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[(study)-224.1(noted)-225.3(that)-223.5(11)-220.3(of)-222.9(12)-226.6(PANDAS)-222.4(cases)-228.5(\(92%\))-219.9(had)-228.6(previous)-221.3(GAS)]TJ
T*
[(pharyngitis)-234.2(documented)-231.2(17)-226.2(times)-234(before)-228.4(the)-232.6(inciting)-229.6(episode.)-237.2(The)]TJ
0 -1.2266 TD
[(initiating)-198.7(infections)-199.2(demonstrated)-200.1(denite)-197.7(pharyngeal)-205(erythema)-196.9(but)]TJ
0 -1.2203 TD
[(was)-201.5(otherwise)-205.3(notably)-203.1(mild:)-202.8(usually)-204.2(afebrile,)-202.9(with)-199.1(minimal)-201.5(exudate)]TJ
T*
[(and)-279.2(cervical)-288.3(lymphadenopathy)-277.1(\()-84.3(Murphy)-284.9(and)-279.2(Pichichero)-283.5(2002\).)]TJ
1.1128 -1.2266 TD
[(Importantly,)-457.1(the)-453.9(relationship)-455.1(between)-453.8(GAS)-459(and)-449.9(PANDAS)-456.4(is)]TJ
-1.1128 -1.2203 TD
[(further)-308(strengthened)-310.4(among)-313.3(those)-308.7(with)-306.6(a)-305.4(history)-311.9(of)-305.1(prior)-310.3(GAS)-307.2(in-)]TJ
T*
[(fections.)-199(Cases)-199.2(with)-192.8(multiple)-195.2(prior)-196.5(GAS)-199.7(infections)-192.8(have)-198.9(been)-198.9(found)]TJ
0 -1.2266 TD
[(to)-205.4(have)-205.2(more)-202.6(frequent)-199.8(relapses)-208.4(\(Swedo)-206.3(et)-201.5(al.)-204.4(1998;)-203.9(Mell)-205.2(et)-201.5(al.)-204.4(2005;)]TJ
0 -1.2203 TD
[(Murphy)-310.2(et)-315.3(al.)-311.9(2007,)-310.8(2012;)-311.4(Murphy)-316.5(et)-309(al.)-318.2(2015\).)-306.6(Further,)-313.2(the)-314.8(rela-)]TJ
27.9978 74.5598 TD
[(tionship)-281.2(appears)-285.8(to)-281.2(be)-279.7(quantitative,)-283.7(with)-281.3(the)-283.2(number)-283.8(of)-279.8(prior)-278.7(GAS)]TJ
0 -1.2203 TD
[(infections)-325.6(being)-320.1(correlated)-321.5(with)-319.2(the)-321.1(frequency)-317.9(and)-323.4(severity)-322.6(of)-317.8(re-)]TJ
0 -1.2266 TD
[(lapses)-286.5(\()-84.3(Murphy)-278.6(and)-279.2(Pichichero)-283.5(2002\).)]TJ
/F2 1 Tf
1.1128 -2.7505 TD
[(Epidemiologic)-1145.3(studies.)]TJ
/F6 1 Tf
11.7669 0 TD
[(Population-based)-1088.8(epidemiologic)]TJ
-12.8798 -1.2203 TD
[(studies)-243.4(provide)-239.6(additional)-237.3(support)-238.3(for)-237.7(an)-241.7(association)-237.6(between)-238.8(GAS)]TJ
T*
[(and)-411.9(PANDAS-like)-416.4(neuropsychiatric)-412.3(syndromes.)-414.1(One)-415.2(such)-406.3(study)]TJ
0 -1.2266 TD
[(showed)-313.8(an)-311.3(association)-313.5(of)-311.4(OCD,)-316.3(tic)-312.5(disorder,)-309(and/or)-309.6(Tourette)-314.9(syn-)]TJ
0 -1.2203 TD
[(drome)-284.3(with)-281.3(streptococcal)-280.8(infection)-287(in)-274.9(the)-283.2(previous)-278.2(3)-277.7(months,)-280.6(with)]TJ
T*
[(an)-267(odds)-264.8(ratio)-263.5(of)-260.9(2.2)-261.2(\()-84.3(Mell)-262.1(et)-264.7(al.)-267.6(2005\).)-262.3(A)-262.1(similar)-265(population-based)]TJ
0 -1.2266 TD
[(study)-445.4(\(Leslie)-443(et)-435.4(al.)-444.7(2008\))-436.4(demonstrated)-440.4(an)-444(association)-440(between)]TJ
0 -1.2203 TD
[(neuropsychiatric)-216.3(symptoms)-211.9(and)-209.6(GAS)-206.1(infection)-211.1(in)-211.7(the)-207.3(previous)-215(year)]TJ
T*
[(\(odds)-285.9(ratio)-276.2(1.54\),)-284.7(although)-278.4(not)-280.8(in)-281.2(the)-276.9(previous)-284.5(3)-277.7(months.)]TJ
/F2 1 Tf
1.1128 -2.7505 TD
[(Prospective)-434.1(study)-428.7(of)-431.6(GAS)-428.8(acquisition.)]TJ
/F6 1 Tf
18.2416 0 TD
[(An)-324.8(i)15.4(m)0(p)22.7(o)13.1(rt)19.6(an)23.8(t)-332.3(p)13.1(ro)23.7(-)]TJ
-19.3544 -1.2203 TD
-.0141 Tc
[(s)-14.1(p)4.7(e)-14.1(c)7.3(ti)-14.1(v)8.1(e)-654.6(s)-14.1(c)8.6(hool)-14.1(-)5.5(b)-1(a)-14.1(s)8.6(e)-14.1(d)-641.5(s)-14.1(t)7(udy)-658.5(e)-14.1(v)9.8(a)-14.1(l)12.1(ua)-14.1(t)5.7(e)-14.1(d)-641.5(t)-14.1(h)8.1(e)-654.6(e)-14.1(f)7.2(f)-14.1(e)7.2(ct)-14.1(s)-644.3(o)-1(f)-654.8(a)-14.1(c)7.3(q)-1(u)-14.1(i)8.2(r)-14.1(e)7.1(d)]TJ
0 -1.2266 TD
0 Tc
[(as)22.7(ym)22.7(p)13.1(t)0(o)22.3(m)0(a)20.3(t)15.4(ic)-448.1(p)13.1(h)0(a)23.8(r)0(y)23.7(n)0(g)19.9(e)0(a)21.4(l)-458.8(G)16.2(A)0(S)-449.8(c)0(o)23.9(l)15.4(on)19.9(i)15.4(z)0(a)21.4(t)0(i)24.5(o)0(n)-447.9(o)13.1(v)13.1(e)0(r)-446.6(8)-461.1(mo)22.7(n)13.1(t)0(h)22.2(s)-455.9(in)-445.6(a)]TJ
0 -1.2203 TD
-.0132 Tc
[(p)-13.2(o)6.7(pul)-13.2(a)6.6(t)2.2(i)-13.2(o)9.1(n)-512.2(o)-13.2(f)-508(693)-518.5(typ)-13.2(i)9(c)-13.2(a)8.2(l)-516.2(e)-13.2(l)13(e)-13.2(m)7.1(e)-13.2(n)10.7(t)-13.2(a)6.6(r)3.7(y)-518.5(s)-13.2(c)9.5(hool)-13.2(c)6.6(h)-.1(i)-13.2(l)11.3(dr)-13.2(e)8(n)-.1(.)-515.6(T)-13.2(h)6.9(e)-514.6(s)-13.2(t)7.9(udy)]TJ
T*
0 Tc
[(sh)18.8(o)13.1(w)0(e)20.5(d)-309.3(a)-311.7(s)0(t)21.1(r)0(i)19.6(k)13.1(i)15.4(n)13.1(g)-315.7(i)0(n)22.3(c)0(r)21.2(e)17(as)22.7(e)-318.1(i)15.4(n)-315.7(n)13.1(eu)23.8(ro)23.7(lo)22.2(g)13.1(i)0(c)-302.6(a)0(n)23.9(d)-315.7(b)13.1(e)0(h)23.9(a)0(v)23.9(i)0(o)22.3(r)0(a)21.2(l)-313.4(sy)25.1(m)15.9(p)0(t)22.3(o)13.1(ms)]TJ
0 -1.2266 TD
[(as)22.7(so)18.8(ci)26.2(at)19.8(ed)-235.4(wi)25.3(th)-237(GA)19.7(S)-244.7(a)0(c)21.4(q)13.1(u)13.1(i)0(s)21.1(i)0(t)24.6(i)0(o)22.3(n)-246.1(\()-71.7(M)12.4(ur)23.7(ph)20(y)-246.1(e)0(t)-239.4(a)0(l)26.2(.)-249.5(2)13.1(0)13.1(0)0(7)20(\))0(.)-232.7(T)0(h)20.1(i)15.4(s)-253.6(i)15.4(s)-247.3(n)0(o)19.9(t)15.4(e-)]TJ
0 -1.2203 TD
[(wo)23(rt)19.6(h)13.1(y)-239.8(g)13.1(i)0(v)22.3(e)0(n)-229.1(t)15.4(he)-229.1(hi)22.2(g)13.1(h)-239.8(po)19.9(i)15.4(n)13.1(t)-243.8(p)13.1(re)21.2(v)13.1(a)0(l)26.2(e)0(n)17.5(c)17(e)-242.2(o)13.1(f)-242.4(c)0(h)23.8(i)0(l)24.5(d)0(h)20(o)13.1(o)13.1(d)-239.8(GA)19.7(S)-238.4(c)0(o)23.9(l)15.4(on)19.9(i)15.4(z)0(a)21.4(-)]TJ
T*
-.0131 Tc
[(t)-13.1(i)5.1(on,)-300.5(r)-13.1(a)8.1(ngi)-13.1(n)9.2(g)-303.5(3%)-13.1()11.1(2)-13.1(6)6.9(%)-299.3(i)-13.1(n)-294.4(va)-13.1(r)8.1(i)2.3(ou)-13.1(s)-291.5(s)-13.1(e)9.6(t)-13.1(t)5.1(i)2.3(ngs)-304.6(\()-13.1(S)5.7(ha)-13.1(i)13(k)0(h)-303.5(e)-13.1(t)-296.8(a)3.9(l)-13.1(.)-291.4(2)-13.1(0)6.8(10\))-13.1(.)-290(I)-13.1(t)-290.6(i)-13.1(s)]TJ
0 -1.2267 TD
0 Tc
[(al)19.8(so)-392.2(n)13.1(o)13.1(t)0(e)19.8(w)16.2(or)23.7(th)22.2(y)-404.2(t)15.4(ha)23.8(t)-408.2(a)-400.3(si)21.1(m)15.9(i)0(l)18.2(a)17(r)-406.8(p)13.1(h)13.1(e)0(n)23.8(o)13.1(me)20.3(n)13.1(o)13.1(n)-404.2(wa)20.5(s)-399(n)13.1(ot)-395.1(o)13.1(b)13.1(s)0(e)22.7(r)0(v)23.7(e)0(d)-393.5(o)13.1(n)]TJ
0 -1.2203 TD
[(fo)23.7(ll)18.2(o)13.1(w)0(-)26.7(u)0(p)-239.3(o)13.1(f)-248.7(4)13.1(1)13.1(1)-246.1(ch)23.9(il)24.5(d)13.1(r)0(e)21.2(n)-246.1(wi)18.9(t)15.4(h)-246.1(pr)23.7(om)22.7(p)13.1(t)0(l)24.6(y)-252.4(t)15.4(r)0(e)21.2(a)0(t)26.1(e)0(d)-235.4(a)0(c)21.4(u)0(t)22.3(e)-248.5(GA)26(S)-251(p)13.1(h)13.1(a)0(r)21.2(y)13.1(n)13.1(-)]TJ
T*
[(gi)22.2(ti)24.5(s)-241(i)0(n)-224.3(a)-242.2(p)13.1(r)0(o)23.7(s)0(p)25.1(e)0(c)21.4(t)0(i)24.5(v)13.1(e)-242.2(p)13.1(ri)26(ma)20.3(ry)23.7(-c)21.2(ar)27.6(e)-242.2(s)0(e)22.7(t)15.4(ti)18.2(n)13.1(g)-233.5(\(P)18.8(er)27.6(ri)19.6(n)-233.5(e)0(t)-233.1(a)17(l.)-227.7(2)13.1(0)0(0)19.9(4)13.1(\).)]TJ
1.1128 -1.2203 TD
[(A)-293.7(degree)-291.5(of)-292.5(confusion)-296.7(has)-286.7(arisen)-294.2(since)-298.5(two)-290.4(additional)-294.2(prospec-)]TJ
-1.1128 -1.2266 TD
[(tive)-387.9(studies)-382.5(seemed)-388.4(to)-382.4(show)-381.9(little)-380(relationship)-385.6(between)-390.5(GAS)-383.1(in-)]TJ
0 -1.2203 TD
[(fections)-411.1(and)-399.3(exacerbations)-409.6(of)-400(proposed)-407(PANDAS)-399.5(cases)-405.5(\(Kurlan)]TJ
T*
[(et)-384.8(al.)-381.4(2008;)-381(Leckman)-386.6(et)-384.8(al.)-381.4(2011\).)-382.5(However,)-386.6(these)-380.7(patients)-387.2(may)]TJ
0 -1.2266 TD
[(have)-281.1(represented)-286.6(a)-273.8(distinctive)-286.3(population)-275.2(\(Luo)-278.7(et)-283.7(al.)-273.9(2004;)-279.8(Kurlan)]TJ
0 -1.2203 TD
[(et)-264.7(al.)-261.3(2008;)-260.8(Leckman)-260.1(et)-264.7(al.)-255(2011;)-260.8(Martino)-263.3(et)-258.4(al.)-261.3(2011;)-260.8(discussed)-260.9(in)]TJ
T*
[(Murphy)-284.9(et)-277.3(al.)-280.3(2014\).)]TJ
/F2 1 Tf
1.1128 -2.7505 TD
[(Molecular)-931.7(mimicry)-934.2(between)-932.6(GAS)-928.3(and)-930.1(neural)-933.6(anti-)]TJ
-1.1128 -1.2266 TD
(gens.)Tj
/F6 1 Tf
3.4397 0 TD
[(Sera)-269.6(from)-272.3(children)-270.8(with)-275(PANDAS)-273(contain)-268.7(group)-272(A)-268.4(strep-)]TJ
-3.4397 -1.2203 TD
[(tococcal)-311(carbohydrate-specic)-320(antibodies)-304.1(whose)-314.3(cognate)-305(antigens)]TJ
T*
[(are)-366.4(mimetic)-362(with)-363.5(neural)-362.6(antigens,)-367.2(including)-357.8(human)-363.9(neuronal)-361.6(do-)]TJ
0 -1.2266 TD
[(pamine)-350.9(receptors)-342.1(1)-347.3(and)-342.4(2,)-343.9(lysoganglioside,)-341.4(and/or)-347.5(tubulin.)-340.4(These)]TJ
0 -1.2203 TD
[(sera)-354.4(also)-347.1(frequently)-348.3(show)-350.3(autoantibody-mediated)-356.9(functional)-349.7(acti-)]TJ
T*
[(vation)-254.1(of)-248.2(a)-248.5(human)-243.8(neural)-255.1(cell)-244.9(line)]TJ
/F7 1 Tf
13.7397 0 TD
[(in)-243.3(vitro)]TJ
/F6 1 Tf
3.1678 0 TD
[(\(Kirvan)-251.8(et)-252.1(al.)-248.6(2003;)-241.9(Cox)]TJ
-16.9075 -1.2203 TD
[(et)-321.6(al.)-311.9(2015;)-317.7(Cunningham)-313.3(and)-317.1(Cox)-319.4(2016\).)-312.9(A)-319(monoclonal)-315(antibody)]TJ
0 -1.2266 TD
[(derived)-330.5(from)-329.3(a)-330.7(patient)-329.6(with)-325.5(Sydenhams)-328.3(chorea)-335.7(has)-324.6(been)-331.7(used)-324.1(to)]TJ
0 -1.2203 TD
[(demonstrate)-371.3(cross-reactive)-377.6(molecular)-364.8(mimicry)-370.8(between)-371.6(the)-365.4(GAS)]TJ
T*
[(polysaccharide)-415.4(and)-405.6(each)-410(of)-406.3(the)-409.6(human)-408.2(neuronal)-405.9(reactions)-413(listed)]TJ
0 -1.2267 TD
[(earlier)-200.5(that)-191.9(are)-195.7(known)-190.5(to)-192.7(be)-197.4(important)-193.3(for)-193.4(patients)-191.2(with)-199.1(PANDAS)-190.8(as)]TJ
0 -1.2203 TD
[(well)-315.3(as)-312.5(for)-313.6(those)-315(with)-312.9(Sydenhams)-315.7(chorea)-310.4(\(Kirvan)-315(et)-315.3(al.)-311.9(2006a,b;)]TJ
T*
[(Kirvan)-312.9(et)-302.6(al.)-311.9(2007;)-305.1(Cox)-306.8(et)-309(al.)-305.6(2013;)-305.1(Cunningham)-307(and)-304.5(Cox)-306.8(2016\).)]TJ
0 -1.2266 TD
[(Each)-470.6(of)-463.2(these)-469.2(cross-reactions)-470.7(can)-464.9(be)-469.3(blocked)-467(by)-466.9(N-acetyl-)]TJ
/F12 1 Tf
24.9502 0 TD
(b)Tj
/F6 1 Tf
.5501 0 TD
(-d-)Tj
-25.5003 -1.2203 TD
[(glucosamine,)-396.9(which,)-395.9(thus,)-391.9(appears)-399.6(to)-395.1(be)-393.5(a)-393.9(key)-393(epitope)-395.2(for)-389.4(GAS)]TJ
T*
[(polysaccharide)-289(cross-reactivity.)]TJ
/F2 1 Tf
1.1128 -2.7505 TD
[(Animal)-400.7(models.)]TJ
/F6 1 Tf
7.9289 0 TD
[(Three)-346.3(animal)-342.3(models)-343.3(have)-344.3(been)-344.3(utilized)-345.8(to)]TJ
-9.0418 -1.2203 TD
[(demonstrate)-194.3(autoantibody-mediated)-186.1(neuropsychiatric)-191(changes)-188.4(after)]TJ
0 -1.2266 TD
[(crude)-390.7(GAS)-389.4(immunization)-388.9(of)-381(mice)-389.8(or)-387.3(rats)-387.6(\(Hoffman)-386.2(et)-384.8(al.)-387.8(2004;)]TJ
0 -1.2203 TD
[(Brimberg)-319.5(et)-315.3(al.)-318.2(2012\),)-312.9(after)-321.4(passive)-317.6(transfer)-317.4(of)-317.8(IgG)-314.3(intravenously)]TJ
