
T*
(impairment)Tj
12.1843 4.445 TD
(Anemia)Tj
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[(Arthralgias)-337.4(or)-330.4(arthritis)]TJ
0 -1.1065 TD
[(Enthesitis)-332(\(knees,)-337.4(heels,)-333(feet\))]TJ
0 -1.1128 TD
[(Back,)-333(neck,)-334.6(or)-336.7(buttock)-329.5(pain.)]TJ
13.1643 3.3322 TD
[(Abdominal)-335.4(tenderness)]TJ
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[(Rectal)-339.6(tags)]TJ
13.1643 1.1128 TD
[(Barium)-336.8(studies,)-334.8(CT,)-335.3(MRI,)]TJ
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[(and)-336.1(endoscopy)-336.7(\(with)]TJ
0 -1.1065 TD
[(pathology\))-337(can)-332.2(all)-337.8(show)]TJ
0 -1.1128 TD
[(signs)-332.7(of)-336.7(IBD.)]TJ
12.1843 3.3322 TD
[(Refer)-341.1(to)-331.8(gastroenterologist)]TJ
1.0053 -1.1128 TD
[(for)-332.5(formal)-334.7(evaluation.)]TJ
0 7.9702 -7.9702 -0 443.1117 65.4803 Tm
[(PANS)7.7(,)-333.3(pedi)6.6(atric)-337.8(acu)6.9(te-ons)6.2(et)-331.9(neurop)5.9(sychia)6.4(tric)-336.7(synd)7.1(rome.)]TJ
/F4 1 Tf
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[(\(thyroglobulin)-368.5(antibodies,)-363.9(thyroperoxidase)-368.5(antibodies\),)-372.3(and)-361.4(para-)]TJ
0 -1.2203 TD
[(neoplastic)-350.7(evaluations.)]TJ
1.1128 -1.2266 TD
[(All)-256.5(patients)-260.8(should)-261.5(have)-255.8(a)-261.2(screening)-257.3(complete)-261.5(blood)-260.8(count)-256.9(with)]TJ
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[(differential)-208.7(\(CBC-D\))-205.2(\(with)-201.2(peripheral)-205.3(blood)-203.9(smear\),)-204.4(ESR,)-206.9(and)-197(CRP)]TJ
T*
[(to)-180.1(evaluate)-184.5(for)-187.1(systemic)-179.3(inammatory)-186.5(process.)-186.4(If)-181.3(signicant)-182.5(anemia)]TJ
0 -1.2266 TD
[(is)-269.8(present,)-271.4(further)-270.1(medical)-274.7(workup)-268.5(should)-267.8(include)-268.7(iron)-270.2(studies)-275(and)]TJ
0 -1.2203 TD
[(consideration)-320.3(of)-317.8(inammatory)-319.3(bowel)-317.1(disease)-320.1(or)-311.4(systemic)-318.4(autoim-)]TJ
T*
[(mune)-237.9(disease.)-234.4(Persistent)-236.9(thrombocytopenia)-232.6(and/or)-240.1(leukopenia)-231.7(may)]TJ
0 -1.2266 TD
[(be)-393.5(a)-400.3(sign)-395.3(of)-393.6(systemic)-400.6(autoimmune)-394.4(diseases)-396.6(including)-402.1(lupus)-394.8(and)]TJ
0 -1.2203 TD
[(other)-468.2(connective)-474.4(tissue)-465.2(diseases.)-475.4(Systemic)-467.5(lupus)-470.7(erythematosus)]TJ
T*
[(\(SLE\),)-231.5(Sjo)]TJ
3.8443 .019 TD
()Tj
.4173 -.019 TD
[(grens)-233.5(syndrome,)-236.4(and)-234.9(APLS)-232.3(can)-231(present)-236.9(with)-230.7(prominent)]TJ
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[(neuropsychiatric)-349.1(symptoms)-344.7(including)-345.2(depression,)-347(headaches,)-353.2(sei-)]TJ
0 -1.2266 TD
[(zures,)-205.1(psychosis,)-210.9(and)-203.3(movement)-208(disorders.)-202.2(OCD,)-208.8(eating)-206(restriction,)]TJ
0 -1.2203 TD
[(and)-253.9(anxiety)-256.1(can)-256.3(be)-260.7(exacerbated)-256(by)-258.3(systemic)-255.1(illness)-253.7(\(such)-256.7(as)-255.5(lupus\))]TJ
T*
[(and)-393(severe)-400.1(anemia,)-394.2(and)-399.3(in)-395.1(patients)-393.6(experiencing)-400.2(a)-393.9(high)-394.1(level)-396.1(of)]TJ
0 -1.2266 TD
[(stress)-281.6(from)-285(nonmedical)-279.5(causes.)]TJ
1.1128 -1.2203 TD
[(If)-288.8(the)-295.8(patient)-291.7(presenting)-296.3(with)-287.6(PANS)-292.7(has)-293(elevated)-298.3(inammatory)]TJ
-1.1128 -1.2203 TD
[(markers)-264.3(\(ESR)-256.7(or)-260.9(CRP\))-261.6(and/or)-259(cytopenias)-258.2(\(low)-260.9(blood)-260.8(counts\),)-256.3(and/)]TJ
0 -1.2266 TD
[(or)-482.2(dry)-481.7(eyes)-478.3(or)-482.2(dry)-481.7(mouth)-479.3(\(not)-478.9(caused)-486(by)-479.6(medications\))-482.4(then)-485(a)]TJ
0 -1.2203 TD
[(screening)-194(ANA)-191.8(test)-186.7(should)-192(be)-191.1(obtained.)-188.9(If)-187.6(the)-188.3(ANA)-191.8(is)-187.6(positive,)-191.7(then)]TJ
T*
[(ANA)-438.4(subtiters)-432.4(\(i.e.,)-433.6(the)-434.9(ANA)-438.4(panel\))-438.5(should)-432.2(be)-431.4(ordered)-436.6(so)-436.5(that)]TJ
T*
[(lupus-specic)-278.1(antibodies)-278.8(\(double)-277.5(stranded)-274.3([ds]DNA,)-281.4(Smith,)-276.2(RNP\))]TJ
0 -1.2266 TD
[(and)-399.3(Sjo)]TJ
2.7631 .0253 TD
()Tj
.4173 -.0253 TD
[(grens)-404.2(syndrome-related)-401.8(antibodies)-398.9(\(SSA)-399.5(or)-400(anti-Ro)-406.4(and)]TJ
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[(SSB)-455.7(or)-456.9(anti-La\))-456.6(may)-459.7(be)-456.7(detected.)-459.3(Additionally,)-452.8(if)-460.9(the)-453.9(ANA)-457.4(is)]TJ
T*
[(positive,)-330.8(then)-327(obtaining)-332.6(complement)-327.3(levels)-333.6(\(C3)-328.3(and)-329.7(C4\))-328.3(can)-325.8(also)]TJ
0 -1.2266 TD
[(guide)-263.2(evaluation.)-263.9(If)-263.5(the)-264.2(patient)-260.1(shows)-262.5(evidence)-269(of)-260.9(a)-261.2(positive)-264.7(result)]TJ
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[(on)-207.7(the)-207.3(ANA)-210.8(panel)-208.7(and)-209.6(low)-208.2(complement)-213.5(levels)-207.1(or)-210.3(systemic)-210.9(features,)]TJ
T*
[(the)-365.4(patient)-361.2(should)-362.7(be)-355.5(referred)-367.8(to)-363.4(a)-356(pediatric)-365.3(rheumatologist.)-365.8(It)-359.7(is)]TJ
0 -1.2266 TD
[(important)-237.5(to)-237(keep)-236.8(in)-237(mind)-239.5(that)-236.1(a)-235.9(positive)-239.4(ANA)-236.1(is)-238.2(found)-240.4(in)-237(1213%)]TJ
0 -1.2203 TD
[(of)-317.8(healthy)-319.3(children)-315.1(\(Hilario)-316.3(et)-321.6(al.)-311.9(2004;)-317.7(Satoh)-318.7(et)-315.3(al.)-318.2(2012\);)-313.5(there-)]TJ
T*
[(fore,)-362.7(a)-356(positive)-359.5(ANA)-362.5(alone)-360.5(does)-362.1(not)-356.6(warrant)-361.7(referral)-365.5(to)-357.1(rheuma-)]TJ
0 -1.2266 TD
[(tology.)-311.5(The)-316.9(rate)-313(of)-311.4(positive)-315.3(ANAs)-312.6(in)-312.9(patients)-311.4(with)-312.9(PANDAS)-317.3(and)]TJ
0 -1.2203 TD
[(PANS)-261.1(may)-257.4(be)-254.4(higher)-259(than)-257.4(the)-257.9(baseline)-259.2(in)-256(the)-257.9(pediatric)-257.8(population,)]TJ
T*
[(an)-241.7(association)-237.6(that)-236.1(is)-238.2(currently)-241.3(undergoing)-238.1(additional)-237.3(examination.)]TJ
1.1128 -1.2203 TD