T*
[(from)-411.5(GAS-immunized)-413.4(mice)-415.1(\(Yaddanapudi)-409.7(et)-410.1(al.)-413(2010\),)-407.7(or)-406.3(after)]TJ
0 -1.2266 TD
[(transfer)-228.9(of)-222.9(IgG)-219.4(into)-221.1(the)-226.3(striatum)-220.2(of)-222.9(na)]TJ
14.8462 .0253 TD
()Tj
.2972 -.0253 TD
[(ve)-222.7(rats)-223.3(\(Lotan)-227.2(et)-220.4(al.)-223.4(2014\).)-218.1(In)]TJ
-15.1434 -1.2203 TD
[(a)-381.3(recent)-377.7(fourth)-373(animal)-380.2(model,)-377.2(it)-373.8(was)-378.5(demonstrated)-377.2(that)-375.2(repeated)]TJ
T*
[(nasopharyngeal)-358.4(GAS)-351.5(infections)-357.2(resulted)-354.2(in)-350.8(trans-olfactory)-352.4(sterile)]TJ
0 -1.2266 TD
[(central)-355.9(nervous)-344.2(system)-350.9(inammation)-352.3(mediated)-350(by)-346.8(Th17)-345.6(lympho-)]TJ
0 -1.2203 TD
[(cytes)-285.8(\(Dileepan)-282.4(et)-283.7(al.)-280.3(2016\).)]TJ
/F4 1 Tf
-27.9978 77.2217 TD
(2)Tj
43.274 0 TD
[(COOPERSTOCK)-335.9(ET)-338.7(AL.)]TJ
ET
endstream
endobj
101 0 obj
<>stream
/GS1 gs
BT
/F11 1 Tf
8.9663 0 0 8.9663 59.7543 725.7825 Tm
0 0 0 rg
0 Tc
0 Tw
[(PANDAS)-338.7(natural)-336.4(history)]TJ
/F2 1 Tf
1.1128 -1.6123 TD
[(Latent)-334.6(period.)]TJ
/F6 1 Tf
7.1449 0 TD
[(The)-285.3(latent)-285.9(period)-284.3(between)-283(GAS)-281.9(infection)-287(and)]TJ
-8.2577 -1.2203 TD
[(the)-371.7(onset)-371.9(of)-368.4(PANDAS)-367.9(has)-375.2(not)-363(been)-375.9(fully)-368.6(claried.)-369.6(The)-367.5(onset)-371.9(of)]TJ
0 -1.2266 TD
[(PANDAS)-386.8(cases)-386.6(reported)-383.2(by)-384.7(Murphy)-379.8(and)-380.3(Pichichero)-384.6(\(2002\))-381.7(was)]TJ
0 -1.2203 TD
[(concurrent)-441.6(with)-433(GAS)-440(infection.)-435.3(Our)-434.4(observations)-435.6(\(unpublished\))]TJ
T*
[(suggest)-182.4(that)-185.5(OCD)-180.6(may)-181.5(begin)-181(as)-179.7(early)-186.1(as)-179.7(13)-181.9(days)-178.7(before)-184.2(the)-182(onset)-182.2(of)]TJ
T*
[(GAS)-212.4(pharyngeal)-205(symptoms,)-208.5(and)-209.6(as)-211.3(late)-206.9(as)-205(30)-207.7(days)-210.3(or)-204(more)-208.9(after)-214(the)]TJ
0 -1.2266 TD
[(GAS)-496.9(infection.)-498.6(The)-494(more)-493.5(prolonged)-497.8(post-streptococcal)-494.9(latency)]TJ
0 -1.2203 TD
[(period)-189.5(observed)-188.1(for)-187.1(Sydenhams)-189.2(chorea)-190.3(\(Eshel)-190.5(et)-188.8(al.)-185.4(1993\))-189.8(seems)-185.3(to)]TJ
T*
[(be)-273.3(rare)-267.3(for)-269.3(PANDAS)-273(exacerbations,)-273.4(but)-268.1(it)-272.6(may)-270(explain)-268.7(difculties)]TJ
0 -1.2266 TD
[(in)-281.3(documenting)-282.9(GAS)-281.9(infections)-281.4(at)-283.7(initial)-278.3(symptom)-280.7(onset.)]TJ
/F2 1 Tf
1.1128 -2.9212 TD
[(Asymptomatic)-352.1(GAS)-346.6(acquisition.)]TJ
/F6 1 Tf
15.0612 0 TD
[(It)-296.5(is)-295.1(also)-296.5(likely)-296.1(that)-299.4(PAN-)]TJ
-16.174 -1.2266 TD
[(DAS)-395.7(may)-396.5(follow)-396.7(asymptomatic)-401.1(acquisition)-396.1(of)-393.6(pharyngeal)-401(GAS.)]TJ
0 -1.2203 TD
[(Asymptomatic)-395.6(acquisition)-389.8(can)-389.1(generate)-398.1(ASO)-389.4(and)-386.6(ADB)-389.2(immune)]TJ
T*
[(responses)-398.6(\()-128.6(Johnson)-391(et)-397.5(al.)-394.1(2010\),)-395.1(and)-393(it)-392.8(is)-396.2(capable)-396(of)-400(generating)]TJ
0 -1.2266 TD
[(rheumatic)-396.4(fever)-399.6(recurrences)-395.1(\(Gerber)-398.2(et)-391.2(al.)-394.1(2009\),)-395.1(as)-394.6(well)-397.5(as)-388.3(the)]TJ
0 -1.2203 TD
[(neurologic)-503.8(symptoms)-502.7(described)-510.2(in)-502.6(the)-498.2(school-based)-509.9(study)-502.3(dis-)]TJ
T*
[(cussed)-453.2(earlier)-453.4(\()-84.3(Murphy)-449.3(et)-448.1(al.)-451(2007\).)-445.7(Asymptomatic)-452.6(pharyngeal)]TJ
0 -1.2266 TD
[(GAS)-357.8(may)-358.6(be)-355.5(found)-354.2(in)-350.8(children)-359.3(presenting)-359.5(with)-350.8(PANS/PANDAS)]TJ
0 -1.2203 TD
[(symptoms.)-303.3(This)-306.6(may)-301.7(be)-298.6(etiologically)-303.2(relevant,)-307.8(especially)-302.6(if)-302.8(rising)]TJ
T*
[(GAS)-281.9(antibody)-284.8(titers)-280.9(are)-277.9(demonstrated.)]TJ
/F4 1 Tf
0 -2.9275 TD
[(Acute)-335.6(GAS)-338.9(Infection)]TJ
/F11 1 Tf
0 -1.8336 TD
[(GAS)-334(pharyngitis)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(GAS)-237.7(pharyngitis)-240.5(characteristically)-241(presents)-237.6(with)-237(the)-238.9(acute)-242.8(onset)]TJ
-1.1128 -1.2203 TD
[(of)-425.3(sore)-427.9(throat,)-424(dysphagia,)-425.9(pharyngeal)-426.3(erythema)-424.5(with)-426.7(or)-425.3(without)]TJ
0 -1.2266 TD
[(exudates,)-340.3(fever,)-339.3(and)-336.1(tender)-343.6(anterior)-336.6(cervical)-345.2(lymphadenopathy)-334(in)]TJ
0 -1.2203 TD
[(the)-257.9(absence)-260.4(of)-260.9(cough)-252.9(or)-260.9(nasal)-254.2(congestion.)-258.7(It)-258.6(should)-255.2(be)-260.7(noted)-256.9(that)-255.1(a)]TJ
T*
[(report)-419.7(of)-412.6(sore)-421.6(throat)-414.8(over)-414.1(the)-416(trachea)-417.5(or)-418.9(larynx,)-413.7(rather)-415.8(than)-421.8(the)]TJ
T*
[(pharynx)-203.9(or)-197.6(cervical)-206.1(nodes,)-200.1(is)-200.2(not)-198.6(characteristic)-207.2(of)-197.6(GAS)-199.7(infection.)-201.4(In)]TJ
0 -1.2266 TD
[(younger)-286.1(children,)-280.1(abdominal)-283.9(pain)-276.4(may)-282.7(be)-279.6(a)-280.1(prominent)-284.1(symptom.)]TJ
1.1128 -1.2203 TD
[(The)-512.9(presence)-515.4(of)-507.5(palatal)-515.4(petechiae)-515.2(or)-507.5(scarlatinaform)-514.3(rash)-510.1(in)]TJ
-1.1128 -1.2203 TD
[(children)-296.1(with)-293.9(pharyngitis)-291.1(is)-295.1(reported)-294.7(to)-293.9(be)-292.3(95%)-291.5(and)-291.8(98%)-291.5(specic,)]TJ
0 -1.2266 TD
[(respectively,)-452.5(for)-440(the)-447.6(diagnosis)-444.7(of)-444.2(GAS)-446.3(\(Shaikh)-446.8(et)-441.7(al.)-444.7(2012\).)-445.7(A)]TJ
0 -1.2203 TD
[(diagnostic)-297.7(throat)-294.7(swab)-295.8(for)-300.9(streptococcal)-293.5(rapid)-297.5(testing)-296.8(or)-292.5(culture)-296.6(is)]TJ
T*
[(generally)-513(required)-509.7(for)-503.3(diagnosis,)-510.9(however,)-509.8(because)-507(no)-504.9(clinical)]TJ
0 -1.2266 TD
[(syndrome)-227.1(is)-219.2(considered)-225.2(sufciently)-228.9(specic)-222.6(for)-225(a)-216.9(clinical)-228.1(diagnosis)]TJ
0 -1.2203 TD
[(\(Shulman)-215.9(et)-214.1(al.)-210.7(2012\).)-211.7(A)-211.5(properly)-216.4(performed)-214.1(throat)-212.5(swab)-213.6(requires)-213.7(a)]TJ
T*
[(vigorous)-206.2(swipe)-204.5(that)-198.2(includes)-206.2(both)-204.4(tonsils)-200.7(and)-203.3(the)-201(posterior)-208.5(pharynx.)]TJ
0 -1.2266 TD
[(If)-225.5(a)-223.2(rapid)-221.6(GAS)-225(screen)-223.1(is)-225.5(negative,)-223(the)-220(specimen)-227.1(should)-223.6(be)-222.7(cultured,)]TJ
0 -1.2203 TD
[(since)-191(about)-193.7(15%)-190.3(of)-185(GAS)-193.4(pharyngitis)-189.9(is)-187.6(missed)-192.8(by)-188.7(current)-187.7(rapid)-190(tests)]TJ
T*
[(\(Lean)-283(et)-283.7(al.)-280.3(2014\).)]TJ
1.1128 -1.2203 TD
[(It)-315.5(is)-320.4(important)-313.4(to)-319.2(note)-314.3(that)-318.3(bona)-316.6(de)-315.7(streptococcal)-318.8(pharyngitis,)]TJ
-1.1128 -1.2266 TD
[(that)-223.5(is,)-228.5(GAS)-218.7(acquisition)-225.4(with)-224.4(rising)-223.9(serum)-222.3(antibodies,)-224.8(may)-225.8(occur)-220(in)]TJ
0 -1.2203 TD
[(the)-283.2(absence)-285.6(of)-279.8(clinical)-278.7(symptoms)-281.4(\()-128.6(Johnson)-277.2(et)-283.7(al.)-280.3(2010\).)]TJ
/F11 1 Tf
0 -2.9275 TD
[(Other)-333.7(GAS)-334(infections)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(PANDAS)-235.1(has)-229.8(been)-230.5(described)-232(in)-230.7(cases)-234.8(of)-229.3(perianal)-235.3(dermatitis)-232(due)]TJ
-1.1128 -1.2203 TD
[(to)-293.9(GAS)-288.3(\(Toufexis)-292.8(et)-290(al.)-292.9(2014\).)-287.6(Perianal)-297.1(dermatitis)-288.9(and)-291.8(other)-291.1(GAS)]TJ
T*
[(perineal)-210(infections)-205.5(occur)-207.3(primarily)-202.2(in)-205.4(children)-207.6(who)-204.2(are)-202(27)-207.2(years)-202.2(of)]TJ
0 -1.2266 TD
[(age,)-379.3(but)-381.9(they)-377.5(can)-376.4(also)-378.7(occur)-378(in)-376.1(older)-379.7(children)-378.3(and)-380.3(adults.)-378.4(These)]TJ
0 -1.2203 TD
[(infections)-407.8(are)-404.3(sometimes)-403.6(familial,)-405.4(and)-399.3(they)-402.8(are)-404.3(often)-404.9(associated)]TJ
T*
[(with)-300.2(pharyngeal)-299.9(acquisition)-294.9(or)-298.8(infection)-299.6(in)-293.9(the)-295.8(patient)-298(or)-298.8(a)-299.1(family)]TJ
0 -1.2266 TD
[(member.)-495(The)-487.6(infection)-489.3(commonly)-490.1(recurs)-488.8(within)-486.7(weeks)-487.4(after)-492.2(a)]TJ
0 -1.2203 TD
[(standard)-236.4(course)-233.3(of)-229.3(oral)-234.7(antimicrobial)-229.5(treatment)-236(\(Clegg)-232.1(et)-233.1(al.)-229.7(2015\).)]TJ
T*
[(Other)-503.1(extra-pharyngeal)-500.7(GAS)-496.9(infections)-502.7(such)-494.8(as)-502.1(vulvovaginitis,)]TJ
0 -1.2266 TD
[(impetigo,)-402.7(or)-406.3(various)-405.2(forms)-399.5(of)-406.3(invasive)-402.2(disease)-402.3(are)-404.3(also)-404(suspect,)]TJ
0 -1.2203 TD
[(although)-284.8(not)-280.8(as)-280.8(yet)-276.9(reported)-282(with)-281.3(PANDAS.)]TJ
/F11 1 Tf
28.0042 74.5598 TD
[(GAS)-334(assessment)-330.7(at)-336.7(PANS)-331.7(onset)-338.8(and)-329.4(exacerbations)]TJ
/F2 1 Tf
1.1128 -1.6123 TD
[(Throat)-271.1(swab.)]TJ
/F6 1 Tf
6.7592 0 TD
[(A)-224.1(throat)-225.1(swab)-219.9(for)-225(GAS)-225(is)-219.2(recommended)-229(during)]TJ
-7.872 -1.2203 TD
[(the)-257.9(initial)-259.4(diagnostic)-259.8(evaluation)-261(for)-263(PANS,)-257.7(particularly)-263(if)-258.6(the)-257.9(child)]TJ
0 -1.2266 TD
[(is)-427.9(not)-426.2(already)-427.8(receiving)-430.8(antistreptococcal)-428.4(treatment.)-428.6(Testing)-431.7(for)]TJ
0 -1.2203 TD
[(GAS)-307.2(is)-307.7(recommended)-311.1(regardless)-317.5(of)-305.1(the)-308.5(presence)-313.1(of)-311.5(clinical)-310.3(phar-)]TJ
T*
[(yngitis)-205.8(or)-210.3(the)-207.3(severity)-208.8(of)-204(neuropsychiatric)-210(symptoms)-211.9(at)-207.8(that)-204.5(time.)-211(A)]TJ
T*
[(throat)-237.8(swab)-232.6(should)-236.2(also)-239.6(be)-235.4(performed)-239.4(both)-236(during)-231.3(exacerbations)-245.2(of)]TJ
0 -1.2266 TD
[(neuropsychiatric)-462.9(symptoms)-464.8(and)-456.2(during)-465.3(episodes)-462.6(of)-463.2(pharyngitis,)]TJ
0 -1.2203 TD
[(particularly)-218.7(in)-211.7(children)-213.9(not)-211.2(receiving)-222.2(an)-210.1(appropriate)-217.5(antibiotic,)-219(or)-210.3(if)]TJ
T*
[(adherence)-396(to)-395.1(the)-397(prophylactic)-401.8(regimen)-397.3(is)-396.3(in)-395.1(doubt.)-390.2(Perineal)-398.3(and)]TJ
0 -1.2266 TD
[(other)-335.4(extra-oral)-340.7(sites)-332.9(should)-337.4(be)-336.6(inspected)-334.6(routinely,)-338.1(with)-338.2(cultures)]TJ
0 -1.2203 TD
[(obtained)-280.9(from)-278.7(suspected)-287.5(infection)-280.7(sites.)]TJ
1.1128 -1.2203 TD
[(The)-260(throat)-256.7(of)-260.9(asymptomatic)-262(family)-260.3(members)-258.9(and)-260.2(other)-259.5(intimate)]TJ
-1.1128 -1.2266 TD
[(contacts)-303.4(should)-299.5(also)-302.9(be)-304.9(swabbed,)-306(if)-296.5(possible,)-302.7(at)-302.6(the)-308.5(time)-302.9(of)-298.8(initial)]TJ
0 -1.2203 TD
[(diagnosis,)-258(and)-260.2(at)-258.4(any)-260.2(time)-258.6(they)-263.7(have)-255.8(pharyngitis)-259.5(symptoms.)-259.1(When)]TJ
T*
[(patients)-229.2(have)-224.2(PANS)-229.4(exacerbations,)-229.1(untreated)-228.5(close)-222.6(contacts)-233.9(should)]TJ
T*
[(be)-393.5(questioned)-394.9(about)-389.7(symptoms)-395.3(of)-393.6(pharyngitis)-392.3(or)-393.6(dermatitis,)-393(and)]TJ
0 -1.2266 TD
[(cultured)-283.5(and)-279.2(treated)-280(if)-283.9(positive.)]TJ
/F2 1 Tf
1.1128 -2.5545 TD
[(GAS)-270.7(serology.)]TJ
/F6 1 Tf
7.4294 0 TD
[(ASO)-218.7(begins)-226(to)-218(rise)-223.3(at)-226.8(about)-219(1)-220.8(week)-227.5(and)-222.3(peaks)]TJ
-8.5423 -1.2203 TD
[(at)-302.6(36)-308.4(weeks)-304.1(after)-308.8(infection)-306(\()-84.3(McCarty)-304.3(1954;)-305.1(Kaplan)-306.4(et)-309(al.)-305.6(1974\);)]TJ
0 -1.2266 TD
[(ADB)-288.1(begins)-295.6(to)-287.6(rise)-292.8(at)-290(12)-289.4(weeks)-297.7(and)-285.5(peaks)-294.4(at)-290(68)-289.4(weeks)-297.7(\(Ayoub)]TJ
0 -1.2203 TD
[(and)-279.2(Wannamaker)-284.7(1962\).)-281.3(These)-281.6(tests)-276(are)-284.2(best)-283.9(performed)-277.3(at)-283.7(or)-279.8(near)]TJ
T*
[(the)-283.2(time)-290.2(of)-279.8(infection)-287(and)-285.5(then)-289(repeated)-290.6(to)-281.3(demonstrate)-289.1(a)-286.5(serologic)]TJ
0 -1.2266 TD
[(rise.)-251.5(It)-258.6(should)-255.2(be)-254.4(noted)-256.9(that)-255.1(even)-255.8(properly)-254.3(timed)-251.8(serial)-260.3(assays)-258.4(have)]TJ
0 -1.2203 TD
[(failed)-322.4(to)-312.9(show)-318.7(a)-324.4(rise)-318.1(in)-319.2(as)-318.8(many)-320.1(as)-318.8(38%)-316.8(of)-317.8(new)-320.4(pharyngeal)-325.1(GAS)]TJ
T*
[(acquisitions)-238.7(\()-128.6(Johnson)-239.2(et)-239.4(al.)-242.3(2010\))-234.1(or)-241.9(in)-237(57%)-240.9(of)-241.9(children)-239.2(with)-237(acute)]TJ
0 -1.2266 TD
[(streptococcal)-280.8(pharyngitis)-284.8(\(Kaplan)-283.2(et)-277.3(al.)-286.6(1971\).)]TJ
1.1128 -1.2203 TD
[(Single)-353.9(titers)-363.1(have)-357(limited)-360.1(utility,)-354.7(since)-361.7(both)-356.2(false)-358(positive)-359.5(and)]TJ
-1.1128 -1.2203 TD
[(false)-471.8(negative)-479.3(values)-475(are)-473.9(very)-477.3(common)-474.4(\()-128.6(Johnson)-473.2(et)-473.4(al.)-476.3(2010\).)]TJ
T*
[(However,)-304.4(as)-312.5(has)-305.6(been)-306.4(noted)-307.5(for)-300.9(rheumatic)-314.2(fever,)-307.7(a)-305.4(single)-305.9(strepto-)]TJ
0 -1.2266 TD
[(coccal)-194.1(antibody)-189.9(may)-194.2(have)-192.6(diagnostic)-196.6(value)-189.8(if)-195.3(elevated)-197.2(at)-188.8(the)-194.7(time)-195.4(of)]TJ
0 -1.2203 TD
[(onset)-194.9(\(Gerber)-195.9(et)-195.1(al.)-198.1(2009\),)-192.8(although)-196.2(such)-191.3(results)-195.4(must)-196.5(be)-197.4(interpreted)]TJ
T*
[(with)-281.3(caution)-281.3(\()-122.2(Johnson)-283.5(et)-277.3(al.)-280.3(2010\).)]TJ
1.1128 -1.2266 TD
[(Current)-297.5(enzyme)-292.4(immunoassay)-303.8(or)-292.5(turbidimetric)-299.2(assays)-296.3(for)-300.9(ASO)]TJ
-1.1128 -1.2203 TD
[(and)-310.8(ADB)-313.4(give)-308(continuous)-316.6(values)-310.6(rather)-314.6(than)-308(serial)-317.2(dilution)-309.4(titers.)]TJ
T*
[(Unfortunately,)-350.8(established)-357.8(standards)-357.2(to)-350.8(dene)-348.7(a)-356(meaningful)-355.6(anti-)]TJ
0 -1.2266 TD
[(body)-263.6(rise)-267.5(are)-271.5(not)-268.1(available.)-266.8(Provisionally,)-270.4(we)-264(accept)-270(a)-267.5(50%)-266.2(rise)-273.8(or)]TJ
0 -1.2203 TD
[(fall)-283(in)-281.3(ASO)-281.9(or)-279.8(ADB)-281.7(as)-280.8(a)-280.1(signicant)-283.7(change.)-285.5(This)-281.3(is)-282.4(quantitatively)]TJ
T*
[(similar)-296.6(to)-300.2(the)-302.1(0.2)-292.8(log)]TJ
6.7246 0 0 5.9768 387.2692 292.3652 Tm
(10)Tj
8.9663 0 0 8.9663 396.6802 293.896 Tm
[(change)-301.5(established)-300.8(in)-300.2(earlier)-301.6(studies)-300.3(using)]TJ
-9.5729 -1.2203 TD
[(serial)-184.5(dilution)-189.2(methods.)-181.4(If)-187.6(prior)-183.8(baseline)-189.6(values)-184.2(are)-189.3(available,)-191(it)-184.1(may)]TJ
0 -1.2267 TD
[(also)-385(be)-387.1(helpful)-389(to)-382.4(assay)-390.5(ASO)-389.4(and)-386.7(ADB)-382.9(during)-389.4(neuropsychiatric)]TJ
0 -1.2203 TD
[(symptom)-407.2(exacerbations.)-412.5(ASO)-408.4(and)-405.6(ADB)-408.2(levels)-409.5(may)-409.1(also)-404(be)-406.1(ob-)]TJ
T*
[(tained)-332.4(electively)-337(at)-334.3(34)-333.6(month)-333.9(intervals)-338.8(to)-331.8(assist)-339.9(the)-333.8(clinical)-335.6(rec-)]TJ
0 -1.2266 TD
[(ognition)-653.1(of)-646.6(subclinical)-657.8(infection)-653.7(or)-652.9(suboptimal)-652.9(antimicrobial)]TJ
0 -1.2203 TD
[(prophylaxis.)-201.5(It)-208(is)-206.6(important)-205.9(to)-205.4(utilize)-207.2(a)-204.3(single)-204.7(reliable)-207.7(laboratory)-209.2(for)]TJ
T*
[(serial)-279.3(testing)-284.1(to)-281.3(maximize)-284(dependability)-282.6(of)-279.8(the)-276.9(results.)]TJ
1.1128 -1.2266 TD
[(The)-228.4(Streptozyme)-235.9(test)-231(\(Wampole)-234.3(Laboratories\),)-235.7(a)-229.5(hemagglutinin)]TJ
-1.1128 -1.2203 TD
[(assay)-289.3(employing)-281.5(red)-288.1(cells)-289.8(coated)-286.6(with)-287.6(ve)-284.1(streptococcal)-293.5(antigens,)]TJ
T*
[(is)-383.6(not)-388.3(recommended)-387(pending)-388.7(better)-385.6(standardization)-395.3(\(Kaplan)-384.4(and)]TJ
0 -1.2266 TD
[(Huew)-279(1980;)-279.8(Kaplan)-281.1(and)-285.5(Kunde)-281.5(1981;)-279.8(Gerber)-282.3(et)-277.3(al.)-280.3(2009\).)]TJ
/F11 1 Tf
0 -2.5545 TD
[(Determination)-337.6(of)-330.4(streptococcal)-336.1(infection)]TJ
0 -1.2203 TD
[(for)-332.5(the)-334.8(diagnosis)-331.2(of)-336.7(PANDAS)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(The)-373.8(determination)-377.2(of)-381(prior)-373.5(GAS)-376.8(infection)-375.5(is)-377.3(often)-379.7(difcult)-378.5(to)]TJ
-1.1128 -1.2203 TD
[(operationalize)-447.6(in)-445.6(practice)-446.4(for)-446.3(several)-447.9(reasons.)-445.6(Retrospective)-447.5(in-)]TJ
0 -1.2266 TD
[(formation)-539.6(is)-535.4(often)-537.7(incomplete)-542.8(or)-532.8(unavailable.)-544.1(In)-532.7(an)-538.9(unknown)]TJ
0 -1.2203 TD
[(fraction)-305(of)-298.8(cases,)-307.3(GAS)-307.2(identied)-301.9(in)-300.2(a)-305.4(throat)-307.3(culture)-302.9(represents)-304.8(in-)]TJ
T*
[(cidental)-236.7(colonization.)-235.4(Conversely,)-236.7(false)-237.8(negative)-239(throat)-231.4(swabs)-239.6(may)]TJ
0 -1.2266 TD
[(occur)-257.9(due)-253.9(to)-256(a)-254.8(faulty)-256.7(technique)-257.5(or)-254.5(an)-254.4(infection)-261.7(sequestered)-259.9(in)-256(deep)]TJ
0 -1.2203 TD
[(tonsillar)-473.1(core)-473.4(tissue)-477.8(\(Saslaw)-472.7(et)-473.4(al.)-476.3(1962;)-475.8(Gul)-473.8(et)-473.4(al.)-469.9(2007\).)-477.3(An)]TJ
/F4 1 Tf
-28.0042 77.228 TD
[(MANAGEMENT)-341.5(OF)-331.2(INFECTIONS)-341.8(IN)-328.8(PANS)]TJ
54.1178 0 TD
(3)Tj
ET
endstream
endobj
105 0 obj
<>stream
/GS1 gs
BT
/F6 1 Tf
8.9663 0 0 8.9663 62.022 725.7825 Tm
0 0 0 rg
0 Tc
0 Tw
[(immunogenic)-242.2(GAS)-244(infection)-242.7(may)-238.4(be)-241.7(clinically)-243.8(overlooked)-240.5(when)-244(it)]TJ
0 -1.2203 TD
[(is)-446.8(mild)-439.6(or)-444.2(asymptomatic.)-441.9(Properly)-448.9(timed)-441.5(serial)-443.7(ASO)-446.3(and)-443.6(ADB)]TJ
0 -1.2266 TD
[(may)-409.1(be)-412.4(unavailable,)-417.6(or)-406.3(falsely)-411.6(negative)-416.1(as)-413.6(noted)-408.7(earlier.)-412(Rising)]TJ
0 -1.2203 TD
[(streptococcal)-261.9(antibodies)-259.8(frequently)-259.8(cannot)-258.8(be)-260.7(determined,)-259.7(because)]TJ
T*
[(symptoms)-268.8(have)-262.1(already)-269.7(been)-268.4(present)-268.5(for)-263(several)-270.9(weeks)-266.1(at)-264.7(the)-264.2(time)]TJ
0 -1.2266 TD
[(of)-248.2(the)-251.6(rst)-251(evaluation.)-257.6(In)-248.2(such)-254.6(cases,)-250.4(a)-254.8(single)-249(set)-252.8(of)-248.2(ASO)-250.3(and)-253.9(ADB)]TJ
0 -1.2203 TD
[(levels)-346.2(might)-344.2(be)-342.9(obtained,)-347(but)-337.7(should)-343.7(be)-349.2(interpreted)-341.6(with)-344.5(caution,)]TJ
T*
[(since)-254.2(a)-248.5(positive)-252(value)-253(may)-251.1(reect)-256.1(a)-248.5(GAS)-250.3(infection)-255.4(that)-248.8(occurred)-255.1(in)]TJ
0 -1.2266 TD
[(the)-289.5(remote)-296.6(past,)-286.8(unrelated)-291.7(to)-293.9(present)-287.4(symptoms,)-290.7(whereas)-295.5(negative)]TJ
0 -1.2203 TD
[(titers)-249.3(are)-246.2(obtained)-249.2(in)-243.3(as)-249.2(many)-244.3(as)-249.2(40%)-247.2(of)-241.9(GAS)-250.3(infections.)-246.3(\()-122.3(Johnson)]TJ
T*
[(et)-372.2(al.)-368.8(2010\).)-369.8(Given)-374(these)-368(uncertainties,)-373.9(it)-373.8(is)-371(often)-367(difcult)-372.2(to)-369.8(es-)]TJ
T*
[(tablish)-309.4()54.8()0(a)-307.5(temporal)-306(relationship)-309.7(of)-305.1(GAS)-307.2(to)-306.5(symptom)-306(onset)-308.7(or)-305.1(ex-)]TJ
0 -1.2266 TD
[(acerbation)52()-394.1(a)0(s)-401(required)-395.9(for)-395.8(a)-393.9(denitive)-403.1(PANDAS)-393.1(diagnosis.)-397.1(To)]TJ
0 -1.2203 TD
[(address)-303.6(this)-304.5(issue,)-306.5(we)-308.2(have)-300.1(found)-303.7(it)-304.2(useful)-304.5(to)-306.5(identify)-304(the)-302.2(level)-307.6(of)]TJ
T*
[(evidence)-344.9(for)-338.9(GAS)-338.8(infection)-337.6(as)-344.1()54.8(adequate)55.5()-343.6(o)0(r)-336.7()54.8(not)-339.8(adequate)51.3()-337.2(t)0(o)]TJ
0 -1.2266 TD
[(justify)-334.9(a)-337(working)-335.3(diagnosis)-330.9(of)-336.7(PANDAS,)-332.8(based)-338.7(on)-334.1(available)-339.8(evi-)]TJ
0 -1.2203 TD
[(dence)-283(\(Table)-280.2(1\).)]TJ
/F4 1 Tf
0 -2.447 TD
[(Management)-335.8(of)-336.6(Streptococcal)-336.3(Infections)-332.3(in)-338(PANDAS)]TJ
/F11 1 Tf
0 -1.8336 TD
[(Primary)-333.5(antimicrobial)-339.3(treatment)-335.5(of)-330.4(acute)]TJ
0 -1.2203 TD
[(streptococcal)-336.1(infections)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(Primary)-231.6(antimicrobial)-235.8(treatment)-236(for)-231.4(all)-236.6(patients)-229.2(with)-237(pharyngeal)]TJ
-1.1128 -1.2203 TD
[(GAS)-376.8(is)-377.3(indicated,)-371.9(with)-376.1(oral)-380.1(or)-374.7(intramuscular)-377(penicillin)-374.1(as)-375.7(a)-375(rst)]TJ
0 -1.2266 TD
[(choice)-223.3(\(Gerber)-227.5(et)-220.4(al.)-223.4(2009\).)-218.1(In)-222.9(current)-225.6(practice,)-221.7(amoxicillin)-225.4(is)-219.2(often)]TJ
0 -1.2203 TD
[(used)-305.1(in)-300.2(suspension)-302.3(form)-304(for)-300.9(younger)-298.8(children)-308.8(due)-298.1(to)-300.2(its)-304.9(enhanced)]TJ
T*
[(palatability)-373.3(\(American)-373(Academy)-371.1(of)-368.4(Pediatrics)-370.9(2015a\).)-371.7(Injectable)]TJ
0 -1.2266 TD
[(antibiotic)-519.6(therapy)-513.9(is)-510.1(considered)-516(the)-517.1(most)-512.6(reliable,)-520.4(although)-512.4(in)]TJ
0 -1.2203 TD
[(practice)-187.1(it)-184.1(is)-181.3(usually)-185.3(reserved)-186.8(for)-187.1(children)-182.3(failing)-184.4(or)-185(unable)-183(to)-186.4(accept)]TJ
T*
[(oral)-557.2(therapy.)-554.7(The)-557.2(objective)-552.4(of)-558(antimicrobial)-558.3(therapy)-551.8(of)-558(acute)]TJ
T*