[(Histone)-321.4(antibodies)-316.7(are)-322.1(associated)-318.7(with)-319.2(drug-induced)-324.4(lupus)-318.9(and)]TJ
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[(lupus)-325.2(cerebritis,)-327.2(and)-329.7(have)-325.3(been)-325.3(reported)-326.3(to)-325.5(be)-330.2(positive)-327.9(in)-319.2(17%)-329.4(of)]TJ
0 -1.2203 TD
[(PANS)-292.7(patients)-292.4(\(Frankovich)-291.8(et)-290(al.)-292.9(2015b,)-285(in)-293.9(press\).)-288.2(Although)-292(anti-)]TJ
T*
[(histone)-280.1(antibodies)-278.8(are)-277.9(of)-279.8(research)-284(interest,)-278.9(at)-277.3(this)-279.2(time)-283.9(they)-276.4(do)-277.2(not)]TJ
0 -1.2266 TD
[(inform)-338.6(clinical)-341.9(management)-338.3(of)-336.7(PANS)-343.3(patients)-336.6(except)-337.1(in)-338.2(cases)-342.3(in)]TJ
0 -1.2203 TD
[(which)-279.2(patients)-286.1(also)-277.6(meet)-282.3(criteria)-286.2(for)-282(SLE.)]TJ
1.1128 -1.2203 TD
[(AP)18.1(L)-182.7(a)0(n)17.5(t)0(i)18.2(b)13.1(od)19.9(ie)19.8(s)-190.4(s)0(h)18.8(o)13.1(ul)15.9(d)-182.9(b)0(e)-178.5(o)13.1(rd)17.3(er)21.2(ed)-178.5(in)-180.1(fo)23.7(r)-191.8(p)13.1(at)19.8(ie)19.8(nt)15.9(s)-184.1(w)0(i)18.9(t)0(h)-180.1(P)14.6(AN)19.7(S)-187.8(i)0(f)-176.4(t)0(h)15.9(e)]TJ
-1.1128 -1.2266 TD
[(pa)17.5(ti)18.2(en)23.9(t)-294.4(h)0(a)17.5(s)-291.6(an)17.5(y)-296.7(o)13.1(f)-293(t)0(h)15.9(e)-292.8(fo)23.7(ll)18.2(ow)16.6(in)22.2(g:)-281.3(Pe)18.9(rs)16.2(is)21.1(te)19.8(nt)-287.6(th)22.3(ro)17.3(mb)22.7(oc)17.5(y)13.1(t)0(o)15.9(p)13.1(en)17.5(ia)19.8(,)-293.8(p)13.1(er)14.9(-)]TJ
0 -1.2203 TD
[(si)21.1(st)14.7(en)23.9(t)-269.1(p)0(e)17.5(t)0(e)19.8(c)0(h)17.5(i)0(a)19.8(e)0(,)-264.1(c)0(h)23.9(o)0(r)17.3(e)0(a)21.4(,)-274.8(cl)19.8(in)22.2(ic)19.8(al)-264.7(th)22.2(ro)17.3(mb)22.7(os)18.8(is)21.1(,)-268.5(m)0(i)18.7(g)0(r)17.3(a)0(i)19.8(n)13.1(es)16.3(,)-268.5(s)0(t)14.7(r)0(o)23.7(k)0(e)17.5(s)0(,)-256.5(o)0(r)]TJ
T*
[(li)18.2(v)13.1(e)0(d)17.5(o)-391.5(re)21.2(ti)18.2(cu)17.5(la)19.8(ri)19.6(s.)-383(T)13.3(h)0(e)-380.8(A)0(P)18.1(L)-391.3(wo)23(rk)17.3(up)-378.4(is)-383.6(co)17.5(st)21.1(ly)-382.4(an)23.9(d)-391.5(s)0(h)18.8(o)13.1(ul)15.9(d)-391.5(o)13.1(nl)22.2(y)-391.5(b)0(e)]TJ
T*
[(or)17.3(d)13.1(e)0(r)14.9(e)0(d)-273.3(i)0(f)-277.5(i)0(n)22.2(d)0(i)15.9(c)0(a)21.4(t)0(e)19.8(d)0(.)-280.6(T)13.3(he)-279.6(AP)18.1(L)-283.9(w)0(o)16.6(r)0(k)23.7(u)0(p)-277.2(i)0(n)22.3(c)0(l)19.8(u)0(d)19.9(e)0(s)-280.8(t)0(h)22.3(e)-286.5(fo)17.3(ll)18.2(o)13.1(w)0(i)18.9(n)0(g)19.9(:)]TJ
/F13 1 Tf
25.0071 0 TD
(b)Tj
/F5 1 Tf
.8346 0 TD
(2-)Tj
-25.8417 -1.2266 TD
[(gl)22.2(yc)17.5(op)19.9(ro)17.3(te)19.8(in)-249.6(an)23.9(ti)18.2(bo)19.9(di)22.2(es)16.3(,)-255.8(a)0(n)17.5(t)0(i)18.2(c)0(a)21.4(r)0(d)17.3(i)0(o)22.2(l)0(i)18.2(p)0(i)22.2(n)-258.7(an)17.5(ti)18.2(b)13.1(o)0(d)19.9(i)0(e)19.8(s)-259.9(\(I)21.1(gG)16.6(,)-255.8(I)0(g)17.3(M)12.4(,)-255.8(I)0(g)17.3(A)0(\))20.4(,)]TJ
0 -1.2203 TD
[(DR)18.2(VV)19.7(T,)-337.4(an)23.9(d)-347.3(l)0(u)22.2(p)13.1(us)-335.3(an)17.5(ti)18.2(co)23.9(ag)17.5(ul)15.9(an)23.9(t.)-335.2(Ab)16.6(n)13.1(o)0(r)17.3(m)0(a)20.3(l)-345(re)21.2(su)18.8(lt)18.2(s)-342.1(s)0(h)18.8(o)13.1(ul)15.9(d)-340.9(b)13.1(e)-343.4(i)0(n)15.9(-)]TJ
T*
[(te)19.8(rp)17.3(re)21.2(te)19.8(d)-271.4(b)0(y)-258.3(a)-273.8(rh)17.3(eu)23.9(ma)20.3(to)15.9(lo)22.2(gi)15.9(st)21.1(.)]TJ
1.1128 -1.2267 TD
[(Be)19.1(h)13.1(c)0(e)15.1(t)0()19.6(s)-392.7(d)13.1(i)0(s)21.1(e)0(a)15.1(s)0(e)-382(c)0(a)21.4(n)-391.5(al)13.5(so)-379.6(p)13.1(r)0(e)14.9(s)0(e)22.7(n)0(t)-382.4(w)0(i)18.9(t)0(h)-382.4(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)-384.8(s)0(y)25.1(m)0(p)16.4(-)]TJ
-1.1128 -1.2203 TD
[(to)22.2(ms)15.2(,)-211.6(a)0(n)23.9(d)-214.5(sh)18.8(o)13.1(u)0(l)15.9(d)-208.2(b)13.1(e)-216.9(co)23.9(ns)18.8(id)15.9(er)21.2(ed)-203.8(in)-199.1(p)13.1(a)0(t)13.5(i)15.4(en)17.5(ts)-200.2(wi)18.9(th)-205.4(re)21.2(cu)17.5(rr)21.1(en)17.5(t)-212.2(o)13.1(ra)21.2(l)-212.2(a)0(n)17.5(d)0(/)22.2(o)0(r)]TJ
T*
[(ge)17.5(n)13.1(i)0(t)18.2(a)0(l)-302.6(u)0(l)15.9(c)0(e)21.4(r)0(s)16.2(.)-306.4(It)-302.8(is)-307.7(n)13.1(e)0(c)15.1(e)0(s)22.7(s)0(a)16.3(r)0(y)-298.8(t)0(o)-306.5(e)0(x)23.9(a)0(m)14(i)0(n)22.2(e)-311.7(th)15.9(e)-311.8(s)0(k)18.8(i)0(n)-300.2(f)0(o)17.3(r)-311.9(si)21.1(g)13.1(n)0(s)-303.7(o)0(f)-305.1(s)0(k)18.8(i)0(n)]TJ
0 -1.2266 TD
[(in)22.2(vo)19.9(lv)15.9(em)20.3(en)17.5(t)-212.2(\()0(a)21.2(c)0(n)17.5(e)0(i)19.8(f)0(o)23.7(r)0(m)-207.5(l)15.4(es)16.3(io)22.2(ns)18.8(,)-211.6(p)0(a)17.5(p)13.1(ul)15.9(o)13.1(-)0(v)17.3(e)0(s)16.3(i)15.4(cu)17.5(lo)15.9(-p)23.7(us)18.8(tu)22.2(la)13.5(r)-210.8(e)0(r)21.2(u)13.1(pt)15.9(io)22.3(ns)18.8(,)]TJ
0 -1.2203 TD
[(ps)18.8(eu)17.5(d)13.1(o)0(f)17.3(o)13.1(ll)18.2(ic)19.8(ul)15.9(i)15.4(t)0(i)18.2(s)0(,)-402(n)0(o)19.9(d)0(u)19.9(l)0(e)19.8(s)0(,)-402(e)0(r)21.2(y)0(t)15.9(h)13.1(em)14(a)-406.6(n)0(o)19.9(d)0(o)19.9(s)0(u)18.8(m)0(,)-404.3(s)0(u)25.1(p)0(e)17.5(r)0()18.8(c)0(i)19.8(a)0(l)-403.8(t)0(h)22.3(r)0(o)17.3(m)0(-)]TJ
T*
[(bo)19.9(ph)19.9(le)19.8(bi)15.9(t)15.4(i)0(s)14.7(,)-357(p)13.1(y)0(o)19.9(d)0(e)17.5(r)0(m)20.1(a)-356(ga)17.5(n)13.1(g)0(r)17.3(e)0(n)17.5(o)13.1(su)18.8(m-)20.1(ty)15.9(p)13.1(e)-356(le)19.8(si)14.7(o)13.1(n)0(s)18.8(,)-357(er)21.2(yt)15.9(h)13.1(e)0(m)20.3(a)-362.3(mu)22.7(lt)18.2(i-)]TJ
0 -1.2266 TD
[(fo)17.3(rm)20.1(e-)21.2(li)18.2(k)13.1(e)-318.1(le)19.8(si)21.1(on)19.9(s,)-307.1(an)17.5(d)-309.3(p)0(a)17.5(l)0(p)15.9(a)0(b)23.9(l)0(e)-309(p)13.1(ur)17.3(p)13.1(u)0(r)17.3(a)0(\))21.2(,)-319.1(p)13.1(e)0(r)21.2(f)0(o)17.3(r)0(m)-302.3(a)-318.1(p)13.1(a)0(t)13.5(h)13.1(er)21.2(gy)-308.8(te)19.8(st)21.1(,)]TJ
0 -1.2203 TD
[(co)17.5(n)13.1(s)0(i)14.7(d)13.1(er)-206.4(HL)16.8(A-)20.4(B5)-206.1(te)19.8(st)21.1(in)15.9(g)13.1(,)-217.9(an)17.5(d)-214.5(r)0(e)21.2(f)0(e)14.9(r)-217.1(t)15.4(h)0(e)-210.1(p)13.1(at)19.8(ie)13.5(n)13.1(t)-218.5(to)-205.4(o)13.1(p)0(h)19.9(t)0(h)15.9(a)0(l)19.8(m)0(o)22.7(l)0(o)15.9(g)13.1(y)-214.5(f)0(o)17.3(r)]TJ
T*
[(ev)17.5(al)19.8(u)13.1(a)0(t)13.5(i)15.4(on)-473.2(o)13.1(f)-476.3(uv)19.9(ei)19.8(ti)18.2(s,)-471.5(as)-464.2(we)14.2(ll)-468.6(as)-464.2(to)-470.9(rh)17.3(eu)23.9(ma)20.3(to)15.9(lo)22.2(gy)-466.9(if)-467.2(cr)14.9(it)18.2(er)21.2(ia)-467(fo)17.3(r)]TJ