[(streptococcal)-261.9(infection)-255.4(is)-257.1(to)-256(eradicate)-258.6(the)-257.9(current)-257.2(GAS)-256.6(infection)-255.4(to)]TJ
0 -1.2266 TD
[(minimize)-696.6(non-suppurative)-694.8(sequelae)-693.8(such)-690.8(as)-691.8(rheumatic)-693.6(fever)]TJ
0 -1.2203 TD
[(\(Shulman)-279.1(et)-283.7(al.)-280.3(2012\).)]TJ
1.1128 -1.2203 TD
[(For)-296.9(children)-302.4(allergic)-308.9(to,)-296.8(or)-298.8(intolerant)-303.2(of,)-301.7(penicillin,)-307.5(cephalexin,)]TJ
-1.1128 -1.2266 TD
[(cefadroxil,)-416.9(clindamycin,)-418.7(azithromycin,)-414.5(or)-412.6(clarithromycin)-423.6(are)-410.6(re-)]TJ
0 -1.2203 TD
[(commended)-357.7(according)-363.6(to)-357.1(the)-359.1(IDSA)-353.6(2012)-358.5(guideline)-360.3(for)-357.8(the)-359.1(treat-)]TJ
T*
[(ment)-355.8(of)-355.7(acute)-362.9(GAS)-351.5(pharyngitis)-360.7(\(Shulman)-355(et)-359.5(al.)-356.1(2012\))-354.2(\(Table)-356.1(2\).)]TJ
0 -1.2266 TD
[(Children)-292.1(with)-293.9(persistent)-295.2(or)-286.2(rapidly)-294.2(relapsing)-296.8(pharyngitis)-291.1(may)-289(also)]TJ
0 -1.2203 TD
[(be)-191.1(treated)-185.2(with)-192.8(these)-184.6(agents,)-193.4(which)-184.3(may)-187.9(be)-191.1(more)-183.6(effective)-195.6(clinically)]TJ
T*
[(than)-282.7(penicillin)-279.3(or)-279.8(amoxicillin)-282.3(\(Casey)-282.3(et)-283.7(al.)-280.3(2008\).)]TJ
1.1128 -1.2267 TD
[(The)-348.5(use)-343.6(of)-349.4(azithromycin)-348.4(as)-350.4(an)-342.9(alternative)-351.8(for)-351.5(the)-346.4(treatment)-349.9(of)]TJ
-1.1128 -1.2203 TD
[(pharyngeal)-268.2(GAS)-263(infection)-261.7(may)-263.7(be)-260.7(less)-266.1(efcacious,)-267(due)-260.2(to)-262.3(regional)]TJ
T*
[(GAS)-427.4(resistance)-422.5(rates)-427.5(as)-426.3(high)-419.4(as)-426.3(5%10%)-424.9(or)-418.9(more)-423.9(\(Silva-Costa)]TJ
T*
[(et)-517.6(al.)-520.5(2015\))-518.6(with)-521.5(an)-519.9(associated)-521(potential)-522.4(for)-522.2(the)-517.1(development)]TJ
0 -1.2266 TD
[(of)-425.3(sequelae)-422(\(Logan)-425.5(et)-422.8(al.)-425.7(2012\).)-426.7(Theoretical)-423.4(advantages)-427.3(of)-425.3(azi-)]TJ
0 -1.2203 TD
[(thromycin)-404.2(include)-401.5(its)-406.1(ease)-404.8(of)-400(administration,)-401.4(its)-406.1(activity)-402.7(against)]TJ
T*
(most)Tj
/F7 1 Tf
2.2573 0 TD
[(Mycoplasma)-314.1(pneumoniae)]TJ
/F6 1 Tf
10.319 0 TD
[(,)-312.7(and)-304.5(its)-311.3(potential)-313.7(immunomodula-)]TJ
-12.5763 -1.2266 TD
[(tory)-447.3(\(Obregon)-443.3(et)-441.7(al.)-444.7(2012\))-442.8(activities.)-450.2(Disadvantages)-447(include)-445.7(its)]TJ
0 -1.2203 TD
[(potential)-294.7(to)-293.9(promote)-293.7(azithromycin)-291.5(resistance)-296(of)-292.5(both)-292.9(GAS)-294.6(and)]TJ
/F7 1 Tf
25.5825 0 TD
(M.)Tj
-25.5825 -1.2203 TD
(pneumoniae)Tj
/F6 1 Tf
4.8939 0 TD
[(.)-205.2(The)-209.4(U.S.)-209.1(Food)-205.3(and)-203.3(Drug)-206.3(Administration)-209.7(recommends)]TJ
-4.8939 -1.2266 TD
[(that)-210.8(it)-203.1(be)-210.1(used)-204(with)-205.4(caution)-211.8(in)-205.4(patients)-210.2(with)-205.4(a)-204.3(prolonged)-207(QT)-210.8(interval)]TJ
0 -1.2203 TD
[(on)-334.1(the)-327.4(electrocardiogram,)-342.4(and)-329.7(may)-333.3(be)-330.2(contraindicated)-339.6(in)-325.5(patients)]TJ
T*
[(receiving)-228.5(medications)-221(that)-223.5(prolong)-224.5(the)-220(QT)-223.4(interval,)-227.2(which)-222.3(includes)]TJ
T*
[(some)-239.1(of)-235.6(the)-238.9(selective)-246.1(serotonin)-237.5(receptor)-240.2(inhibitors)-242.6(\(SSRIs\),)-238(as)-236.6(well)]TJ
0 -1.2266 TD
[(as)-280.8(anti-psychotic)-285.9(medications)-284.2(and)-279.2(other)-278.5(psychoactive)-284.9(drugs.)]TJ
1.1128 -1.2203 TD
[(The)-297.9(use)-293(of)-292.5(oral)-297.9(clindamycin)-295.7(suspension)-302.3(may)-295.3(be)-292.3(problematic)-298.3(in)]TJ
-1.1128 -1.2203 TD
[(children)-485.8(due)-481.5(to)-483.6(its)-482(unfavorable)-485.3(taste.)-482.4(Recent)-487.3(data)-481.1(suggest)-485.9(that)]TJ
0 -1.2266 TD
[(clindamycin)-415.8(resistance)-416.1(may)-415.5(also)-410.3(be)-418.7(emerging,)-412.4(albeit)-412.3(at)-416.4(a)-412.9(lower)]TJ
0 -1.2203 TD
[(frequency)-444.3(than)-440.8(azithromycin,)-439.8(in)-439.3(North)-443.8(America)-440.9(and)-443.6(worldwide)]TJ
T*
(\(Villasen)Tj
3.2626 .0063 TD
()Tj
.4173 -.0063 TD
[(or-Sierra)-342.3(et)-346.9(al.)-343.5(2012;)-343(ODwyer)-342.9(et)-346.9(al.)-343.5(2013\),)-344.5(notably)-342.2(ap-)]TJ
-3.6799 -1.2266 TD
[(pearing)-362.1(in)-357.1(localized)-365.1(outbreaks)-362.3(of)-355.7(specic)-368(GAS)]TJ
/F7 1 Tf
19.7212 0 TD
(emm)Tj
/F6 1 Tf
2.2446 0 TD
[(types)-359.3(\(Smit)]TJ
-21.9658 -1.2203 TD
[(et)-340.6(al.)-343.5(2015\).)-344.5(Also)-341.7(of)-336.7(concern,)-344.5(clindamycin)-346.3(appears)-342.7(to)-338.2(disturb)-343.5(the)]TJ
27.9978 4.8939 TD
[(protective)-396.4(throat)-389.5(and)-393(fecal)-390.8(microbiome)-390.7(to)-395.1(a)-387.6(much)-389.7(greater)-398.8(and)-386.6(a)]TJ
0 -1.2266 TD
[(more)-436.6(prolonged)-440.9(degree)-436.9(than)-434.4(other)-436.6(commonly)-439.6(used)-431.6(oral)-437(antimi-)]TJ
0 -1.2203 TD
[(crobial)-284(agents)-285.3(\(Zaura)-278.8(et)-283.7(al.)-280.3(2015\).)]TJ
1.1128 -1.2203 TD
[(For)-391.7(children)-390.9(allergic)-391.1(or)-387.3(intolerant)-391.7(to)-388.7(the)-390.7(penicillins,)-390.4(the)-390.7(Con-)]TJ
-1.1128 -1.2267 TD
[(sortium)-473.5(preference)-476.6(favors)-473.8(cephalexin)-474.4(\(bid)-466.2(or)-475.8(tid\))-470.3(or)-469.5(cefadroxil)]TJ
ET
313.058 700.157 239.131 .28345 re
f
313.058 327.458 239.131 .28345 re
f
313.058 681.505 239.131 .22668 re
f
313.058 464.031 239.131 .28348 re
f
313.058 445.89 239.131 .22678 re
f
BT
/F9 1 Tf
8.9663 0 0 8.9663 339.6472 725.7825 Tm
(Table)Tj
/F6 1 Tf
3.0034 0 TD
(1.)Tj
/F9 1 Tf
1.2519 0 TD
[(Provisional)-331.7(Determination)-335.3(of)-335.1(Prior)]TJ
-4.2427 -1.1128 TD
[(Streptococcal)-331.9(Infection)-338(for)-334.7(an)-332.5(Operational)]TJ
5.1469 -1.1128 TD
[(Denition)-337.3(of)-328.8(PANDAS)]TJ
/F7 1 Tf
-8.1249 -2.017 TD
[(Adequate)-339.9(for)-332.5(a)-334.6(diagnosis)-334.8(of)-331.8(PANDAS)]TJ
/F6 1 Tf
1.0053 -2.0866 TD
[(A)-255.7(rise)-261.2(in)-262.3(serial)-260.3(antibody)-259.5(level,)-259.9(regardless)-260.6(of)-260.9(rapid)-259.5(test)-262.6(or)-260.9(culture)]TJ
.999 -1.1128 TD
[(result.)-330.4(This)-338.2(denition)-331.1(does)-336.8(not)-331.3(require)-339.4(clinical)-335.6(pharyngitis.)]TJ
-.999 -1.1065 TD
[(Acute)-332.2(pharyngitis)-335.4(with)-331.9(a)-337(positive)-334.2(GAS)-332.5(throat)-338.9(culture,)-331.1(with)-338.2(or)]TJ
.999 -1.1128 TD
[(without)-334.4(a)-330.7(rising)-337.7(antibody)-335.3(level.)]TJ
6.7246 0 0 5.9768 446.1731 643.1243 Tm
(a)Tj
8.9663 0 0 8.9663 322.0724 629.1778 Tm
[(Pharyngitis)-334(with)-331.9(characteristic)-340(palatal)-338.4(petechiae.)]TJ
6.7246 0 0 5.9768 499.4077 633.1463 Tm
(b)Tj
8.9663 0 0 8.9663 322.0724 619.1998 Tm
[(Pharyngitis)-334(with)-331.9(a)-337.1(characteristic)-340(scarlatinaform)-337.2(rash.)]TJ
6.7246 0 0 5.9768 515.1684 623.225 Tm
(b)Tj
8.9663 0 0 8.9663 322.0724 609.2786 Tm
[(Pharyngitis)-334(without)-334.4(a)-330.7(throat)-338.9(swab)-333.8(or)-330.4(serology,)-338(but)-331.3(intimate)]TJ
.999 -1.1128 TD
[(\(usually)-332.8(household\))-334.1(exposure)-333.5(to)-338.2(a)-330.7(proven)-337.2(GAS)-332.5(case.)]TJ
6.7246 0 0 5.9768 524.6927 603.2692 Tm
(c)Tj
8.9663 0 0 8.9663 322.0724 589.3227 Tm
[(Asymptomatic)-332.4(pharyngeal)-337.8(colonization)-333.6(documented)-338.7(after)-334.1(an)]TJ
.999 -1.1065 TD
[(intimate)-336.7(exposure.)]TJ
-.999 -1.1128 TD
[(Asymptomatic)-332.4(pharyngeal)-337.8(colonization)-333.6(after)-340.4(a)-330.7(negative)-333.9(throat)]TJ
.999 -1.1128 TD
[(swab)-333.7(documented)-332.4(within)-334.9(the)-333.8(prior)-335.6(34)-333.7(months.)]TJ
-.999 -1.1128 TD
[(Single)-334.9(ASO)-332.5(or)-330.4(ADB)-338.7(antibody)-335.3(level)-332.9(within)-334.9(6)-334.6(months)-328.3(after)-340.4(the)]TJ
.999 -1.1065 TD
[(initial)-335.3(onset)-334(of)-330.4(neuropsychiatric)-336.5(symptoms)-338.4(may)-333.3(be)-336.5(accepted)]TJ
0 -1.1128 TD
[(as)-331.4(positive)-334.2(if)-334.4(it)-335.9(is)]TJ
/F10 1 Tf
7.5179 0 TD
(>)Tj
/F6 1 Tf
.5501 0 TD
[(95th)-337.2(percentile,)-338.5(using)-331.6(the)-333.8(laboratorys)]TJ
-8.068 -1.1128 TD
[(normal)-332.1(standard)-337.5(for)-332.5(children)-334(of)-336.7(comparable)-337.4(age,)-335.1(or)]TJ
T*
[(provisionally)-332.1(ASO)]TJ
/F10 1 Tf
7.9479 0 TD
()Tj
/F6 1 Tf
.5501 0 TD
[(1:480)-330.4(or)-336.7(ADB)]TJ
/F10 1 Tf
6.2154 0 TD
()Tj
/F6 1 Tf
.5564 0 TD
(1:1280.)Tj
6.7246 0 0 5.9768 495.0991 513.6377 Tm
(d)Tj
8.9663 0 0 8.9663 322.0724 499.6912 Tm
[(Both)-285(ASO)-288.3(and)-291.8(ADB)-288.1(are)-290.5(elevated)-292(at)]TJ
/F10 1 Tf
14.8146 0 TD
(>)Tj
/F6 1 Tf
.5501 0 TD
[(80%)-291.5(percentile)-291.3(for)-288.3(age)-294.2(in)]TJ
-14.3657 -1.1128 TD
[(the)-251.6(same)-254.2(serum)-260.2(sample)-250.9(within)-259(6)-252.4(months)-252.4(after)-258.2(the)-251.6(initial)-259.4(onset)]TJ
T*
[(of)-330.4(neuropsychiatric)-336.5(symptoms.)]TJ
6.7246 0 0 5.9768 443.5652 483.7605 Tm
(e)Tj
8.9663 0 0 8.9663 322.0724 469.8141 Tm
[(Culture-documented)-336.2(streptococcal)-337.7(dermatitis.)]TJ
/F13 1 Tf
-1.0053 -2.0297 TD
[(Suggestive)-340.4(evidence)-334.7(not)-337.7(adequate)-333.7(for)-332.5(a)-334.6(diagnosis)-334.8(of)-331.8(PANDAS)]TJ
/F6 1 Tf
1.0053 -2.0297 TD
[(GAS)-332.5(cultured)-334(from)-335.6(a)-330.7(normal-appearing)-337.4(throat,)-335.5(without)-334.4(rising)]TJ
.999 -1.1128 TD
[(antibody)-335.4(titers.)]TJ
6.7246 0 0 5.9768 385.7385 427.4644 Tm
(f)Tj
8.9663 0 0 8.9663 322.0724 413.518 Tm
[(Pharyngitis)-334(without)-334.4(a)-330.7(swab.)]TJ
6.7246 0 0 5.9768 424.0062 417.4865 Tm
(g)Tj
8.9663 0 0 8.9663 322.0724 403.5401 Tm
[(Either)-300.8(ASO)-300.9(or)-298.8(ADB,)-303.6(but)-299.7(not)-299.7(both,)-302.2(elevated)-304.7(at)]TJ
/F10 1 Tf
19.013 0 TD
(>)Tj
/F6 1 Tf
.5501 0 TD
[(80%)-297.8(percentile)]TJ
-18.5641 -1.1128 TD
[(of)-330.4(age)-338.5(norms)-333.7(within)-334.9(6)-328.3(months)-334.6(after)-340.4(the)-333.8(initial)-335.2(onset)-334(of)]TJ
T*
[(neuropsychiatric)-336.5(symptoms,)-334.9(and)-329.7(culture)-340.9(negative)-333.9(or)]TJ
0 -1.1065 TD
(unavailable.)Tj
6.7246 0 0 5.9768 374.7968 377.6314 Tm
(h)Tj
8.9663 0 0 8.9663 322.0724 363.6849 Tm
[(Household)-335.3(exposure)-333.5(to)-331.8(a)-337(proven)-330.9(GAS)-332.5(case)-341.6(without)-334.4(clinical)]TJ
.999 -1.1128 TD
[(pharyngitis)-246.9(or)-254.5(suggestive)-250.6(dermatitis,)-247.6(and)-253.9(without)-252.2(a)-248.5(diagnostic)]TJ
0 -1.1065 TD
(swab.)Tj
6.7246 0 0 5.9768 351.666 347.7542 Tm
(c)Tj
8.9663 0 0 8.9663 322.0724 333.8078 Tm
[(Intertrigo)-333.6(or)-330.4(perianal)-336.5(dermatitis)-339.5(without)-334.4(conrmatory)-333.3(culture.)]TJ
6.7246 0 0 5.9768 547.6534 337.7763 Tm
(i)Tj
5.9774 0 0 5.3127 321.0519 319.181 Tm
(a)Tj