T*
[(Be)19.1(hc)17.5(et)19.8(s)-262.1(d)13.1(i)0(s)14.7(e)0(a)21.4(s)0(e)-261.9(i)0(s)-257.1(m)0(e)14(t)0(.)]TJ
1.1128 -1.2266 TD
[(Patients)-354.2(meeting)-348.1(criteria)-355.7(for)-351.5(PANS)-349.6(commonly)-351(report)-350.2(pain,)-348.8(in-)]TJ
-1.1128 -1.2203 TD
[(cluding)-430.7(chest)-424.9(pain,)-424.7(abdominal)-429.3(pain,)-431(headaches,)-429.1(musculoskeletal)]TJ
T*
[(pain,)-336.2(and)-336.1(fatigue.)-337.4(Many)-336.3(of)-336.7(these)-336.4(patients)-343(meet)-332.9(criteria)-343.1(for)-332.5(a)-337(pain)]TJ
0 -1.2267 TD
[(processing)-331.4(disorder)-337.7(\(e.g.,)-328.5(bromyalgia\))-336.8(\(Frankovich)-329.7(et)-334.3(al.)-330.8(2015a,)]TJ
27.9978 74.5598 TD
[(in)-211.7(press\),)-206(and)-209.6(a)-210.6(minority)-204(have)-211.5(comorbid)-211(autoimmune/inammatory)]TJ
0 -1.2203 TD
[(disease.)-335.6(The)-329.6(psychiatric)-333.9(symptoms)-332(that)-331(PANS)-330.6(patients)-336.6(report)-331.2(are)]TJ
0 -1.2266 TD
[(often)-316.4(so)-310(severe)-317.9(that)-312(they)-314.3(overshadow)-310.5(pain)-314.3(complaints.)-316.8(Therefore,)]TJ
0 -1.2203 TD
[(we)-327.2(recommend)-322.4(asking)-320.8(about)-320.1(pain)-320.6(in)-319.2(all)-325.1(patients)-317.7(with)-325.5(PANS.)-320.9(De-)]TJ
T*
[(pending)-218(upon)-219.4(the)-220(pattern)-220.7(of)-216.6(pain)-213.1(and)-222.3(the)-213.6(physical)-218.8(examination,)-222.7(one)]TJ
0 -1.2266 TD
[(whould)-478.6(consider)-476.6(the)-479.2(following)-475.2(causes)-480.9(of)-475.8(joint)-477.5(pain)-478.7(and/or)-474(ab-)]TJ
0 -1.2203 TD
[(dominal)-453.2(pain:)-444.3(Acute)-452.3(rheumatic)-447(fever,)-453.1(juvenile)-449.3(arthritis,)-447.1(inam-)]TJ
T*
[(matory)-275.2(bowel)-266.5(disease,)-272.4(and)-272.8(celiac)-274(disease.)-272.4(Table)-271.8(4)-265.1(provides)-271.9(details)]TJ
0 -1.2266 TD
[(regarding)-287.9(the)-276.9(workup)-281.2(of)-279.8(pain)-282.7(in)-281.3(patients)-279.7(with)-281.3(PANS.)]TJ
1.1128 -1.2203 TD
[(Immune)-293.7(complex)-299.8(panels)-291.6(and)-298.1(ferritin)-296.6(levels)-295.7(are)-290.5(of)-298.8(interest)-295(from)]TJ
-1.1128 -1.2203 TD
[(the)-314.8(research)-315.7(standpoint,)-317.2(but)-312.4(at)-309(this)-317.1(juncture,)-311.7(these)-311.1(tests)-313.9(do)-315.2(not)-312.4(in-)]TJ
T*
[(form)-329.3(clinical)-329.3(management)-332(of)-324.1(patients)-330.3(with)-325.5(PANS)-324.3(unless)-328.4(disease-)]TJ
0 -1.2266 TD
[(specic)-285.8(symptoms)-281.4(are)-284.2(also)-277.6(present.)]TJ
/F10 1 Tf
0 -3.054 TD
[(Neural)-337.6(autoimmunity)]TJ
/F5 1 Tf
1.1128 -1.8336 TD
[(Testing)-482.3(for)-484.3(the)-485.5(presence)-483.8(of)-482.2(cross-reactive)-485.1(antineuronal)-484(anti-)]TJ
-1.1128 -1.2203 TD
[(bodies)-459.9(may)-459.7(help)-459.7(guide)-459.2(diagnosis)-457.4(toward)-458.3(or)-456.9(away)-461.4(from)-462(PANS.)]TJ
0 -1.2266 TD
[(Serum)-194.4(samples)-194.7(from)-196.5(acutely)-195.2(ill)-187.6(children)-194.9(with)-192.8(SC)-198.3(or)-191.3(PANDAS)-190.8(show)]TJ
0 -1.2203 TD
[(elevated)-304.7(titers)-299.9(of)-298.8(antibodies)-304.1(against)-301.5(lysoganglioside)-300.5(\(Kirvan)-302.4(et)-296.3(al.)]TJ
T*
[(2006a\),)-618.3(tubulin)-615.6(\(Kirvan)-618.5(et)-612.5(al.)-621.7(2007\),)-610.1(dopamine)-621.8(D2)-609.3(receptor)]TJ
T*
[(\(Brimberg)-290(et)-290(al.)-286.6(2012;)-286.1(Ben-Pazi)-285.2(et)-290(al.)-286.6(2013;)-286.1(Cox)-287.8(et)-283.7(al.)-286.6(2013\),)-287.6(and)]TJ
0 -1.2266 TD
[(dopamine)-229.8(D1)-223.6(receptor)-227.6(\(Ben-Pazi)-224.1(et)-226.8(al.)-223.4(2013\).)-224.4(More)-225.1(importantly,)-224.5(in)]TJ
0 -1.2203 TD
[(both)-292.9(SC)-286.9(and)-291.8(PANDAS,)-288.6(the)-289.5(antibodies)-291.4(produced)-288.1(activation)-296.7(of)-286.2(cal-)]TJ
T*
[(cium)-456.9(calmodulin)-458.1(protein)-452.3(kinase)-456(II)-453.2(\(CaMK)-453.9(II\))-455.3(in)-452(the)-453.9(SK-N-SH)]TJ
0 -1.2266 TD
[(human)-224.8(neuronal)-228.9(cell)-225.9(line)-223.5(\(Kirvan)-226.5(et)-220.4(al.)-229.7(2003,)-222.3(2006b\).)-223.9(Activation)-221.7(of)]TJ
0 -1.2203 TD
[(CaMK)-407.5(II)-402.6(results)-404(in)-401.4(neuronal)-399.6(excitation)-410.5(and)-399.3(increased)-405.1(dopamine)]TJ
T*
[(transmission)-271.2(\(Kirvan)-264.4(et)-271(al.)-261.3(2006b\),)-268.2(which)-266.5(may)-263.7(be)-267(at)-264.7(least)-270.9(partially)]TJ
0 -1.2266 TD
[(responsible)-309.7(for)-307.2(PANS)-311.6(symptoms.)-303.3(Recent)-310.2(studies)-312.9(have)-306.4(shown)-305.5(that)]TJ
0 -1.2203 TD
[(IgG)-371.2(in)-369.8(youth)-368.3(with)-369.8(SC)-362.7(and)-374(PANDAS)-367.9(reacts)-372.5(with)-369.8(and)-367.7(signals)-369.8(the)]TJ
T*
[(dopamine)-204.5(D2)-204.7(receptor)-202.3(expressed)-203.8(in)-199.1(transfected)-202.1(cell)-206.9(lines)-198.9(\(Cox)-201.4(et)-201.5(al.)]TJ
0 -1.2266 TD
[(2013\).)-363.5(Similar)-363.5(results)-359.8(have)-363.3(also)-359.8(been)-363.3(shown)-356.1(for)-364.1(the)-359.1(D1)-356.4(receptor)]TJ
0 -1.2203 TD
[(expressed)-305(in)-300.2(transfected)-303.3(cell)-301.8(lines,)-296.7(but)-299.7(those)-302.4(data)-297.8(are)-303.1(not)-293.4(yet)-302.1(pub-)]TJ
T*
[(lished)-413.4(\(Cunningham,)-406.9(et)-410.1(al.,)-409.6(unpublished)-410.9(data\).)-410.3(Currently,)-410.9(Mole-)]TJ
T*
[(culera)-207(Labs)-203.8(\(www.moleculera.com\))-212.7(is)-206.6(the)-201(only)-204.4(Clinical)-205.1(Laboratory)]TJ
0 -1.2266 TD
[(Improvement)-395.1(Amendments)-394.9(\(CLIA\)-certied/Commission)-402.4(on)-391(Of-)]TJ
0 -1.2203 TD
[(ce)-368.7(Laboratory)-363.1(Accreditation)-366.8(\(COLA\)-accredited)-368.5(laboratory)-361(that)]TJ
T*
[(provides)-619.7(testing)-612.9(for)-617.1(antitubulin,)-614.4(antilysoganglioside)-612.5(and)-614.3(anti-)]TJ
0 -1.2266 TD
[(dopamine)-324.6(receptor)-322.4(antineuronal)-319.6(antibody)-316.4(titers)-325.2(by)-315.2(enzyme-linked)]TJ
0 -1.2203 TD
[(immunosorbent)-552.4(assay)-554.9(\(ELISA\),)-546.3(as)-552.7(well)-549.3(as)-552.7(assays)-549.2(to)-546.8(measure)]TJ
T*
[(CaMKII)-456(signaling.)-450.5(Although)-450(the)-447.6(Moleculera)-452.4(panel)-449(can)-452.3(provide)]TJ
0 -1.2266 TD
[(useful)-234.9(ancillary)-232.5(information)-226.5(for)-231.4(children)-226.6(with)-230.7(suspected)-230.6(PANDAS,)]TJ
0 -1.2203 TD
[(it)-253.7(is)-244.5(not)-249.2(yet)-251.6(clear)-251.7(that)-248.8(the)-245.2(assays)-252.1(are)-252.6(helpful)-249.9(for)-244(the)-251.6(larger)-251.4(cohort)-246.4(of)]TJ
T*
[(children)-479.5(meeting)-474.6(PANS)-476(criteria)-475.9(\(without)-475.6(GAS)-477.9(etiology\).)-470.9(More)]TJ
T*
[(research)-410.5(is)-408.9(needed)-402.7(to)-407.7(delineate)-403(the)-409.6(sensitivity)-405.2(and)-405.6(specicity)-406.2(of)]TJ
0 -1.2266 TD
[(these)-285.8(tests)-282.3(for)-282(youth)-279.8(with)-281.3(PANS.)]TJ
/F10 1 Tf
0 -3.054 TD
[(Evaluation)-339.5(for)-332.5(immunodeciency)]TJ
/F5 1 Tf
1.1128 -1.8336 TD
.0109 Tc
[(Some)-604.4(reports)-603.1(indicate)-604.3(that)-599.6(ce)]TJ
13.335 0 TD
.0107 Tc
[(rt)-5.5(ain)-602.1(p)-1.5(atients)-597(w)-4.8(ith)-602.1(Tourette)]TJ
-14.4479 -1.2203 TD
.0122 Tc
[(syndrome,)-420.7(OCD)-426.9(a)4(nd)-423.6(PANDAS)-422.2(have)]TJ
16.0286 0 TD
.012 Tc
[(an)-423.8(increased)-423.8(t)2.1(endency)-423.8(t)2.1(o)]TJ
-16.0286 -1.2266 TD
[(develo)12.1(p)-429.5(i)2.2(nfections)-418.6(or)-420(to)-423.7(s)5.1(how)-420.7(ot)]TJ
14.0432 0 TD
[(her)-426.5(e)3.6(viden)11.9(c)-8.5(e)-420(o)-.3(f)-420.2(i)2.1(mmune)-420(dys)4.9(-)]TJ
-14.0432 -1.2203 TD
.0116 Tc
[(functio)11.6(n)-524.9(\(Ho)11.6(r)-9(nig)-512.7(2013\).)-516.1(P).9(relimin)]TJ
14.4226 0 TD
.0118 Tc
[(ary)-512.5(s)-1.6(tudies)-513.7(high)11.8(l)-10.2(i)1.9(ght)-510.2(a)-2.8(ltered)]TJ
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.0122 Tc
[(immunoglob)12.2(u)-5.8(lin)-505.8(p)0(roles)-507(\(IgM)12.2(,)-515.7(I)3.8(gG)-509.1(su)12.2(b)-5.8(c)-2.4(las)5.2(s)-1.1(es)5.2(,)-509.2(I)3.8(gA\))-502.1(a)-2.4(nd)-505.8(de-)]TJ
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[(creas)5.2(e)-2.4(d)-278.2(r)3.8(egu)12.2(l)-9.8(atory)-271.8(T)-278(cell)-275.9(count)-275.9(amo)12.2(n)-5.8(g)-278.2(t)2.3(his)-279.3(p)0(o)12.2(p)-5.8(ulation)-278.2(c)3.9(omp)12.2(a)-8.2(red)]TJ
0 -1.2203 TD
0 Tc
[(wi)18.9(th)-338.2(h)13.1(e)0(a)21.4(l)0(t)18.2(h)13.1(y)-347.3(c)0(o)17.5(n)13.1(tr)19.6(o)13.1(l)0(s)-339.3(\()0(K)20.4(a)0(w)26.9(i)0(k)15.9(o)13.1(v)13.1(a)-349.7(et)-340.6(al)26.2(.)-350.7(2)13.1(00)19.9(7)13.1(,)-350.7(2)13.1(0)13.1(1)0(0)19.9(;)-351.3(B)14.7(o)0(s)18.8(-)0(V)20.4(e)0(n)23.8(e)0(m)20.3(a)0(n)]TJ
T*
-.0145 Tc
[(e)-14.5(t)-348.8(a)-14.5(l)11.7(.)-358.9(2011)-14.5(\).)]TJ
1.1128 -1.2203 TD
0 Tc
[(PANS)-463.4(patients)-463.1(should)-457.5(undergo)-463.2(an)-456.7(immunodeciency)-465(assess-)]TJ
-1.1128 -1.2266 TD
[(ment)-311.5(if)-309.1(there)-312.5(is)-307.7(a)-305.4(history)-311.9(of)-305.1(repeated)-315.9(infections,)-309.6(infection)-312.3(with)-306.6(an)]TJ
0 -1.2203 TD
[(atypical)-236.7(organism)-231.2(or)-229.3(an)-229.1(unusual)-231.8(clinical)-234.4(course,)-229.9(rst-degree)-234.8(family)]TJ
T*
[(member)-447.9(with)-452(a)-444.5(history)-444.7(of)-450.5(overwhelming)-446.4(and/or)-448.7(fatal)-443(infection,)]TJ
0 -1.2267 TD
[(or)-545.4(if)-549.4(the)-542.4(clinician)-550.1(is)-548(considering)-548.7(intravenous)-548.7(immunoglobulin)]TJ
/F4 1 Tf
-27.9978 77.2217 TD
(10)Tj
47.4471 0 TD
[(CHANG)-336.8(ET)-338.7(AL.)]TJ
ET
endstream
endobj
105 0 obj
<>stream
/GS1 gs
BT
/F5 1 Tf
8.9663 0 0 8.9663 59.7543 725.7825 Tm
0 0 0 rg
0 Tc
0 Tw
[(\(IVIG\))-235.4(treatment.)-239(Patients)-234.1(with)-237(solely)-230(autoimmune)-236.4(features)-235.1(should)]TJ
0 -1.2203 TD
[(also)-397.7(have)-394.9(an)-393.5(immune)-396.3(evaluation,)-396.7(as)-394.6(autoimmunity)-392.8(may)-396.5(initially)]TJ
0 -1.2266 TD
[(present)-287.4(as)-280.8(the)-276.9(sole)-283.9(feature)-284.9(of)-279.8(immune)-276.1(dysregulation.)]TJ
1.1128 -1.2203 TD
[(Immunodeciency)-330.8(screening)-333.1(should)-324.8(proceed)-335.2(in)-325.5(multiple)-327.9(steps,)]TJ
-1.1128 -1.2203 TD
[(complemented)-284.5(with)-281.3(repeated)-284.3(clinical)-285(evaluation)-280(of)-279.8(the)-283.2(patient.)]TJ
1.1128 -1.2266 TD
[(Initial)-283.2(workup)-281.2(should)-280.5(include)-281.3(the)-276.9(following:)]TJ
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[(I.)-498.2(Lymphocyte)-361.4(subsets)-360.7(\(T,)-358.4(B,)-361.2(natural)-359.8(killer)-361.9([NK])-357.6(cells\))-361.5(with)]TJ
1.0812 -1.2266 TD
[(CBC)-335.2(with)-338.2(manual)-331.9(differential.)]TJ
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[(II.)-500.3(Quantitative)-404.2(immunoglobulins)-402.7(\(IgG,)-407.8(IgA,)-399.4(IgM,)-403.1(IgE\))-401.4(with)]TJ
1.4163 -1.2203 TD
[(IgG)-333.2(subclasses)]TJ
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[(III.)-496.1(Vaccine)-525.7(responses)-518.8(\()]TJ
/F8 1 Tf
10.2937 0 TD
(Pneumococcus)Tj
/F5 1 Tf
6.5316 0 TD
[(and)-519.4(tetanus)-522.8(antibody)]TJ
-15.0801 -1.2203 TD
(titers\))Tj
-1.6376 -1.8906 TD
[(If)-200.2(t)15.4(h)0(e)-203.8(i)15.4(ni)22.2(ti)18.2(al)-195.1(ev)17.5(al)26.2(ua)17.5(t)15.4(i)0(o)22.2(n)-208.2(is)-200.2(re)21.2(as)22.7(su)18.8(ri)19.6(n)13.1(g)13.1(,)-211.6(n)13.1(o)-208.2(fu)23.7(rt)19.6(h)13.1(e)0(r)-200.1(w)0(o)23(r)0(k)23.7(u)0(p)-201.4(i)15.4(s)-209.4(n)0(e)17.5(e)0(d)23.9(e)0(d)23.8(.)]TJ
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[(If)-389.9(th)22.2(e)-400.3(e)0(v)17.5(a)0(l)19.8(u)13.1(at)19.8(i)15.4(o)0(n)-391(i)0(s)-389.9(a)0(b)23.9(n)0(o)19.9(r)0(m)20.1(a)0(l)-384.8(a)0(n)17.5(d)-397.9(ra)21.2(is)21.1(es)-388.3(co)17.5(n)13.1(c)0(e)21.4(r)0(n)23.7(s)-399(ab)17.5(o)13.1(u)13.1(t)-401.9(po)19.9(te)19.8(n)13.1(t)0(i)24.5(a)0(l)]TJ
T*
[(im)18.7(mu)22.7(n)13.1(e)-286.5(d)13.1(e)0()18.9(c)0(i)19.8(e)0(n)23.9(c)0(y)23.9(,)-287.4(th)22.2(e)-286.5(p)13.1(at)19.8(ie)19.8(n)13.1(t)-281.7(sh)18.8(o)13.1(u)13.1(l)0(d)-274.9(b)13.1(e)-286.5(r)0(e)21.2(f)0(e)21.2(r)0(r)21.1(e)0(d)-273.3(t)0(o)-274.9(a)0(n)-273.3(i)0(m)25(m)0(u)16.4(n)13.1(o)13.1(l)0(o)22.2(-)]TJ
0 -1.2266 TD