7.9702 0 0 7.9702 323.7164 315.666 Tm
[(A)-242.3(large)-232.6(fraction)-235.4(of)-241.1(new)-234.2(asymptomatic)-230.3(GAS)-238.4(acquisitions)-233.9(and)-231.7(acute)-239.6(GAS)]TJ
-1.3373 -1.1239 TD
[(pharyngitis)-236.5(occurs)-233.3(without)-232.4(a)-243(rise)-239.8(in)-236.2(either)-236.2(ASO)-238.4(or)-241.1(anti-DNA)12.6(se)-242.1(B)-237.4(\(see)-244.5(text\).)]TJ
5.9774 0 0 5.3127 321.0519 301.2661 Tm
(b)Tj
7.9702 0 0 7.9702 324.0566 297.7511 Tm
[(A)-249.4(systematic)-175.2(review)-176.2(demonstr)13.9(ated)-181.5(palatal)-175.5(petechiae)-172.2(as)-178.1(95%)-172.9(specic,)-176.5(and)]TJ
-1.38 -1.1239 TD
[(scarlatina)-255.3(rash)-255.6(as)-263.4(98%)-251.2(specic)-255.7(for)-256.6(GAS)-259.8(pharyngitis)-250.7(\(Shaikh)-251.5(et)-260.7(al.)-252.6(2012\).)]TJ
5.9774 0 0 5.3127 321.0519 283.3511 Tm
(c)Tj
7.9702 0 0 7.9702 323.7164 279.7794 Tm
[(Danchin)-327.2(et)-331.9(al.)-330.8(\(2007\).)]TJ
5.9774 0 0 5.3127 321.0519 274.3936 Tm
(d)Tj
7.9702 0 0 7.9702 324.0566 270.822 Tm
[(Upper)-361.5(l)24.9(i)24.9(m)27(i)24.9(t)-266.7(o)23.4(f)-271.6(n)30.5(o)23.4(r)27.1(m)27(a)27.3(l)-273.8(f)27.1(o)30.5(r)-271.6(G)28(A)20.9(S)-266(h)23.4(a)27.3(s)-269.4(c)27.3(o)23.4(n)30.5(v)23.4(e)27.3(n)23.4(t)24.9(i)24.9(o)30.5(n)23.4(a)27.3(l)24.9(l)24.9(y)-268.2(b)23.4(e)27.3(e)27.3(n)-268.2(g)23.4(i)24.9(v)30.5(e)20.2(n)-268.2(a)27.3(t)-273.8(t)32.1(h)23.4(e)-271.4(8)30.5(0)23.4(t)24.9(h)]TJ
-1.38 -1.1239 TD
-.0245 Tc
[(rath)6(er)-267.7(th)6(an)-264.3(th)6(e)-274.6(9)6(5th)-264.3(p)-1.1(ercen)6(tile)-267.5(to)-264.3(ad)6(just)-269.9(for)-267.7(t).4(h)6(e)-267.5(hig)6(h)-271.4(freq)6(u)-1.1(ency)-264.3(of)-267.7(strep)6(t).4(ococcal)]TJ
T*
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0 Tc
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(f)Tj
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[(not)-333.7(clear)-328.3(\()-129.3(Johnson)-322.1(et)-331.9(al.)-330.8(2010\).)]TJ
5.9774 0 0 5.3127 321.0519 184.7054 Tm
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[(Clegg)-323.2(et)-331.9(al.)-337.9(\(2015\).)]TJ
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[(ADB,)-486.2(anti-DNAse)-478.4(B;)-489.9(ASO,)-486.3(anti-strep)10.9(tolysin)-487.2(O;)-487.6(PANDAS,)-475.8(pediatric)]TJ
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[(autoimmune)-765(neuropsychia)12.2(tric)-777.7(disorder)-768.4(associated)-766.7(with)-773.6(streptococca)14.4(l)]TJ
T*
[(infection;)-331.5(GAS,)-322.7(group)-327.3(A)]TJ
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10.4563 0 TD
[(Streptococc)11.9(us.)]TJ
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8.9663 0 0 8.9663 62.022 749.6502 Tm
(4)Tj
43.274 0 TD
[(COOPERSTOCK)-335.9(ET)-338.7(AL.)]TJ
ET
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BT
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[(\(once)-295.9(daily\),)-291.3(in)-293.9(the)-289.5(absence)-292(of)-292.5(immediate-type)-294.1(hypersensitivity)-294(to)]TJ
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[(penicillin.)-358.1(Among)-352.2(patients)-355.6(with)-357.1(conrmed)-353.4(amoxicillin)-358.2(hypersen-)]TJ
T*
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T*
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[(provide)-366(this)-367.7(initial)-366.9(treatment)-368.8(for)-364.1(3)-366.2(weeks,)-370.2(awaiting)-364.1(resolution)-367.5(of)]TJ
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[(Treatment)-337.6(of)-330.4(GAS)-334(in)-336.5(children)-335.7(with)-336.5(PANS)-331.7(or)-335.3(PANDAS)]TJ
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[(provide)-555.7(an)-551.5(initial)-550.2(course)-549.5(of)-551.7(antimicrobial)-551.9(treatment)-552.2(for)-553.8(acute)]TJ
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[(streptococcal)-318.8(infection)-312.3(as)-312.4(described)-314.2(earlier,)-310.9(regardless)-311.1(of)-311.5(whether)]TJ
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T*
[(ommendations)-571.7(for)-566.5(the)-567.7(initial)-569.2(management)-566(of)-564.4(rheumatic)-573.5(fever)]TJ
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[(\(Gerber)-316(et)-315.3(al.)-311.9(2009\).)-312.9(Although)-310.9(data)-316.7(from)-310.3(controlled)-311.8(clinical)-316.6(trials)]TJ
0 -1.2203 TD
[(are)-328.4(lacking,)-322.2(aggressive)-327.5(diagnosis)-324.6(and)-317.1(treatment)-330.9(of)-317.8(GAS)-326.2(infection)]TJ
T*
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0 -1.2266 TD
[(practice,)-322.8(the)-314.8(majority)-320.2(of)-311.4(children)-321.4(with)-312.9(recent-onset)-321.7(PANDAS)-317.3(ex-)]TJ
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[(perience)-284.3(a)-273.8(reduction)-283(in)-274.9(neuropsychiatric)-279.6(symptoms)-281.4(within)-271.7(days)-279.9(or)]TJ
T*
[(weeks)-342(after)-334.1(antimicrobial)-343.3(treatment)-337.2(active)-334.8(against)-339.4(acute)-337.6(GAS)-338.8(in-)]TJ
0 -1.2266 TD
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0 -1.2203 TD
[(et)-283.7(al.)-280.3(2005;)-279.8(Falcini)-283.9(et)-277.3(al.)-280.3(2013\).)]TJ
1.1128 -1.2203 TD
[(A)-603.5(protocol)-603.5(for)-604.4(the)-605.6(suggested)-607.5(management)-610.2(of)-602.3(infection)-603.1(in)]TJ
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[(PANDAS)-285.7(is)-282.4(presented)-282.6(in)-274.9(Table)-284.4(3.)]TJ
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[(Secondary)-337.3(antimicrobial)-332.9(prophylaxis)]TJ
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[(for)-338.9(children)-329.4(with)-336.5(PANDAS)]TJ
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[(There)-447.4(is)-440.5(currently)-450(insufcient)-443.9(evidence)-446.1(to)-445.6(support)-440.7(long-term)]TJ
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[(streptococcal)-280.8(prophylaxis)-280.8(for)-275.6(children)-277.1(with)-281.3(PANDAS.)-275.9(There)-276.7(have)]TJ
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0 -1.2203 TD
[(250)-169.3(mg)-337.7(bid)-331.3(prophylaxis)-337.7(reduced)-335.2(neither)-340.9(GAS)-332.5(infections)-338.3(nor)-336.3(neu-)]TJ
T*
[(ropsychiatric)-430.4(symptoms)-420.5(\(Garvey)-427.2(et)-422.8(al.)-425.7(1999\).)-420.4(In)-425.3(a)-425.6(second)-420.4(trial,)]TJ
T*
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[(frequency)-267.3(of)-267.2(GAS)-263(infections)-268.7(versus)-263.7(the)-264.2(previous)-265.6(year)-264.7(by)-264.6(95%)-266.2(and)]TJ
0 -1.2203 TD
[(96%,)-300.7(respectively,)-300.8(with)-300.2(corresponding)-299.8(reductions)-296.3(in)-300.2(neuropsychi-)]TJ
T*
[(atric)-284.9(exacerbations)-283.1(by)-283.6(75%)-278.9(and)-279.2(56%)-278.9(\(Snider)-285(et)-277.3(al.)-280.3(2005\).)]TJ
1.1128 -1.2266 TD
[(The)-234.7(potential)-237.8(benet)-238.5(for)-231.4(secondary)-240.6(antimicrobial)-235.8(prophylaxis)-236.5(in)]TJ
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[(children)-289.8(with)-287.6(well-dened)-292.6(PANDAS)-285.7(lies)-287.9(in)-287.6(the)-289.5(possibility)-289(of)-286.2(pre-)]TJ
T*
[(venting)-367.4(neural)-368.9(injury)-368.1(from)-360.9(future)-369.1(GAS-associated)-368.8(exacerbations.)]TJ
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[(Prospective)-404.3(evaluations)-400.8(of)-400(50)-397.4(children)-397.3(in)-395.1(the)-403.3(original)-398.9(PANDAS)]TJ
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[(cohort)-347.6(demonstrated)-351.9(that)-349.9(77%)-348.4(of)-343.1(144)-346.3(exacerbations)-352.7(were)-350.2(associ-)]TJ
28.0042 51.5064 TD
[(ated)-304.1(with)-306.6(denite)-305.2(or)-305.1(probable)-304.7(GAS)-307.2(\(Swedo)-307.5(et)-302.6(al.)-305.5(1998\).)-306.6(A)-306.3(recent)]TJ
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[(follow-up)-372.6(study)-369.5(of)-374.7(PANS)-368.5(patients)-374.6(with)-376.1(or)-368.4(without)-372.4(demonstrable)]TJ
T*
[(GAS)-237.7(association)-237.6(at)-239.4(onset)-239.1(\(Frankovich)-241.2(et)-233.1(al.)-242.3(2015\))-234.1(identied)-238.7(one)-241.2(or)]TJ
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[(more)-322.8(GAS-associated)-324.5(exacerbations)-321.1(in)-319.2(14)-321.5(out)-318.7(of)-324.1(19)-315.2(\(74%\))-321(cases.)]TJ
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[(These)-243.7(cohorts)-240.8(show)-242.8(that)-248.8(GAS)-237.7(may)-244.8(be)-241.7(temporally)-245.8(associated,)-245.8(if)-245.9(not)]TJ
T*
[(causally)-316.1(related,)-320.9(to)-319.2(approximately)-322.6(3)-315.7(out)-318.7(of)-317.8(4)-315.7(o)0(f)-317.8(symptom)-312.4(exacer-)]TJ
0 -1.2267 TD
[(bations)-387.6(in)-382.4(PANDAS)-393.2(patients.)-383.8(Therefore,)-392.8(the)-384.3(prevention)-390(of)-387.3(GAS)]TJ
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[(infections)-534.3(may)-529.3(prolong)-534.3(symptom)-533.7(remissions)-533.8(and)-532.1(decrease)-536.8(the)]TJ
T*
[(number)-277.5(of)-279.8(PANDAS)-285.7(exacerbations.)]TJ
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[(To)-409.8(this)-411.9(end,)-414.9(members)-416.9(of)-412.6(the)-409.6(Consortium)-413.6(commonly)-414.3(institute)]TJ
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[(long-term)-248.8(streptococcal)-255.5(prophylaxis)-255.5(for)-250.3(the)-251.6(most)-253.4(severely)-251.4(affected)]TJ
T*
[(children,)-400.2(and)-405.6(for)-402.1(those)-403.5(with)-407.7(multiple)-403.8(GAS-associated)-406.7(neuropsy-)]TJ
0 -1.2266 TD
[(chiatric)-321.5(exacerbations.)-324(The)-316.9(rationale)-327.3(for)-319.9(using)-318.9(secondary)-322.8(prophy-)]TJ
0 -1.2203 TD
[(lactic)-212.4(measures)-220.5(is)-212.9(to)-211.7(prevent)-216.7(recurrences)-218.1(of)-210.3(intolerable,)-219.5(debilitating)]TJ
T*
[(symptoms,)-353.9(as)-350.4(well)-353.2(as)-356.7(to)-350.8(minimize)-355.2(the)-352.7(possible)-356.7(risk)-353.6(of)-349.4(long-term)]TJ
ET
59.754 720.113 490.167 .22681 re
f
59.754 586.998 490.167 .22675 re
f
59.754 701.405 490.167 .28345 re
f
BT
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8.9663 0 0 8.9663 156.0755 725.7825 Tm
(Table)Tj
/F6 1 Tf
3.0034 0 TD
(2.)Tj
/F9 1 Tf
1.2456 0 TD
[(Antimicrobial)-339.5(Treatment)-333.7(of)-335.1(Acute)-329.5(Streptococcal)-338.2(Pharyngitis)]TJ
/F7 1 Tf
-14.9916 -2.0233 TD
[(Agent,)-335.5(route,)-336.9(duration)-18139.4(Dose,)-330.3(frequency)-15868.3(Rating)]TJ
/F6 1 Tf
6.7246 0 0 5.9768 529.1148 711.6093 Tm
(a)Tj
8.9663 0 0 8.9663 59.7543 688.9888 Tm
[(Penicillin)-341.1(V)-331.6(p)0(o)]TJ
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6.4051 0 TD
()Tj
/F6 1 Tf
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[(10)-334.1(days)-5186.4(Children:)-333.6(250)-169.3(mg/dose)-336.5(bid)-331.3(or)-330.4(tid;)-338.9(Adolescents)-331.8(or)-336.7(adults:)-334.7(500)-162.9(mg/dose)-336.5(bid)-2146(Strong,)-334(high)]TJ