[(gi)22.2(st)-162.3(fo)23.7(r)-172.8(f)0(u)17.3(r)0(t)26(h)0(e)17.5(r)-166.5(ev)17.5(al)19.8(u)13.1(a)0(t)19.8(i)15.4(on)19.9(.)-173.6(A)0(d)23(d)13.1(it)18.2(i)15.4(o)0(n)19.9(a)0(l)-163.5(b)13.1(lo)22.3(o)13.1(d)-170.2(wo)16.6(rk)-159.7(ma)20.3(y)-170.2(i)0(n)22.2(c)0(l)19.8(u)13.1(d)13.1(e)0(:)-163.5(B)-168.6(an)17.5(d)]TJ
0 -1.2203 TD
[(T)-385(c)0(e)21.4(l)0(l)-373.8(m)0(a)20.3(t)0(u)22.2(r)0(a)21.2(t)0(i)18.2(o)13.1(n)-385.2(p)13.1(an)23.9(el)19.8(,)-382.3(p)0(o)19.9(s)0(t)21.1(v)13.1(ac)21.4(ci)19.8(n)13.1(a)0(t)19.8(i)0(o)22.3(n)-385.2(an)23.9(ti)18.2(b)13.1(o)13.1(d)0(y)-378.4(t)15.4(it)18.2(er)21.2(s)-380.1(a)0(t)-378.5(l)15.4(ea)21.4(st)-377.3(4)]TJ
T*
[(we)20.5(ek)17.5(s)-177.7(f)0(o)23.7(l)0(l)24.6(o)0(w)16.6(i)15.4(ng)-169.7(p)13.1(n)13.1(e)0(u)17.5(m)15.9(oc)17.5(o)13.1(c)0(c)21.4(a)0(l)-169.9(p)13.1(o)13.1(l)0(y)22.2(s)0(a)16.3(c)0(c)21.4(h)13.1(ar)21.2(id)22.2(e)-179(v)13.1(ac)21.4(ci)19.8(n)13.1(e)-179(\(P)18.8(n)13.1(e)0(u)23.9(m)0(o)22.7(v)0(a)17.5(x)]TJ
T*
[(23)19.9(\),)-270.6(an)17.5(d)-284(T)-283.9(ce)21.4(ll)-272.6(fu)23.7(nc)17.5(t)15.4(i)0(o)22.2(n)0(a)17.5(l)-281.7(st)21.1(u)13.1(d)0(i)22.2(e)0(s)-274.5(o)13.1(r)-286.6(a)0(n)23.9(y)-284(ad)17.5(d)13.1(i)0(t)18.2(i)15.4(on)19.9(al)-271(im)18.7(mu)22.7(n)13.1(e)-286.5(p)13.1(h)13.1(e)0(n)17.5(o)13.1(-)]TJ
0 -1.2266 TD
[(ty)22.2(pi)22.2(ng)-258.3(re)21.2(le)19.8(v)13.1(a)0(n)17.5(t)-269.1(to)-256(th)22.2(e)-273.8(c)0(l)26.2(i)0(n)22.2(i)0(c)19.8(a)0(l)-258.4(h)0(i)22.2(s)0(t)21.1(o)13.1(ry)-260.9(o)13.1(r)-274(p)13.1(r)0(i)19.6(o)13.1(r)-267.7(l)0(a)19.8(b)13.1(o)13.1(r)0(a)14.9(t)15.4(or)17.3(y)-265.1()0(n)21.4(d)13.1(in)22.2(gs)18.8(.)]TJ
/F10 1 Tf
0 -2.9402 TD
[(Additional)-336.9(diagnostic)-334.8(evaluations)]TJ
/F5 1 Tf
1.1128 -1.8336 TD
[(Brain)-435(MRIs)-430.9(are)-435.9(helpful)-433.3(when)-433.7(other)-430.2(conditions)-434.4(are)-435.9(suspected)]TJ
-1.1128 -1.2266 TD
[(\(e.g.,)-265.2(central)-267.4(nervous)-268.4(system)-262.3([CNS])-268.6(small)-265.7(vessel)-261.2(vasculitis,)-267.9(limbic)]TJ
0 -1.2203 TD
[(encephalitis\))-371(or)-368.4(when)-364.2(the)-365.4(patient)-367.6(has)-368.9(severe)-368.5(headaches,)-365.9(gait)-368.9(dis-)]TJ
T*
[(turbances,)-418.3(cognitive)-410.8(deterioration,)-410.8(or)-412.6(psychosis.)-413.2(For)-410.7(particularly)]TJ
0 -1.2266 TD
[(severe)-393.8(cases,)-389.5(an)-387.1(MRI)-385.9(with)-388.8(T-2)-386.6(weighted)-391.6(images)-390(or)-387.3(contrast)-385.8(en-)]TJ
0 -1.2203 TD
[(hancement)-297.4(may)-289(be)-292.3(useful)-291.8(in)-293.9(demonstrating)-289.8(inammatory)-294(changes)]TJ
T*
[(in)-395.1(the)-390.7(basal)-393.3(ganglia,)-398.1(including)-389.5(volumetric)-397.5(changes)-390.7(\(Giedd)-395.1(et)-391.2(al.)]TJ
0 -1.2266 TD
[(1996,)-279.2(2000\).)]TJ
1.1128 -1.2203 TD
[(EEGs,)-485.6(particularly)-484.3(overnight)-482.9(evaluations,)-485.9(may)-478.7(be)-482(helpful)-483.9(in)]TJ
-1.1128 -1.2203 TD
[(demonstrating)-466.8(focal)-457.9(or)-456.9(generalized)-466.3(slowing)-458(and/or)-461.4(epileptiform)]TJ
T*
[(activity.)-266.5(These)-269(signs)-263.2(of)-267.2(abnormal)-264(brain)-265.8(activity)-269.9(or)-260.9(irritability)-270.2(were)]TJ
0 -1.2266 TD
[(found)-259.4(in)-262.3(7)-252.4(o)0(f)-260.9(4)0(2)-258.3(\(16%\))-257.8(patients)-260.8(with)-262.3(PANDAS)-260.4(\(Zhou)-259.2(et)-258.4(al.)-255(2014\).)]TJ
0 -1.2203 TD
[(Similarly,)-483.3(polysomnography)-480.7(\(PSG\))-477.5(also)-486.2(called)-480.3()54.8(sleep)-477.6(studies)51.7()]TJ
T*
[(might)-287.3(reveal)-295.5(evidence)-288(of)-286.2(obstructive)-287.2(sleep)-292.1(apnea)-289.3(or)-286.2(abnormalities)]TJ
0 -1.2266 TD
[(of)-324.1(sleep)-317.4(architecture,)-329.9(particularly)-319.9(in)-319.2(children)-327.7(with)-319.2(recent)-320.8(onset)-321.3(of)]TJ
0 -1.2203 TD
[(insomnia)-447.6(or)-444.2(parasomnias)-444.4(\(e.g.,)-442.3(sleepwalking,)-444.5(night)-441.9(terrors\).)-447(No)]TJ
T*
[(data)-278.8(are)-277.9(yet)-276.9(available)-282.9(for)-275.6(results)-277.6(of)-273.5(PSG)-277.2(evaluations)-280.7(in)-274.9(PANS,)-276.6(but)]TJ
0 -1.2266 TD
[(PSG)-321.5(studies)-325.6(in)-319.2(11)-321.5(children)-321.4(with)-325.5(PANDAS)-323.6(revealed)-322.2(parasomnias,)]TJ
0 -1.2203 TD
[(periodic)-365.7(limb)-363.7(movements,)-363.4(and)-361.4(abnormalities)-365.7(of)-362(rapid)-360.7(eye)-363.8(move-)]TJ
T*
[(ment)-438(\(REM\))-438(sleep,)-440.5(including)-433.7(REM)-433.7(behavior)-437.5(disorder)-438.9(and)-437.2(non-)]TJ
T*
[(specic)-210(REM)-212.4(motor)-203.7(disinhibition)-208.7(\(Hommer)-210.6(et)-207.8(al.)-204.4(2014\).)-205.4(If)-212.9(the)-207.3(PSG)]TJ
0 -1.2266 TD
[(reveals)-378.4(specic)-380.7(abnormalities)-378.4(of)-374.7(sleep)-374.3(architecture,)-380.5(they)-371.2(may)-377.5(be)]TJ
0 -1.2203 TD
[(targets)-481.1(of)-475.8(specic)-475.5(pharmacologic)-485.4(interventions,)-476.5(such)-475.9(as)-476.8(use)-476.4(of)]TJ
T*
[(benzodiazepines)-288.3(for)-282(REM)-282(behavior)-279.4(disorder.)]TJ
1.1128 -1.2267 TD
[(Lumbar)-252(puncture)-254.1(\(LP\))-248.2(should)-255.2(be)-248(considered)-256.8(if)-252.2(there)-249.3(are)-252.6(MRI)-253.2(or)]TJ
-1.1128 -1.2203 TD
[(EEG)-387.2(abnormalities,)-387.6(or)-381(encephalopathic)-392.3(symptoms)-382.6(such)-381(as)-388.3(delir-)]TJ
T*
[(ium,)-243(alteration)-242.4(of)-241.9(consciousness,)-246.5(seizures,)-242.9(or)-241.9(psychosis.)-242.5(If)-244.5(an)-241.7(LP)-237.7(is)]TJ
0 -1.2266 TD
[(done,)-224.7(the)-220(CSF)-221.7(evaluation)-229.4(should)-217.3(include)-224.4(oligoclonal)-224.2(bands,)-225.4(as)-217.6(well)]TJ
0 -1.2203 TD
[(as)-293.5(standard)-293.3(measures)-290.1(such)-292.5(as)-293.5(glucose)-291.2(and)-291.8(protein.)-290.8(In)-292.5(addition,)-285.4(as-)]TJ
T*
[(says)-287.4(for)-282(antineuronal)-287.9(antibodies,)-281.7(such)-286.2(as)-287.2(anti-NMDA)-284.8(receptor)-284.5(an-)]TJ
0 -1.2266 TD
[(tibodies,)-406.7(should)-394.3(be)-406.1(performed)-397.5(by)-403.7(a)-400.3(reliable)-403.7(laboratory)-398.9(\(e.g.,)-404.3(the)]TJ
0 -1.2203 TD
[(Neuroimmunology)-439.7(Laboratory)-445.3(at)-435.4(Mayo)-443.8(Clinic)-439.9(Laboratories,)-442.2(di-)]TJ
T*