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[(Amoxicillin)-340.1(po)]TJ
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6.3545 0 TD
()Tj
/F6 1 Tf
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[(10)-334.1(days)-5237(50)-169.7(mg/kg)-327.6(once)-338(daily,)-333.4(maximum)-336.1(1)-163.9(g)-17747.9(Strong,)-334(high)]TJ
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[(Benzathine)-340(penicillin)-336.2(G)-331.6(i)0(m)-335.4(once)]TJ
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15.4785 0 TD
()Tj
/F6 1 Tf
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[(27)-169.7(kg)-334.1(\(60)-329.9(lb\):)-337.5(600,000)-164.4(U)]TJ
/F10 1 Tf
10.3633 0 TD
(>)Tj
/F6 1 Tf
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[(27)-163.4(kg)-334.1(\(60)-329.9(lb\):)-337.5(1.2)-166.3(M)-335.3(U)-11485.2(Strong,)-334(high)]TJ
/F8 1 Tf
-3.8759 -1.4416 TD
[(If)-331.6(penicillin-allergic)]TJ
/F6 1 Tf
-23.0723 -1.448 TD
(Cephalexin)Tj
6.7246 0 0 5.9768 100.7433 647.1494 Tm
(b)Tj
8.9663 0 0 8.9663 107.1496 643.1243 Tm
(po)Tj
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1.1634 0 TD
()Tj
/F6 1 Tf
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[(10)-334.1(days)-5142.2(20)-169.7(mg/kg/dose)-332.8(bid,)-334.3(maximum)-329.8(500)-169.3(mg/dose)-14695.9(Strong,)-334(high)]TJ
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(Cefadroxil)Tj
6.7246 0 0 5.9768 98.2488 637.1715 Tm
(b)Tj
8.9663 0 0 8.9663 104.5984 633.203 Tm
(po)Tj
/F10 1 Tf
1.1697 0 TD
()Tj
/F6 1 Tf
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[(10)-334.1(days)-5426.7(30)-169.7(mg/kg)-327.6(once)-338(daily,)-333.4(maximum)-336.1(1)-163.9(g)-17747.9(Strong,)-334(high)]TJ
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[(Clindamycin)-335.9(po)]TJ
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6.6896 0 TD
()Tj
/F6 1 Tf
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[(10)-327.8(days)-4908.2(7)-163.9(mg/kg/dose)-339.1(tid,)-332(maximum)-336.1(300)-162.9(mg/dose)-15416.7(Strong,)-334(moderate)]TJ
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[(Azithromycin)-336.6(po)]TJ
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()Tj
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[(5)-334.6(days)-5022(12)-169.7(mg/kg)-327.6(once,)-334.6(maximum)-336.1(500)-169.3(mg,)-334.3(then)-333.3(6)-163.9(mg/kg)-333.9(daily,)]TJ
8.6877 -1.1128 TD
[(maximum)-336.1(250)-162.9(mg,)-334.3(for)-338.9(4)-328.3(days)]TJ
31.2036 1.1128 TD
[(Strong,)-334(moderate)]TJ
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[(Clarithromycin)-337.4(po)]TJ
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7.6381 0 TD
()Tj
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[(10)-334.1(days)-3959.8(7.5)-166.3(mg/kg/dose)-332.8(bid,)-334.3(maximum)-336.1(250)-162.9(mg/dose)-14449.3(Strong,)-334(moderate)]TJ
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[(American)-328.1(Heart)-327.6(Association,)-324.3(American)-328.1(Academ)11(y)-332.2(o)0(f)-333.6(Pediatrics)-328.1(\(adapted)-322.1(from)-329.2(Shulman)-322.8(et)-339(al.)-330.8(2012\).)]TJ
5.9774 0 0 5.3127 67.748 569.7636 Tm
(a)Tj
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[(Strength)-326.2(of)-333.6(recommen)10.8(dation,)-328.1(level)-327.3(of)-333.6(evidence)-329(\(as)-328.8(detailed)-329.9(in)-328.6(Shulman)-322.8(et)-331.9(al.)-330.8(2012\).)]TJ
5.9774 0 0 5.3127 67.748 560.8062 Tm
(b)Tj
7.9702 0 0 7.9702 70.7527 557.2345 Tm
[(Avoid)-324.9(with)-325.5(immediate)-327.8(\(type)-329(I\))-329.8(hypersensitiv)12.2(ity)-332.2(to)-335.8(a)-328.3(penicillin.)]TJ
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[(bid,)-325.5(twice)-336.9(daily;)-327.6(tid,)-324(three)-332.2(times)-328.8(daily;)-327.6(po,)-329.1(per)-334.7(os;)-327.8(im,)-331.1(intramuscul)12.9(ar.)]TJ
ET
310.847 325.587 239.074 .22678 re
f
310.847 78.179 239.074 .22681 re
f
BT
/F9 1 Tf
8.9663 0 0 8.9663 332.9574 331.2566 Tm
(Table)Tj
/F6 1 Tf
2.9971 0 TD
(3.)Tj
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1.2519 0 TD
[(Management)-331(of)-335.1(Infection)-338(in)-331.7(PANDAS)]TJ
/F6 1 Tf
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[(1.)-331.2(Rule)-338(out)-331.4(co-existing)-337.8(infectious)-332(causes)-335.5(with)-338.2(a)-330.7(thorough)-337.8(history)]TJ
.999 -1.1128 TD
[(and)-336.1(physical)-332.6(examination,)-336.5(supported)-334.6(by)-334.1(appropriate)-337.6(laboratory)]TJ
0 -1.1065 TD
[(testing.)-306(A)-306.3(variety)-309.2(of)-305.1(different)-307.2(infections)-306.7(have)-306.4(been)-306.4(proposed)-305.8(to)]TJ
0 -1.1128 TD
[(stimulate)-305.8(PANS)-305.3(symptoms,)-309.7(and)-304.5(these)-311.1(should)-305.8(be)-304.9(diagnosed)-302.8(and)]TJ
T*
[(managed)-336.2(according)-332(to)-338.2(standard)-331.2(practices.)]TJ
-.999 -1.4416 TD
[(2.)-293.3(The)-291.6(provisional)-297.4(guideline)-290.7(in)-293.9(Table)-297.1(1)-290.4(may)-295.3(be)-292.3(used)-298.8(to)-293.9(determine)]TJ
.999 -1.1128 TD
[(the)-333.8(association)-338.8(with)-331.9(GAS)-332.5(infection.)-340.5(Patients)-335.2(with)-331.9()54.8(adequate)49.2()]TJ
T*
[(evidence)-275.3(for)-275.6(an)-273.3(association)-281.9(with)-275(streptococcal)-274.5(infection)-280.7(may)-270(be)]TJ
0 -1.1065 TD
[(given)-332.8(a)-337(provisional)-335.4(diagnosis)-330.9(of)-336.7(PANDAS.)]TJ
-.999 -1.4479 TD
[(3.)-242.7(For)-246.3(those)-245.5(with)-249.7(PANDAS,)-250.6(an)-241.7(initial)-246.7(course)-252.3(of)-241.9(treatment)-248.7(for)-250.3(GAS)]TJ
.999 -1.1128 TD
[(is)-333(suggested,)-338.5(including)-332.6(re-culture)-334.4(and)-336.1(follow-up)-334.6(management)]TJ
0 -1.1065 TD
[(according)-338.3(to)-331.8()54.8(Primary)-334.9(antimicrobial)-337(treatment)-337.2(for)-332.5(acute)]TJ
0 -1.1128 TD
[(streptococcal)-337.7(infections)51.6()-330.9(and)-336.1(Table)-335(2)-334.6(given)-332.8(earlier.)-336.1(Continued)]TJ
T*
[(prophylaxis)-331.4(may)-339.6(then)-333.3(be)-330.2(initiated)-336.7(\(see)-335.5(text\).)]TJ
-.999 -1.4416 TD
[(4.)-249(For)-246.3(those)-251.8(with)-249.7(documented)-250.2(GAS)-256.6(pharyngitis,)-249.8(a)-248.5(follow-up)-252.4(throat)]TJ
.999 -1.1128 TD
[(swab)-333.7(27)-333.6(days)-336.8(after)-334.1(treatment)-337.2(is)-333(prudent,)-331(as)-337.7(currently)]TJ
T*
[(recommended)-336.4(for)-332.5(children)-334(with)-338.2(rheumatic)-333.2(fever.)-339.3(Re-treatment)]TJ
0 -1.1065 TD
[(is)-333(recommended)-336.4(if)-334.4(still)-337.3(positive.)]TJ
-.999 -1.4479 TD
[(5.)-274.3(Ongoing)-275.8(vigilance)-280.5(for)-282(streptococcal)-280.8(infection)-280.7(in)-274.9(the)-276.9(patient)-279(and)]TJ
.999 -1.1128 TD
[(all)-331.5(family)-336.1(members)-334.7(is)-333(also)-340.8(warranted.)-334.5(With)-336.8(the)-333.8(appearance)-334.7(of)]TJ
0 -1.1065 TD
[(suspect)-260.7(symptoms)-262.5(in)-262.3(any)-260.2(family)-266.6(member)-258.2(or)-260.9(other)-265.8(close)-260.5(contact,)]TJ
0 -1.1128 TD
[(an)-336.6(early)-331.5(diagnostic)-335.7(study)-331.6(is)-339.3(indicated,)-334(followed)-334.9(by)-334.1(prompt)]TJ
T*
[(treatment)-337.2(for)-332.5(those)-334(with)-338.2(documented)-332.4(GAS)-332.5(infection.)]TJ
7.9702 0 0 7.9702 318.7841 66.3307 Tm
[(PANS,)-226(p)23.4(e)27.3(d)23.4(i)24.9(a)27.3(t)24.9(r)27.1(i)24.9(c)-136.3(a)27.3(c)27.3(u)23.4(t)24.9(e)27.3(-)27.1(o)23.4(n)23.4(s)29.3(e)27.3(t)-138.7(n)30.5(e)20.2(u)30.5(r)27.1(o)23.4(p)23.4(s)29.3(y)23.4(c)27.3(h)30.5(i)24.9(a)20.2(t)24.9(r)27.1(i)24.9(c)-129.2(s)22.2(y)23.4(n)30.5(d)23.4(r)27.1(o)23.4(m)27(e)27.3(;)-131.6(P)25.6(A)28(N)20.9(D)28(A)28(S)25.6(,)-134.1(p)30.5(e)20.2(d)30.5(i)24.9(a)20.2(t)32(r)20(i)24.9(c)]TJ
-.9958 -1.1239 TD
-.0252 Tc
[(auto)5.3(immun)5.3(e)-261.1(neu)5.3(r)-5.2(o)5.3(p)-1.8(sychiatric)-261.1(d)5.3(i)-.3(so)5.3(rd)5.3(er)-261.2(as)]TJ
15.656 0 TD
-.0263 Tc
[(sociate)-6.1(d)-259(with)-259(s)-4.1(t)5.7(r)-6.3(e)1(ptococca)-6.1(l)-257.4(i)-1.4(nfection.)]TJ
/F4 1 Tf
8.9663 0 0 8.9663 59.7543 749.7069 Tm
0 Tc
[(MANAGEMENT)-341.5(OF)-331.2(INFECTIONS)-341.8(IN)-328.8(PANS)]TJ
54.1178 0 TD
(5)Tj
ET
endstream
endobj
117 0 obj
<>stream
/GS1 gs
BT
/F6 1 Tf
8.9663 0 0 8.9663 62.022 725.7825 Tm
0 0 0 rg
0 Tc
0 Tw
[(sequelae)-238.6(or)-229.3(chronic)-235.7(symptoms.)-227.5(Weighing)-236.1(these)-235.2(theoretical)-231.6(benets)]TJ
0 -1.2203 TD
[(against)-516.5(the)-517.1(known)-513(risks)-512.4(of)-513.8(long-term)-520.6(antibiotic)-513.2(administration)]TJ
0 -1.2266 TD
[(requires)-327.5(a)-324.4(careful)-329.2(consideration)-326.6(of)-324.1(the)-327.4(patients)-326.1(history)-324.6(and)-329.7(clini-)]TJ
0 -1.2203 TD
[(cal)-336.2(status.)-329(We)-338.5(believe)-334.3(that)-331(the)-333.8(decision)-332.6(to)-331.8(institute)-335.5(long-term)-330.9(an-)]TJ
T*
[(timicrobial)-354.5(prophylaxis)-350.3(may)-345.9(best)-353.4(be)-349.2(made)-347.9(in)-350.8(consultation)-351.4(with)-350.8(a)]TJ
0 -1.2266 TD
[(pediatric)-276.8(infectious)-275(diseases)-276.5(specialist,)-283(or)-273.5(a)-273.8(member)-277.1(of)-273.5(the)-270.5(PANS/)]TJ
0 -1.2203 TD
[(PANDAS)-405.8(Clinical)-401.1(Research)-406.3(Consortium.)-397.5(When)-400.7(secondary)-405(GAS)]TJ
T*
[(prevention)-314.1(is)-320.4(chosen,)-315.8(the)-314.8(antimicrobial)-318(regimens)-315.8(should)-312.1(be)-317.6(based)]TJ
0 -1.2266 TD
[(on)-479.6(guidelines)-474.8(developed)-481.1(for)-478(the)-479.2(prevention)-478.5(of)-475.8(rheumatic)-478.6(fever)]TJ
0 -1.2203 TD
[(\(Gerber)-284.4(et)-277.3(al.)-286.6(2009\).)]TJ
/F2 1 Tf
1.1128 -2.447 TD
[(Duration)-415.1(of)-412.6(antimicrobial)-415.1(prophylaxis.)]TJ
/F6 1 Tf
17.7294 0 TD
[(A)-356.9(recommendation)]TJ
-18.8423 -1.2203 TD
[(for)-294.6(the)-295.8(duration)-293.7(of)-298.8(prophylaxis)-293.4(will)-297.9(depend)-292.8(on)-296.2(an)-292.3(emerging)-295.6(expe-)]TJ
T*
[(rience)-377.7(with)-376.1(late)-377.7(relapses)-372.8(during)-376.7(prolonged)-377.7(follow-up)-372.6(of)-374.7(children)]TJ
T*
[(and)-279.2(young)-275.8(adults)-274.3(with)-281.3(PANDAS.)-275.9(Anecdotal)-279.8(experiences)-286.4(with)-275(late)]TJ
0 -1.2266 TD
[(relapses)-240(suggest)-245.7(that)-236.1(the)-238.9(preventive)-247(regimen)-239.2(should)-236.2(continue)-242.9(for)-237.7(at)]TJ
0 -1.2203 TD
[(least)-378.4(a)-375(year)-378.5(or)-374.7(two)-378.9(after)-378.4(symptoms)-376.3(have)-375.9(abated.)-378(For)-372.8(children)-378.3(in)]TJ
T*
[(remission,)-384.2(some)-384.6(clinicians)-386.4(optionally)-386.7(suspend)-380.7(antibiotic)-386.8(prophy-)]TJ
0 -1.2266 TD
[(laxis)-198.9(during)-199.7(the)-201(summer)-206.4(months)-195.5(when)-199.8(GAS)-206.1(exposures)-201.4(are)-202(expected)]TJ
0 -1.2203 TD
[(to)-369.8(be)-374.5(less)-373.6(common.)-369.9(Prophylaxis)-374.2(is)-371(resumed)-375.5(in)-369.8(the)-378(fall)-371.5(when)-370.5(the)]TJ
T*
[(child)-324.2(returns)-325.6(to)-325.5(school.)-330.1(If)-320.4(the)-327.4(child)-324.2(remains)-328.9(symptom)-325(free)-324.2(during)]TJ
0 -1.2266 TD
[(the)-245.2(academic)-256(year,)-248.7(antibiotics)-248.4(may)-244.8(be)-248(discontinued)-252.5(completely)-245.6(the)]TJ
0 -1.2203 TD
[(following)-323.4(summer.)-329.4(Continuing)-321.7(prophylaxis)-331.4(to)-319.2(age)-332.2(18)-321.5(in)-325.5(the)-327.4(most)]TJ
T*
[(severe)-229.4(cases)-234.8(seems)-229.6(reasonable,)-230.5(but)-230.2(should)-229.9(be)-229.1(individualized,)-232.1(based)]TJ
T*
[(on)-359.4(the)-359.1(frequency)-362.2(and)-361.4(severity)-360.5(of)-362(neuropsychiatric)-361.8(exacerbations,)]TJ
0 -1.2266 TD
[(time)-290.2(since)-285.8(previous)-284.5(exacerbation,)-291.7(and)-285.5(risk)-284.1(of)-286.2(GAS)-288.3(exposure)-282.9(\(e.g.,)]TJ
0 -1.2203 TD
[(crowded)-506.8(living)-502.3(conditions,)-506.9(younger)-501.1(siblings)-503.7(at)-505(home,)-506.4(or)-501.1(GAS)]TJ
T*
[(outbreaks)-280.1(at)-283.7(school\).)]TJ
/F4 1 Tf
0 -2.447 TD
[(Antimicrobial)-336.6(Management)-335.8(Of)-334(Nonstreptococcal)-337.9(PANS)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(Among)-251(PANS)-248.4(patients)-248.1(with)-249.7(no)-251.9(evidence)-250.1(for)-250.3(a)-248.5(GAS)-250.3(initiation,)-252.2(it)]TJ
-1.1128 -1.2203 TD
[(has)-299.3(been)-293.7(our)-298.3(practice)-300.9(to)-293.9(provide)-302.8(an)-292.3(initial)-297.3(course)-302.9(of)-292.5(antimicrobial)]TJ
0 -1.2267 TD
[(treatment)-299.3(as)-299.8(for)-294.6(acute)-299.7(streptococcal)-299.8(infection)-299.6(as)-299.8(described)-295.2(earlier,)]TJ
0 -1.2203 TD
[(even)-224.2(though)-228.7(GAS)-225(is)-225.5(not)-223.9(identied)-226.1(at)-226.8(the)-226.3(time)-227(of)-222.9(diagnosis,)-226.3(because)]TJ
T*
[(negative)-321.2(studies)-319.2(do)-315.2(not)-318.7(absolutely)-323(rule)-316.9(out)-318.7(a)-318.1(hidden)-319.7(source)-315.5(of)-317.8(in-)]TJ
0 -1.2266 TD
[(fection,)-198.3(as)-192.3(described)-200.4(earlier.)-197(This)-192.8(is)-193.9(similar)-195.4(to)-192.7(the)-194.7(recommendations)]TJ
0 -1.2203 TD
[(for)-250.3(the)-245.2(initial)-246.7(management)-249.8(of)-248.2(rheumatic)-251(fever)-247.9(\(Gerber)-246.5(et)-245.7(al.)-248.6(2009\).)]TJ
T*
[(However,)-228.5(in)-230.7(cases)-228.5(without)-233.2(a)-223.2(clear)-232.7(link)-227.4(to)-230.7(GAS)-225(infection,)-233(long-term)]TJ
T*
[(antimicrobial)-292.7(prophylaxis)-287.1(is)-282.4(not)-287.1(currently)-291.9(recommended.)-288.8(The)-285.3(risk)]TJ
0 -1.2266 TD
[(of)-279.8(symptom)-274.4(exacerbations)-283.1(may)-282.7(be)-279.6(independent)-275.5(of)-279.8(GAS)-281.9(infections)]TJ
0 -1.2203 TD
[(and)-241.2(antibiotic)-247.7(prophylaxis)-242.8(would)-238.8(offer)-241.7(no)-245.6(protection)-242.2(against)-244.6(future)]TJ
T*
[(recurrences.)-366.4(For)-353.8(these)-361.7(patients,)-364.9(close)-361.7(monitoring)-354.8(and)-361.4(early)-363.1(treat-)]TJ
0 -1.2267 TD
[(ment)-317.8(for)-319.9(GAS)-313.5(infection)-318.6(in)-319.2(the)-314.8(patient)-323.3(and)-317.1(family)-317.2(members)-315.8(is)-320.4(ad-)]TJ
0 -1.2203 TD
[(vised)-251.8(\(Table)-254.9(4\).)-251.1(GAS)-256.6(cultures)-253(should)-248.9(be)-254.4(obtained)-255.6(during)-250.3(symptom)]TJ
T*
[(ares.)-393.4(Positive)-389.7(cultures)-392.1(should)-388(be)-387.1(managed)-393.1(as)-388.3(described)-390(earlier,)]TJ
0 -1.2267 TD
[(under)-293.4()54.8(Primary)-290.7(Antimicrobial)-293.6(Treatment)-295.1(for)-294.6(Streptococcal)-297.2(Infec-)]TJ
0 -1.2203 TD
[(tions.)51.4()-362.5(Repeated)-362.3(GAS-incited)-367.1(ares)-365.2(would)-365.3(change)-364.7(the)-365.4(diagnosis)]TJ
T*
[(from)-278.7(non-streptococcal)-287.8(PANS)-280(to)-281.3(PANDAS.)]TJ
/F4 1 Tf
0 -2.447 TD
[(Streptococcal)-336.3(Illness)-333(in)-338(Contacts)-335.1(of)-330.2(Patients)]TJ
0 -1.2203 TD
[(with)-336.8(PANDAS)-335.9(or)-335.1(PANS)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(At)-240.3(the)-238.9(time)-239.7(of)-235.6(the)-238.9(rst)-238.4(presentation,)-241.5(attention)-244.1(should)-236.2(be)-241.7(given)-237.9(to)]TJ
-1.1128 -1.2203 TD
[(family)-412(history)-419.4(of)-412.6(pharyngitis,)-414.2(impetigo,)-409(perianal)-418.7(dermatitis,)-418.3(and)]TJ
0 -1.2266 TD
[(other)-348(signs)-351.7(and)-348.7(symptoms)-351(of)-349.4(GAS)-351.5(infections.)-347.5(If)-352(possible,)-347(family)]TJ
0 -1.2203 TD
[(members)-379(should)-375.3(have)-382.3(a)-375(throat)-376.9(swab)-378(cultured)-378.3(for)-376.8(GAS.)-379.7(Ongoing)]TJ
T*
[(vigilance)-489.1(against)-491.2(GAS)-484.3(infections)-490(in)-489.9(any)-487.8(of)-482.2(the)-491.8(patients)-484.2(close)]TJ
0 -1.2266 TD
[(contacts)-448.9(is)-446.8(important,)-449.1(as)-445.2(symptom)-445.1(exacerbations)-453.9(have)-445.5(been)-445.5(re-)]TJ
0 -1.2203 TD
[(ported)-537.2(after)-542.7(exposure)-542.2(to)-534.2(a)-539.4(sibling)-541(with)-534.2(GAS,)-544.1(even)-540.3(when)-534.9(the)]TJ
T*
[(PANDAS)-285.7(patient)-279(had)-279.2(no)-283.6(evidence)-281.7(of)-279.8(frank)-283.4(infection.)]TJ
1.1128 -1.2266 TD
[(For)-309.5(families)-311.2(in)-312.9(which)-310.8(there)-312.5(are)-309.5(unaffected)-317.5(siblings)-307.7(in)-312.9(the)-308.5(312)]TJ
-1.1128 -1.2203 TD
[(year)-416.5(age)-414.4(group,)-414.1(prompt)-411.9(medical)-420.1(attention)-414.9(to)-414(symptoms)-414.2(that)-413.2(are)]TJ
27.9978 32.6325 TD
[(suggestive)-421.4(of)-412.6(streptococcal)-413.6(infection)-419.8(is)-415.2(important)-414.6(to)-414(protect)-410.4(not)]TJ
0 -1.2203 TD
[(only)-242.3(the)-232.6(index)-237.9(patient)-241.1(but)-236.5(also)-233.3(the)-238.9(siblings)-238.2(themselves)-237.6(who)-235.8(may)-238.4(be)]TJ
T*
[(at)-365.9(an)-355.5(increased)-367.2(genetic)-359.6(risk)-359.9(for)-357.8(PANDAS)-361.5(\(Dranitzki)-368.3(and)-355(Steiner)]TJ
0 -1.2266 TD
[(2007,)-285.5(Lewin)-279(et)-283.7(al.)-280.3(2011;)-279.8(unpublished)-278.2(personal)-280.6(observations\).)]TJ
/F4 1 Tf
0 -3.3006 TD
[(Infections)-338.7(Other)-332.1(than)-334(GAS)]TJ
/F11 1 Tf
0 -1.8273 TD
[(Upper)-334.3(respiratory)-339.7(infections)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(The)-361.2(onset)-359.3(and)-361.4(exacerbations)-365.3(of)-362(PANS)-362.2(are)-360.1(very)-357.2(frequently)-367.3(as-)]TJ
-1.1128 -1.2266 TD
[(sociated)-385.6(with)-382.4(common)-379.6(upper)-382(respiratory)-383.2(tract)-379.8(infections)-382.5(\(Swedo)]TJ
0 -1.2203 TD
[(et)-315.3(al.)-311.9(1998;)-311.4(Murphy)-310.2(et)-309(al.)-311.9(2014;)-311.4(Frankovich)-308.7(et)-315.3(al.)-305.6(2015\).)-312.9(In)-311.4(these)]TJ
T*
[(reports,)-195.7(the)-194.7(specic)-197.3(causative)-197.9(organism)-193.2(was)-195.1(rarely)-194.5(identied.)-197.4(Acute)]TJ
0 -1.2266 TD
[(rhinosinusitis)-202.8(\(the)-190.5(common)-196.2(cold\),)-199.2(otitis)-197.7(media,)-196.2(and)-197(acute)-192.2(or)-197.6(chronic)]TJ
0 -1.2203 TD
[(sinusitis)-293.5(are)-290.5(often)-284.8(anecdotally)-294.6(observed)-289.3(with)-287.6(initial)-291(onset)-283.4(or)-292.5(exac-)]TJ
T*
[(erbations)-416.9(of)-406.3(PANS.)-409.4(Such)-410(infections)-414.2(should)-406.9(be)-412.4(judiciously)-412.7(diag-)]TJ
0 -1.2266 TD
[(nosed)-399.5(and)-393(treated)-400.2(according)-395.2(to)-395.1(standard)-394.4(clinical)-398.8(practice.)-398.7(In)-393.7(the)]TJ
0 -1.2203 TD
[(absence)-589.1(of)-583.3(a)-590(suggestive)-585.8(clinical)-582.2(syndrome,)-590.5(unfocused)-585.9(broad-)]TJ
T*
[(spectrum)-290.5(serologic)-284.2(diagnostic)-285.1(testing)-284.1(for)-288.3(various)-285(microbial)-284.2(patho-)]TJ
T*
[(gens)-286.2(is)-276.1(generally)-285.4(not)-280.8(useful.)]TJ
1.1128 -1.2266 TD
[(Sinusitis)-284.5(is)-282.4(one)-285.5(of)-279.8(the)-283.2(more)-284.8(common)-278.4(infections)-287.7(inciting)-286.5(PANS.)]TJ
-1.1128 -1.2203 TD
[(Guidelines)-357.9(for)-351.5(the)-352.7(appropriate)-350.3(management)-357.3(of)-349.4(acute)-356.6(and)-348.7(chronic)]TJ
T*
[(rhinosinusitis)-335.6(should)-337.4(be)-330.2(followed)-334.9(\(Slavin)-337(et)-334.3(al.)-330.8(2005;)-330.4(Wald)-335.2(et)-334.3(al.)]TJ
0 -1.2266 TD
[(2013;)-241.9(Hamilos)-249(2016\).)-237(Although)-247.7(over-diagnosis)-241.3(should)-242.6(be)-241.7(avoided,)]TJ
0 -1.2203 TD
[(close)-431.2(attention)-433.8(to)-426.7(those)-428.8(meeting)-430.3(diagnostic)-430.5(criteria)-425.3(for)-433.7(acute)-426.1(or)]TJ
T*
[(chronic)-292.6(sinusitis)-287.1(is)-282.4(encouraged.)-288.5(When)-286.9(antimicrobial)-292.7(therapy)-286.3(is)-288.8(in-)]TJ
0 -1.2266 TD
[(dicated,)-444.8(amoxicillin-clavulanate)-448.7(is)-440.5(generally)-443.5(preferred)-443.2(for)-440(acute)]TJ
0 -1.2203 TD
[(sinusitis)-312.4(in)-312.9(children)-315.1(with)-312.9(moderate)-310.7(or)-311.5(severe)-311.6(PANS)-311.6(or)-311.4(PANDAS,)]TJ
ET
313.058 720.113 239.131 .22681 re
f
313.058 402.916 239.131 .28348 re
f
BT
/F9 1 Tf
8.9663 0 0 8.9663 329.1023 725.7825 Tm
(Table)Tj
/F6 1 Tf
2.9971 0 TD
(4.)Tj
/F9 1 Tf
1.2519 0 TD
[(Management)-331(of)-335.1(Nonstreptococcal)-334.7(PANS)]TJ
/F6 1 Tf
-6.0384 -1.7451 TD
[(1.)-337.5(Although)-260.4(an)-260.7(initial)-259.4(course)-264.9(of)-260.9(antimicrobial)-261.1(treatment)-261.3(is)-263.5(herein)]TJ
1.0053 -1.1128 TD
[(recommended)-260.6(for)-263(cases,)-263(both)-261.3(with)-256(and)-260.2(without)-264.9(evidence)-262.7(for)]TJ
0 -1.1065 TD
[(streptococcal)-261.9(infection,)-264.6(long-term)-261.4(secondary)-259.6(antibiotic)]TJ
0 -1.1128 TD
[(prophylaxis)-198.6(against)-206.7(streptococcal)-205(infections)-199.2(is)-200.2(not)-204.9(recommended)]TJ
T*
[(for)-256.7(patients)-267.1(with)-256(non-streptococcal)-268.8(PANS)-261.1(\(dened)-261.8(in)-256(Table)-265.5(1\).)]TJ
T*
[(Since)-257.9(the)-264.2(likelihood)-260.2(of)-260.9(a)-261.2(future)-261.6(GAS-induced)-264.2(recrudescence)-263.6(is)]TJ
0 -1.1065 TD
[(unclear,)-260(the)-264.2(possibility)-257.4(of)-260.9(benet)-263.7(does)-260.9(not)-261.8(outweigh)-256.5(potential)]TJ
0 -1.1128 TD
[(adverse)-184.7(effects)-191.3(of)-191.3(antimicrobial)-185.2(exposure)-188.1(on)-188.7(microbial)-189.4(resistance)]TJ
T*
[(and)-260.2(on)-258.3(the)-257.9(protective)-263.6(host)-262.5(microbiome.)]TJ
-1.0053 -1.4416 TD
[(2.)-337.5(Children)-336.3(with)-331.9(PANS)-336.9(often)-329.1(experience)-342.6(exacerbation)-333(of)]TJ
1.0053 -1.1128 TD
[(neuropsychiatric)-336.5(symptoms)-332(during)-332.5(intercurrent)-337.4(sinusitis)-337.7(or)]TJ
T*
[(other)-329.1(non-streptococcal)-344.7(infections.)-334.9(These)-332.2(should)-337.4(be)-330.2(promptly)]TJ
0 -1.1065 TD
[(evaluated)-335.8(and)-329.7(managed)-336.2(according)-338.3(to)-331.8(current)-339.4(standards)-331.9(of)]TJ
0 -1.1128 TD
(practice.)Tj