[(rected)-282.8(by)-283.6(Dr.)-279.7(Vanda)-283.9(Lennon.\))]TJ
1.1128 -1.2203 TD
[(Sw)18.1(al)19.8(lo)22.2(wi)18.9(ng)-182.4(st)21.1(ud)19.9(ie)13.5(s)-190.4(m)0(i)18.7(g)13.1(ht)-180.1(be)-184.8(in)22.2(di)15.9(ca)21.4(te)19.8(d)-189.2(f)0(o)17.3(r)-191.8(ch)17.5(il)18.2(d)13.1(r)0(e)21.2(n)-195.5(wi)18.9(th)-180.1(re)21.3(st)21.1(ri)19.6(ct)13.5(ed)]TJ
-1.1128 -1.2266 TD
[(fo)17.3(o)13.1(d)-277.7(in)15.9(t)15.4(a)0(k)17.5(e)0(,)-264.1(p)0(a)17.5(r)0(t)19.6(i)0(c)19.8(u)0(l)15.9(a)0(r)21.2(l)0(y)-268.6(w)0(h)23(e)0(n)-267(r)0(e)21.2(l)0(a)13.5(t)0(e)19.8(d)-271.4(to)-268.6(fe)21.3(ar)14.9(s)-272.6(o)0(f)-267.2(c)0(h)17.5(o)13.1(ki)15.9(n)13.1(g)-277.7(o)13.1(r)-274(vo)19.9(mi)18.7(t-)]TJ
0 -1.2203 TD
[(in)15.9(g)13.1(.)-281.1(In)-273.5(S)14.6(C)0(,)-272.7(s)0(w)15.5(a)0(l)19.8(l)0(o)22.2(w)0(i)18.9(n)0(g)-270.9(s)0(t)21.1(u)0(d)19.9(i)0(e)19.8(s)-285.2(re)21.2(ve)17.5(al)19.8(ed)-273.3(d)13.1(y)0(s)18.8(p)0(h)19.9(a)0(g)17.5(i)0(a)-271(r)0(e)21.3(l)0(a)19.8(t)0(e)13.5(d)-277.7(to)-268.6(mo)16.4(to)22.2(r)]TJ
T*
[(ab)17.5(no)19.9(rm)20.1(al)19.8(it)18.2(ie)19.8(s)-601.4(a)0(n)17.5(d)-593.9(dy)19.9(sc)16.3(o)13.1(o)0(r)17.3(d)13.1(in)15.9(at)19.8(io)22.2(n)-600.2(o)0(f)-589.7(t)0(h)22.2(e)-602.6(v)13.1(o)0(l)15.9(u)13.1(nt)15.9(ar)21.2(y)13.1(/)0(i)18.2(n)0(v)19.9(o)0(l)15.9(u)13.1(nt)22.2(ar)14.9(y)]TJ
0 -1.2267 TD
[(mu)16.4(sc)22.7(le)13.5(s)-266.3(o)0(f)-260.9(t)0(h)22.2(e)-273.8(es)16.3(o)13.1(p)0(h)19.9(a)0(g)17.5(u)13.1(s)-272.6(\()0(S)18.8(w)0(e)20.5(d)0(o)-258.3(e)0(t)-264.7(a)0(l)19.8(.)-268.5(19)19.9(94)19.9(\).)]TJ
/F4 1 Tf
28.0042 74.5598 TD
(Discussion)Tj
/F5 1 Tf
1.1128 -1.8336 TD
[(The)-285.3(recommended)-292.2(diagnostic)-285.1(workup)-287.5(for)-288.3(youth)-286.1(with)-287.6(suspected)]TJ
-1.1128 -1.2203 TD
[(PANS)-362.2(presented)-358.4(here)-365.9(represents)-361.7(a)-362.3(consensus)-364.4(of)-362(the)-359.1(expert)-362.6(panel)]TJ
0 -1.2266 TD
[(assembled.)-205.4(It)-208(is)-206.6(not)-204.9(intended)-205(to)-205.4(be)-210.1(algorithmic;)-208.6(therefore,)-207.3(clinicians)]TJ
0 -1.2203 TD
[(should)-400.6(use)-406.8(these)-405.9(guidelines)-411.5(along)-402.3(with)-407.7(their)-402.6(best)-404(judgment.)-405(Al-)]TJ
T*
[(though)-279.3(we)-283(tried)-282.5(to)-281.2(be)-279.6(as)-280.8(comprehensive)-286.6(as)-280.8(possible,)-283.7(we)-283(are)-277.9(aware)]TJ
0 -1.2266 TD
[(that)-280.4(individual)-279.2(cases)-285.4(may)-276.4(require)-282.5(evaluation)-280(that)-280.4(is)-282.4(not)-280.8(mentioned)]TJ
0 -1.2203 TD
[(here.)-349.8(As)-351.3(with)-350.8(all)-344.1(new)-352(presentations)-353.1(of)-349.4(psychiatric)-352.8(disease)-351.7(and/or)]TJ
T*
[(escalations)-271.7(of)-273.5(psychiatric)-277(symptoms,)-271.7(investigation)-272.7(into)-271.6(the)-270.5(history)]TJ
T*
[(must)-455.7(include)-452.1(the)-453.9(medical)-458(history)-457.3(\(with)-454.1(emphasis)-459.8(on)-454.3(recent)-453.6(ill-)]TJ
0 -1.2266 TD
[(nesses,)-533.2(exposures,)-539.5(fevers,)-536(history)-539.5(of)-532.8(painful)-534.5(joints,)-538(abdominal)]TJ
0 -1.2203 TD
[(pain\),)-281.4(review)-283.7(of)-279.8(systems)-288.3(\(including)-284.1(discussion)-281(about)-282.2(pain)-282.7(and)-285.5(rel-)]TJ
T*
[(evant)-335.2(rashes,)-338.6(such)-336.8(as)-337.7(scarlatina)-336.8(rash,)-336(erythema)-336(marginatum\),)-338.8(and)]TJ
0 -1.2266 TD
[(physical)-313.7(examnation)-311.1(\(with)-308.7(focus)-313.6(on)-308.8(evaluating)-317.9(chorea)-310.4(and)-310.8(chore-)]TJ
0 -1.2203 TD
[(iform)-345.4(movements\).)-346.5(Since)-346.4(this)-348.7(syndrome)-347.3(presents)-351.4(with)-344.5(prominent)]TJ
T*
[(behavior)-532.4(regression)-530(and)-532.1(personality)-533.8(change,)-532(reactionary)-536(social)]TJ
0 -1.2266 TD
[(disruptions)-277.2(\(including)-284.1(issues)-285.3(with)-281.3(school)-276.6(functioning,)-286.5(friends,)-277.9(and)]TJ
0 -1.2203 TD
[(parent)-299.4(accommodation\))-298.8(may)-301.7(give)-295.3(the)-302.1(appearance)-303.1(of)-298.8(there)-299.9(being)-294.8(a)]TJ
T*
[(psychosocial)-486(cause)-486.5(to)-489.9(the)-485.5(illness.)-484.2(Acute-onset)-491.2(neuropsychiatric)]TJ
0 -1.2266 TD
[(symptoms)-616.6(can)-616.7(be)-614.8(related)-615.2(to)-616.4(psychosocial)-618.8(traumas/stress,)-623.2(but)]TJ
0 -1.2203 TD
[(trauma/stress)-233.9(response)-239.9(should)-229.9(be)-235.4(a)-235.9(diagnosis)-236.1(of)-229.3(exclusion.)-233.9(There)-238.8(is)]TJ
T*
[(also)-264.9(clinical)-259.7(overlap)-267.3(between)-264.1(the)-264.2(symptoms)-262.5(of)-260.9(PANS)-261.1(and)-266.5(those)-264.4(of)]TJ
T*
[(conversion)-545.2(disorder)-552.7(and)-551(psychosomatic)-546(illnesses.)-550.1(Therefore,)-550.8(a)]TJ
0 -1.2266 TD
[(comprehensive)-299.2(history,)-289.5(psychiatric)-302.3(interview,)-293.2(and)-298.1(complete)-293.1(phys-)]TJ
0 -1.2203 TD
[(ical)-282.8(examination)-283(are)-277.9(critical)-287.6(in)-274.9(all)-287.2(cases)-279.1(of)-279.8(suspected)-287.5(PANS.)]TJ
1.1128 -1.2203 TD
[(During)-304.2(the)-302.1(evaluation)-311.6(of)-305.1(children)-308.8(with)-306.6(PANS,)-301.9(it)-310.6(is)-301.4(particularly)]TJ
-1.1128 -1.2266 TD
[(important)-528.4(to)-521.5(consider)-533.5(alternative)-528.8(medical)-527.6(explanations)-526.8(for)-528.5(the)]TJ
0 -1.2203 TD
[(neuropsychiatric)-355.4(symptoms.)-353.9(Lupus)-352.6(cerebritis)-362.3(and)-348.7(the)-359.1(various)-354.6(au-)]TJ
T*
[(toimmune)-304.5(encephalitides)-307.1(may)-308(present)-306.4(with)-306.6(isolated)-305(cognitive)-303.4(and)]TJ
0 -1.2266 TD
[(behavioral)-480.9(symptoms,)-486.7(personality)-483.2(change,)-481.5(and)-481.5(other)-487.1(symptoms)]TJ
0 -1.2203 TD
[(\(Dale)-214.7(and)-209.6(Brillot)-209.7(2012\).)-211.7(Referral)-215.9(to)-211.7(a)-210.6(neurologist)-215.2(or)-210.3(rheumatologist)]TJ
T*
[(can)-376.4(be)-380.8(helpful)-376.4(in)-376.1(some)-378.2(cases,)-383.2(but)-375.6(should)-375.3(be)-380.8(focused)-378.3(on)-378.4(specic)]TJ
T*
[(signs)-389.7(or)-387.3(symptoms)-388.9(of)-387.3(concern,)-388.7(as)-388.3(the)-390.7(subspecialists)-394.3(may)-383.9(not)-388.3(be)]TJ
0 -1.2266 TD
[(experienced)-399(with)-401.4(the)-397(evaluation)-406.5(of)-393.7(psychiatric)-403.4(symptomatology.)]TJ
0 -1.2203 TD
[(Therefore,)-316.9(the)-314.8(responsibility)-317.8(of)-317.8(evaluating)-317.9(PANS)-318(falls)-315.3(to)-319.2(primary)]TJ
T*
[(care)-393.6(clinicians)-392.7(and)-393(child)-393.7(psychiatrists.)-390.4(In)-393.6(the)-390.7(future,)-397.3(empirically)]TJ
0 -1.2266 TD
[(based)-376.6(algorithms)-377.3(for)-376.8(diagnosis)-381.5(and)-374(treatment)-381.5(will)-380.1(be)-374.5(developed.)]TJ
0 -1.2203 TD
[(Until)-215.3(then,)-222.4(we)-219.7(hope)-215.5(that)-217.2(this)-215.9(article)-220.8(serves)-221.9(as)-217.6(a)-223.2(starting)-216.7(template)-221.3(for)]TJ
T*
[(the)-276.9(proper)-282.9(evaluation)-286.3(of)-279.8(youth)-279.8(with)-281.3(PANS.)]TJ
/F4 1 Tf
0 -3.0413 TD
(Disclosures)Tj
/F5 1 Tf
1.1128 -1.8336 TD
[(Dr.)-665.4(Chang)-668.6(is)-674.5(an)-665.3(unpaid)-673.7(consultant)-670.8(for)-667.6(GlaxoSmithKline,)]TJ
-1.1128 -1.2203 TD
[(Lilly,)-214.7(and)-222.3(Bristol-Myers)-219.7(Squibb.)-217.6(He)-219.7(is)-219.2(on)-220.3(the)-220(DSMB)-220.3(for)-218.7(Sunovion.)]TJ
0 -1.2266 TD
[(In)-539.1(the)-542.4(past)-536.8(two)-543.3(years)-543.6(he)-538.9(has)-539.6(received)-543.5(research)-543.3(support)-541.9(from)]TJ
0 -1.2203 TD
[(GlaxoSmithKline)-247.6(and)-241.2(Merck.)-242.6(Dr.)-241.8(Walter)-248.4(is)-244.5(on)-239.3(the)-245.2(Advisory)-241.2(Board)]TJ
T*
[(of)-463.2(Baxter)-468.5(regarding)-464.9(IGHy,)-465.4(a)-463.5(new)-465.8(formulation)-466.8(of)-463.2(subcutaneous)]TJ
T*
(immunoglobulin.)Tj
1.1128 -1.2266 TD
[(Dr.)-380.9(Madeleine)-393.4(Cunningham)-382.9(is)-383.6(co-founder)-387.1(and)-386.7(chief)-388.4(scientic)]TJ
-1.1128 -1.2203 TD
[(ofcer)-606.4(of)-608.6(Moleculera)-610.5(Labs,)-605.1(which)-608(provides)-607(specialized)-614.3(anti-)]TJ
T*
[(neuronal)-456.5(antibody)-455.5(testing.)-457.8(Several)-458(members)-461.2(of)-456.9(the)-460.2(PANS)-457.1(Col-)]TJ
0 -1.2266 TD
[(laborative)-605.1(Consortium)-609.6(have)-603.6(scientic)-609(collaborations)-608.3(with)-603.7(Dr.)]TJ
0 -1.2203 TD
[(Cunningham.)-278.3(The)-285.3(other)-278.5(authors)-278.7(have)-281.1(nothing)-282.8(to)-281.3(disclose.)]TJ
/F4 1 Tf
0 -2.7758 TD
(References)Tj
/F5 1 Tf
8.4682 0 0 8.4682 310.8472 109.5874 Tm
[(Allen)-484.4(AJ,)-488.1(Leona)-9.3(rd)-485.9(HL,)-486.7(Swedo)-489.8(SE:)-487.8(Case)-491.9(study:)-485.3(A)-487.1(new)-490.7(infection-)]TJ
1.0042 -1.2318 TD
[(triggered,)-459.5(autoimmune)-458.4(subtype)-455.3(of)-452.4(pediatr)-9.4(ic)-450.3(OCD)-462.1(and)-454.3(Tourettes)]TJ
0 -1.2385 TD
[(syndrome.)-249.4(J)-251(A)0(m)-255(Acad)-251.3(Child)-255.8(Adolesc)-256.9(Psychiatry)-252.8(34:307311,)-251.2(1995.)]TJ
-1.0042 -1.2318 TD
[(American)-257(Academy)-257.2(of)-251.6(Pediatrics:)-257.2(Mycoplasma)-256.5(pneumoniae)-252(and)-253.5(other)]TJ
1.0042 -1.2385 TD
[(mycoplasma)-347.1(species)-355(infections.)-347.5(In:)-345.5(Red)-348.6(Book)-344.6(2012,)-347.6(Report)-352.6(of)-345.3(the)]TJ
0 -1.2318 TD
[(Committee)-375.4(on)-372.4(Infectious)-378.1(Diseases,)-379(29th)-374.7(ed.,)-374(edited)-375.9(by)-379.1(L.K.)-370.6(Pick-)]TJ
/F4 1 Tf
8.9663 0 0 8.9663 59.7543 749.7069 Tm
[(PANS)-336.6(CLINICAL)-339.4(EVALUATION)-334.8(CONSENSUS)-341.1(RECOMMENDATIONS)-21546(11)]TJ
ET
endstream
endobj
109 0 obj
<>stream
/GS1 gs
BT
/F5 1 Tf
8.4682 0 0 8.4682 70.526 725.7825 Tm
0 0 0 rg
0 Tc
0 Tw
[(ering.)-467.3(Elk)-472.9(Grove)-467.8(Village,)-470.5(IL:)-465.8(American)-478(Academy)-471.5(of)-465.8(Pediatrics,)]TJ
0 -1.2318 TD
[(518521,)-333.8(2012.)]TJ
-1.0042 -1.2385 TD
[(Ben-Pazi)-357.3(H,)-344.2(Stoner)-352.8(JA,)-354.2(Cunningham)-348.2(MW:)-350.7(Dopamine)-358.4(receptor)-347.3(auto-)]TJ
1.0042 -1.2318 TD
[(antibodies)-403.7(correlate)-407.2(with)-402.5(symptoms)-406(in)-404(Sydenhams)-404.2(chorea.)-403.3(PLoS)]TJ
0 -1.2385 TD
[(One)-336.7(8:e73516,)-333.5(2013.)]TJ
-1.0042 -1.2318 TD
[(Bos-Veneman)-321.4(NG,)-322.4(Olieman)-320.9(R,)-315.8(Tobiasova)-318.2(Z,)-321(Hoekstra)-318.9(PJ,)-319.3(Katsovich)]TJ
1.0042 -1.2385 TD
[(L,)-374.5(Bothwell)-376.4(AL,)-372.9(Leckman)-374.6(JF,)-372.9(Kawikova)-374.5(I:)-376.8(Altered)-373.9(immunoglob-)]TJ
0 -1.2318 TD
[(ulin)-553.6(proles)-556.9(in)-551.3(children)-553.8(with)-549.8(Tourette)-560.3(syndrome.)-550.6(Brain)-558(Behav)]TJ
0 -1.2385 TD
[(Immun)-338.6(25:532538,)-331.5(2011.)]TJ
-1.0042 -1.2318 TD
[(Brimberg)-537.4(L,)-541.9(Benhar)-534.7(I,)-541.7(MascaroBlanco)-539.1(A,)-538.3(Alvarez)-542.6(K,)-538.3(Lotan)-536.8(D,)]TJ
1.0042 -1.2385 TD
[(Winter)-237.1(C,)-235.5(Klein)-243.4(J,)-235.3(Moses)-236.6(AE,)-239(Somnier)-234.6(FE,)-237.6(Leckman)-240.7(JF,)-239(Swedo)-235.4(SE,)]TJ
0 -1.2318 TD
[(Cunningham)-415.2(MW,)-421.9(Joel)-415.5(D:)-413.6(Behavioral,)-422.7(pharmacological,)-422.3(and)-414.2(im-)]TJ
0 -1.2385 TD
[(munological)-284.3(abnormalities)-286.8(after)-281.3(streptococcal)-287.5(exposure:)-277.9(a)-282.7(novel)-282.6(rat)]TJ
0 -1.2318 TD
[(model)-316.2(of)-311.8(Sydenham)-312.1(chorea)-318.6(and)-313.7(related)-316.8(neuropsychiatric)-314.1(disorders.)]TJ
0 -1.2385 TD
[(Neuropsychopharmacology)-342(37:20762087,)-335.8(2012.)]TJ
-1.0042 -1.2318 TD
[(Caruso)-429.4(JM,)-434.9(Tung)-430(GA,)-429.6(Gascon)-430.7(GG,)-436.3(Rogg)-424.9(J,)-429.5(Davis)-434(L,)-428.1(Brown)-436.3(WD:)]TJ
1.0042 -1.2385 TD
[(Pe)21.6(rs)21.7(i)13.2(s)0(t)23.3(e)0(n)23.1(t)-241.2(pr)22.9(ec)17(ed)23.1(i)13.2(n)0(g)-231.8(f)0(o)22.9(c)0(a)23.7(l)-241.2(ne)23.1(ur)22.9(ol)17.8(o)18(g)0(i)17.8(c)-242.6(de)23.1(c)21.6(i)13.2(t)13.2(s)-244.3(i)13.2(n)-243.1(ch)23.1(i)13.2(l)0(d)24.5(r)0(e)16.8(n)-236.4(wi)21.6(th)-229.9(ch)16.4(ro)22.9(n)18(i)0(c)]TJ
0 -1.2318 TD
[(Ep)22.7(st)23.3(ei)18.4(n)29.3(Ba)21.7(rr)-311.4(vi)17.8(ru)22.9(s)-318(e)0(n)23.1(c)0(e)17(p)0(h)29.3(a)0(l)18.4(i)13.2(t)13.2(i)0(s)16.6(.)-319.1(J)-324.6(C)16.6(hi)17.8(l)13.2(d)-323.5(N)15.1(e)0(u)23.1(r)0(o)22.9(l)-321.5(15)22.6(:)13.2(7)0(9)22.6(1)0()22.6(7)0(9)22.6(6)0(,)-307.8(2)0(0)22.6(0)0(0)22.6(.)]TJ
-1.0042 -1.2385 TD
-.0245 Tc
[(Cente)-6(r).5(s)-436.2(f).5(or)-441.3(Disease)-441.1(C)-1.2(ontrol)-439.8(a).7(nd)-441.7(Prevention)6.9(:)-439.8(L)-6.3(yme)-434.4(D)-2.8(isea)-6(s)5.7(e)-6(,)-437.3(T).4(wo-S)5.3(tep)]TJ
1.0042 -1.2385 TD
-.0251 Tc
[(Labora)-6.6(t)1.5(ory)-469.1(T)-.2(esting)-469.1(P)-2(rocess,)-464.7(2011.)-471.4(Av)]TJ
15.311 0 TD
-.0246 Tc
[(ailable)-468(a)-6.1(t)-466.6(h).1(ttp://www.cdc.gov/)]TJ
-15.311 -1.2318 TD
-.025 Tc
[(lyme)-6.5(/diagnosiste)-6.5(s)5.2(t)-5.1(ing/La)-6.5(b)6.4(T)-6.8(est/TwoStep/index.html.)-906.4(A)-3.3(ccessed)-904.1(J)-1.5(une,)]TJ
0 -1.2385 TD
-.0247 Tc
(2014.)Tj
-1.0042 -1.2318 TD
0 Tc
[(Centers)-462.5(for)-454.1(Disease)-465(Control)-453.8(and)-461(Prevention:)-459.4(Lyme)-456.4(Disease)-458.3(\(map\),)]TJ
1.0042 -1.2385 TD
[(2013.)-541.7(Available)-543.4(at)-544(http://www.cdc.gov/lyme/stats/maps/map2)-19.8(012)]TJ
0 -1.2318 TD
[(.html.)-334.9(Accessed)-341.3(August,)-333.9(2014.)]TJ
-1.0042 -1.2385 TD
[(Cherry)-514.8(J,)-509.8(Mundi)-507.3(J)-512.1(and)-507.9(Shapiro)-515.6(N:)-507.3(Rhinosinusitis.)-518(In:)-506.1(Feigin)-511.9(and)]TJ
1.0042 -1.2318 TD
[(Cherrys)-319(Textbook)-322.2(of)-311.8(Pediatric)-320.7(Infectious)-324.5(Diseases,)-318.8(7th)-319.1(ed.,)-313.7(edited)]TJ
0 -1.2385 TD
[(by)-439.4(J.D.)-438.9(Cherry,)-438.9(G.J.)-438.9(Harrison,)-437.3(S.L.)-442.9(Kaplan,)-438.7(W.J.)-437.5(Steinbach,)-441.2(and)]TJ
0 -1.2318 TD
[(P.J.)-337.1(Hotez.)-336.2(Philadelphia:)-339(Elsevier)-333.9(Saunders,)-337.2(193203,)-333.8(2014.)]TJ
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[(Cox)-355.8(CJ,)-359.3(Sharma)-361(M,)-357.9(Leckman)-361.2(JF,)-359.5(Zuccolo)-359.7(J,)-355.8(Zuccolo)-359.7(A,)-364.3(Kovoor)-356.7(A,)]TJ
1.0042 -1.2318 TD
[(Swedo)-362.6(SE,)-364.8(Cunningham)-361.6(MW:)-364.1(Brain)-363.9(human)-365(monoclonal)-364.5(autoanti-)]TJ
0 -1.2385 TD
[(body)-631.1(from)-623.8(sydenham)-633.1(chorea)-633.2(targets)-626.5(dopa)-7.9(minergic)-627.6(neurons)-631(in)]TJ
0 -1.2318 TD
[(transgenic)-331.1(mice)-320.2(and)-327.1(signals)-327.4(dopamine)-322(d2)-325.6(receptor:)-327.4(Implications)-325.5(in)]TJ
0 -1.2385 TD
[(human)-338.2(disease.)-332.6(J)-338(Immunol)-334.2(191:55245541,)-331.2(2013.)]TJ
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[(Dale)-530.5(RC,)-526.9(Brilot)-530.1(F:)-526(Autoimmune)-528.8(basal)-524.2(ganglia)-532(disorders.)-524.7(J)-532.2(Child)]TJ
1.0042 -1.2385 TD
[(Neurol)-334.1(27:14701481,)-335.8(2012.)]TJ
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[(Ercan)-336.9(TE,)-336.3(Ercan)-343.6(G,)-337.5(Severge)-335.6(B,)-335.9(Arpaozu)-337.6(M,)-337.9(Karasu)-343.3(G:)-333.3(Mycoplasma)]TJ
1.0042 -1.2385 TD
[(pneumoniae)-533.2(infection)-527.2(and)-528(obsessive-compulsive)-534.2(disease:)-529.2(a)-523.7(case)]TJ
0 -1.2318 TD
[(report.)-335.2(J)-338(Child)-329.4(Neurol)-340.8(23:338340,)-331.5(2008.)]TJ
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[(Fallon)-297.7(BA,)-300.8(Kochevar)-299(JM,)-294.3(Gaito)-303.6(A,)-297.3(Nields)-293.5(JA:)-303.1(The)-293.5(underdiagnosis)-301.1(of)]TJ
1.0042 -1.2318 TD
[(neuropsychiatric)-494.8(Lyme)-489.9(disease)-488.9(in)-484.3(children)-493.6(and)-487.8(adults.)-482.5(Psychiatr)]TJ
0 -1.2385 TD
[(Clin)-334(North)-339.2(Am)-328.7(21:693703,)-338.2(viii,)-335.1(1998.)]TJ
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[(Frankovich)-434.3(J,)-429.5(Thienemann)-439.3(M,)-431.6(Rana)-430.5(S,)-429.8(Chang,)-430.9(K:)-433.7(Five)-429.3(youth)-430.4(with)]TJ
1.0042 -1.2385 TD
[(pediatric)-345.9(acute-onset)-339.3(neuropsychiatric)-347.6(syndrome)-338.7(of)-338.6(differing)-341.5(etiol-)]TJ
0 -1.2318 TD
[(ogies.)-335(J)-338(Child)-329.4(Adolesc)-337.2(Psychopharm)-339.3(15:3137,)-334(2015a.)]TJ
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[(Frankovich)-240.2(J,)-228.6(Thienemann)-238.4(M,)-237.4(Pearlstein)-237(J,)-235.3(Crable)-238.2(A,)-230.4(Brown)-235.4(K,)-237.1(Chang)]TJ
1.0042 -1.2318 TD
[(K:)-607.8(Multidisciplinary)-614.5(Clinic)-610.2(Dedicated)-618.4(to)-604.8(Treating)-613.9(Youth)-607.4(with)]TJ
0 -1.2385 TD
[(Pediatric)-769.2(Acute-Onset)-774.2(Neuropsychiatric)-772.3(Syndrome:)-767.7(Presenting)]TJ
0 -1.2318 TD
[(Characteristics)-318.7(of)-305.1(the)-311.8(First)-310.3(47)-305.5(Consecutive)-314.8(Patients.)-311.7(Child)-309.3(Adolesc)]TJ
0 -1.2385 TD
[(Psycopharm)-337.2(25:3847,)-334(2015b.)]TJ
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[(Gabbay)-362.6(V,)-364.3(Coffey)-360.9(BJ,)-359.3(Babb)-364.1(JS,)-359.5(Meyer)-360.5(L,)-361.2(Wachtel)-365.6(C,)-356(Anam)-365.8(S,)-356.2(Ra-)]TJ
1.0042 -1.2385 TD
[(binovitz)-479.2(B:)-479(Pedia)-9.1(tric)-479(autoimmune)-478.4(neuropsychiatr)-11.1(ic)-477.1(disorders)-480.1(as-)]TJ
T*
[(sociated)-240.2(with)-241.8(streptococcus:)-237.8(Comparison)-241.9(of)-238.2(diagnosis)-237.9(and)-240.1(treatment)]TJ
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[(in)-276.8(the)-271.6(community)-276(and)-280.3(at)-276.2(a)-269.3(specialty)-280.5(clinic.)-278(Pediatrics)-277.1(122:273278,)]TJ
0 -1.2385 TD
(2008.)Tj
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[(Garvey)-462.7(MA,)-456.7(Giedd)-459.5(J,)-456.3(Swedo)-456.3(SE:)-461(PANDAS:)-456.2(The)-460.8(search)-460.4(for)-454.1(envi-)]TJ
1.0042 -1.2385 TD
[(ronmental)-321.8(triggers)-320.9(of)-325.2(pediatric)-319.1(neuropsychiatric)-327.5(disorders.)-323.8(Lessons)]TJ
0 -1.2318 TD
[(from)-335.9(rheumatic)-334.6(fever.)-341.1(J)-331.3(Child)-336.1(Neurol)-334.1(13:413423,)-338.2(1998.)]TJ
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[(Giedd)-359.1(JN,)-354.2(Rapoport)-356.8(JL,)-357.8(Garvey)-362.2(MA,)-356.3(Perlmutter)-356.6(S,)-356.2(Swedo)-362.6(SE:)-353.9(MRI)]TJ
1.0042 -1.2318 TD
[(assessment)-370.6(of)-372.1(children)-366.4(with)-369(obsessive-compulsive)-380.2(disorder)-369.7(or)-365.4(tics)]TJ
0 -1.2385 TD
[(associated)-332.1(with)-335.6(streptococcal)-334.3(infection.)-330.8(Am)-328.7(J)-331.3(Psychiatry)-333.2(157:281)]TJ
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