-1.0053 -1.4479 TD
[(3.)-280.6(It)-271.2(is)-276.1(possible)-274.5(that)-280.4(GAS)-275.6(may)-276.4(initiate)-273.9(a)-273.8(symptom)-274.4(are)-282.3(in)-274.9(children)]TJ
1.0053 -1.1065 TD
[(with)-331.9(an)-336.6(initial)-335.3(diagnosis)-330.9(of)-336.7(non-streptococcal)-338.4(PANS.)-333.5(It)-334.4(is,)]TJ
0 -1.1128 TD
[(therefore,)-251.6(important)-250.2(for)-250.3(families)-254.3(to)-249.6(be)-248(vigilant)-248.5(for)-250.3(possible)-249.2(GAS)]TJ
T*
[(infection)-331.3(in)-338.2(both)-330.9(the)-333.8(patient)-336(and)-336.1(close)-330.1(family)-336.1(members.)]TJ
-1.0053 -1.4416 TD
[(4.)-318.6(If)-314.1(the)-321.1(PANS)-318(patient)-317(or)-317.8(close)-317.4(contact)-315.4(has)-318.3(a)-318.1(sore)-314.1(throat,)-322.9(a)-311.8(throat)]TJ
1.0053 -1.1128 TD
[(swab)-333.7(should)-331.1(be)-336.6(obtained)-331.4(and)-336.1(treated)-336.9(promptly)-332.7(if)-334.4(GAS)-332.5(is)]TJ
T*
(identied.)Tj
-1.0053 -1.4416 TD
[(5.)-274.3(If)-269.8(the)-270.5(PANS)-273.7(patient)-272.7(has)-267.7(a)-273.8(denite)-273.6(increase)-272.8(in)-268.6(PANS)-273.7(symptoms,)]TJ
1.0053 -1.1128 TD
[(careful)-335.5(physical)-332.6(evaluation)-336.9(for)-332.5(an)-336.5(inciting)-337.1(infection)-331.3(should)-337.4(be)]TJ
T*
[(performed.)-299.2(Skin)-297.8(infection,)-296.2(including)-300.9(perianal)-298.5(dermatitis,)-304.5(would)]TJ
0 -1.1065 TD
[(warrant)-304.8(appropriate)-306(cultures.)-300.2(A)-306.3(throat)-301(swab)-308.5(for)-300.9(GAS)-307.2(should)-299.5(be)]TJ
0 -1.1128 TD
[(performed)-334.3(even)-331.7(in)-338.2(the)-333.8(absence)-336.2(of)-330.4(clinical)-335.6(pharyngitis.)-338.3(GAS)]TJ
T*
[(serology)-335.1(\(ASO)-334.6(and)-329.7(ADB\),)-337.4(and)-336.1(a)-330.7(polymerase)-336.2(chain)-335.2(reaction)]TJ
T*
[(test)-332.2(for)]TJ
/F13 1 Tf
3.2247 0 TD
[(Mycoplasma)-339.4(pneumoniae)]TJ
/F6 1 Tf
10.6794 0 TD
[(may)-333.3(be)-330.2(performed)-340.6(as)-331.4(well.)]TJ
-13.9041 -1.1065 TD
[(A)-331.6(listing)-336.3(of)-330.4(selected)-337.5(laboratory)-335.7(tests)-339.2(for)-332.5(infection)-331.2(is)-339.3(presented)]TJ
0 -1.1128 TD
[(in)-331.8(Table)-335(5.)]TJ
7.9702 0 0 7.9702 321.0519 391.1243 Tm
[(A)-349(plan)-356.2(for)-349.1(PANS)-347.9(patients)-342.1(who)-351.9(had)-352.6(negative)-345.6(GAS)-345.1(studies,)-349.8(and)-345.5(are)-352.1(not)]TJ
-1.003 -1.1239 TD
[(currently)-325.8(receiving)-332.7(daily)-324.1(antimicrobial)-323.4(prophylaxis.)]TJ
/F4 1 Tf
8.9663 0 0 8.9663 62.022 749.6502 Tm
(6)Tj
43.274 0 TD
[(COOPERSTOCK)-335.9(ET)-338.7(AL.)]TJ
ET
endstream
endobj
121 0 obj
<>stream
/GS1 gs
BT
/F6 1 Tf
8.9663 0 0 8.9663 59.7543 725.7825 Tm
0 0 0 rg
0 Tc
0 Tw
[(and)-323.4(for)-319.9(those)-321.3(who)-324.3(have)-319(recently)-323.8(been)-319(treated)-324.3(with)-319.2(other)-322.7(antibiot-)]TJ
0 -1.2203 TD
[(ics.)-268.3(For)-259(frequently)-266.1(recurrent)-267.6(or)-260.9(chronic)-261(sinusitis,)-264.8(specialist)-267.4(referral)]TJ
0 -1.2266 TD
[(should)-337.4(be)-336.6(considered.)-341.9(Therapies)-333(that)-337.3(avoid)-339.1(antimicrobials)-337.7(should)]TJ
0 -1.2203 TD
[(be)-286(used)-279.9(initially)-281.4(whenever)-281.1(possible.)]TJ
/F11 1 Tf
0 -2.447 TD
(Inuenza)Tj
/F6 1 Tf
1.1128 -1.8336 TD
[(Inuenza)-270.1(has)-267.7(often)-265.8(been)-268.4(documented)-269.2(anecdotally)-269.3(at)-271(both)-267.6(initial)]TJ
-1.1128 -1.2203 TD
[(onset)-251.8(and)-253.9(exacerbations)-257.8(of)-248.2(PANS.)-251.3(Annual)-253.4(inuenza)-252.5(immunization)]TJ
T*
[(is)-301.4(strongly)-298.8(advised)-297.5(for)-300.9(PANS)-299(patients)-305(and)-298.1(all)-299.8(close)-298.5(contacts.)-300(This)]TJ
0 -1.2266 TD
[(should)-217.3(be)-216.4(performed)-214.1(according)-218.1(to)-211.7(annual)-214.6(inuenza)-220.9(guidelines)-215.5(from)]TJ
0 -1.2203 TD
[(the)-283.2(Centers)-285.8(for)-275.6(Disease)-285.4(Control)-283.8(\(2016a\).)]TJ
1.1128 -1.2203 TD
[(Since)-232.6(inuenza)-233.6(is)-231.9(highly)-226.4(contagious,)-233.4(good)-232(hand)-228.1(hygiene,)-229.7(proper)]TJ
-1.1128 -1.2266 TD
[(cough)-221.3(technique,)-228.8(and)-222.3(avoidance)-224.3(of)-216.6(close)-228.9(contact)-220.5(with)-224.4(ill)-219.3(people)-227.2(are)]TJ
0 -1.2203 TD
[(appropriate)-343.9(during)-338.8(inuenza)-341.1(season.)-336(Typical)-338.1(inuenza)-341.1(symptoms)]TJ
T*
[(include)-376.2(abrupt)-379.2(onset)-371.9(of)-374.7(fever,)-377.2(myalgia,)-376.3(malaise,)-379.9(sore)-377.3(throat,)-373.5(and)]TJ
T*
[(cough.)-394.9(Vigilance)-391.3(for)-395.8(inuenza)-391.7(symptoms)-395.3(in)-388.7(patients)-393.6(and)-393(family)]TJ
0 -1.2266 TD
[(members)-492.8(is)-484.8(prudent)-492.5(during)-484.2(community)-487.4(epidemic)-489.1(periods,)-490.3(with)]TJ
0 -1.2203 TD
[(prompt)-285.4(pursuit)-280.3(of)-279.8(appropriate)-280.7(diagnosis)-280.3(and)-285.5(treatment.)]TJ
1.1128 -1.2203 TD
[(Older)-218.6(rapid)-215.3(inuenza)-220.9(immunoassays)-216(are)-220.9(highly)-213.8(specic)-216.3(but)-217.5(only)]TJ
-1.1128 -1.2266 TD
[(50%70%)-462.4(sensitive,)-460.4(and)-462.5(are,)-457.8(therefore,)-460.2(useful)-462.5(only)-457.3(if)-460.9(positive.)]TJ
0 -1.2203 TD
[(Newer)-270.8(rapid)-265.8(and)-266.5(highly)-264.4(sensitive)-267.8(inuenza)-265.2(nucleic)-264.8(acid)-266.1(assays)-271(are)]TJ
T*
[(available)-510.5(for)-509.6(swab)-510.8(specimens)-506(from)-512.6(the)-504.5(anterior)-513.7(nose)-507.5(\(Alere)]TJ
/F10 1 Tf
25.7848 0 TD
()Tj
/F6 1 Tf
-25.7848 -1.2267 TD
[(Inuenza)-402.9(A&B)-402.1(assay,)-406(Alere-Scarborough,)-400(Scarborough,)-404.5(ME\))-400(or)]TJ
0 -1.2203 TD
[(nasopharynx)-332.1(\(Cobas)-324.1(inuenza)-328.4(A/B)-326.7(PCR,)-325.6(Roche)-323.3(Molecular)-330.4(Diag-)]TJ
T*
[(nostics,)-284.2(Indianapolis,)-283.3(IN\).)]TJ
1.1128 -1.2203 TD
[(The)-310.6(clinical)-316.6(diagnosis)-305.6(and)-310.8(treatment)-318.2(of)-305.1(inuenza)-315.8(is)-307.7(considered)]TJ
-1.1128 -1.2266 TD
[(appropriate)-280.7(without)-277.5(laboratory)-272.4(testing)-277.8(for)-275.6(anyone)-273.8(with)-275(compatible)]TJ
0 -1.2203 TD
[(symptoms)-351(during)-351.5(active)-347.5(community)-348.2(inuenza)-353.7(epidemics;)-347.9(current)]TJ
T*
[(guidelines)-228.2(for)-218.7(diagnosis)-223.4(and)-222.3(treatment)-229.7(should)-223.6(be)-222.7(followed)-221.1(\(Centers)]TJ
0 -1.2266 TD
[(for)-313.6(Disease)-317(Control)-315.4(2016a\).)-314.8(In)-311.4(adults,)-315.1(antiviral)-316.3(treatment)-318.2(with)-312.9(ei-)]TJ
0 -1.2203 TD
[(ther)-285.3(oral)-279(oseltamivir)-282.1(or)-279.8(inhaled)-281.3(zanamivir)-282.6(is)-282.4(most)-278.7(effective)-284.1(within)]TJ
T*
[(the)-409.6(rst)-402.8(48)-410(hours)-406(of)-406.3(illness.)-408.4(However,)-405.6(the)-409.6(initiation)-407.4(of)-400(antiviral)]TJ
0 -1.2267 TD
[(treatment)-280.3(should)-267.8(not)-274.4(be)-273.3(withheld)-273.1(beyond)-277.7(that)-274.1(48-hour)-267.4(window)-273.3(for)]TJ
0 -1.2203 TD
[(children,)-254.8(who)-248.4(may)-251.1(excrete)-253.1(the)-251.6(virus)-245.6(for)-250.3(longer)-252.7(periods)-253.4(than)-251.1(adults.)]TJ
/F11 1 Tf
0 -2.447 TD
[(Mycoplasma)-338.9(pneumoniae)]TJ
/F7 1 Tf
1.1128 -1.8336 TD
[(M.)-396.6(pneumoniae)]TJ
/F6 1 Tf
6.7782 0 TD
[(is)-396.3(a)-400.3(suspected,)-404.2(but)-394.6(not)-400.9(yet)-397(proven,)-403.4(trigger)-397.9(of)]TJ
-7.891 -1.2203 TD
[(PANS.)-270.3(Most)]TJ
/F7 1 Tf
5.3745 0 TD
[(M.)-270.1(pneumoniae)]TJ
/F6 1 Tf
6.5126 0 TD
[(infections)-268.7(are)-265.2(indistinguishable)-269.6(from)]TJ
-11.8871 -1.2203 TD
[(common)-196.2(viral)-194(upper)-192.3(respiratory)-199.9(tract)-190.1(infection.)-195.1(Although)-197.1(cough)-189.7(is)-193.9(a)]TJ
0 -1.2267 TD
[(common)-411.2(symptom)-407.2(in)-407.7(the)-409.6(acute)-413.5(infection,)-410(the)-409.6(characteristic)-415.8(per-)]TJ
0 -1.2203 TD
[(sistent)-323.3(cough)-322.4(syndrome,)-318.6(often)-316.4(presenting)-321.6(sequentially)-328.5(in)-319.2(multiple)]TJ
T*
[(family)-190.7(members,)-192.2(is)-193.9(less)-190.2(common)-189.9(\(American)-196(Academy)-187.7(of)-191.3(Pediatrics)]TJ
T*
[(2015b\).)-230.2(A)-230.4(denitive)-232.4(diagnosis)-229.7(is)-231.9(best)-233.3(made)-227.7(with)-230.7(a)]TJ
/F7 1 Tf
20.1258 0 TD
[(M.)-232.2(pneumoniae)]TJ
/F6 1 Tf
6.2091 0 TD
(-)Tj
-26.3349 -1.2266 TD
[(specic)-393.3(molecular)-390.1(assay.)-393.4(This)-388.8(assay,)-393.4(which)-386.7(is)-389.9(available)-390.4(through)]TJ
0 -1.2203 TD
[(several)-359.4(commercial)-363.9(reference)-363.3(laboratories,)-357.9(may)-358.6(be)-355.5(performed)-359.5(on)]TJ
T*
[(nasopharyngeal)-250.9(or)-241.9(pharyngeal)-249.3(secretions.)-245.9(A)-243.1(rising)-249.2(IgG)-244.7(titer,)-245.2(which)]TJ
0 -1.2266 TD
[(requires)-555.1(acute)-552.6(and)-551(convalescent)-552.9(sera,)-553.4(may)-548.3(also)-555.8(be)-551.5(diagnostic)]TJ
0 -1.2203 TD
[(\()-84.3(Medjo)-238.6(et)-239.4(al.)-236(2014\).)]TJ
/F7 1 Tf
8.2704 0 TD
[(M.)-238.5(pneumoniae)]TJ
/F6 1 Tf
6.4557 0 TD
[(IgG)-238.4(titers)-236.6(may)-238.4(be)-241.7(elevated)-235.1(for)]TJ
-14.7261 -1.2203 TD
[(life;)-267.6(a)-261.2(single)-268(elevated)-260.4(IgG)-263.7(titer)-267.6(with)-262.3(neither)-265(an)-260.7(IgM)-267.4(response)-265.1(nor)-260.4(a)]TJ
0 -1.2266 TD
[(positive)-422.8(PCR)-417.5(is)-421.5(not)-419.9(indicative)-416.8(of)-418.9(current)-421.6(infection.)-422.7(Further,)-420.7(the)]TJ
0 -1.2203 TD
[(reliability)-285.4(of)-286.2(a)-286.5(single)-280.6(IgM)-286.4(serology)-284.5(has)-280.3(been)-287.4(inconsistent)-283(between)]TJ
T*
[(studies,)-202(and)-197(it)-203.1(is)-193.9(often)-202.6(prone)-198.6(to)-199.1(false)-199.9(positives)-202.1(\(Thurman)-196.8(et)-201.5(al.)-198.1(2009;)]TJ
T*
[(Bradley)-202.4(et)-201.5(al.)-204.4(2011;)-197.6(Medjo)-200.7(et)-201.5(al.)-204.4(2014\).)-199.1(Positive)-200(IgM)-204.2(ELISA)-197.7(results)]TJ
0 -1.2266 TD
[(should)-514.4(be)-507.3(conrmed)-511.5(by)-511.2(indirect)-508.8(immunouorescence)-516.8(antibody)]TJ
0 -1.2203 TD
[(testing)-227.2(\(Smith)-224.8(1986\).)-218.1(However,)-228.5(combined)-223.5(molecular)-225.7(diagnosis)-223.4(and)]TJ
T*
[(serologic)-284.2(testing)-284.1(together)-283.5(provide)-277.5(the)-283.2(most)-278.7(accurate)-286.7(diagnosis.)]TJ
/F7 1 Tf
1.1128 -1.2266 TD
[(M)-7.9(.)-451.8(pn)-18(e)-8.3(u)0(m)-15(o)-12.2(ni)-15.7(a)-12.2(e)-8.3(,)]TJ
/F6 1 Tf
7.2208 0 TD
.0105 Tc
[(diag)10.5(n)-7.5(o)10.5(s)-8.7(e)2.3(d)-437.9(s)3.5(erolo)10.5(g)-7.5(ically)-437.9(with)-431.6(Ig)10.5(M)-444.5(a)2.2(nt)10.5(ibo)10.5(d)-7.5(y)]TJ
-8.3336 -1.2203 TD
.0101 Tc
[(an)10.1(d)-330.4(I)1.7(gG)-321.5(serol)10.1(o)-5.6(g)10.1(i)-5.6(c)-326.9(titer)-327.1(r)1.7(ises)-325.7(\(Yis)-325.7(20)10.1(0)-7.9(8)10.1(\))-333(o)10.1(r)-333(p)10.1(o)-7.9(l).2(y)10.1(m)-5.1(erase)-326.9(c)1.8(hain)-324.5(re-)]TJ
T*
0 Tc
[(a)-14.6(c)-8.3(t)-9.9(i)-9.9(o)0(n)-454.3(\()-8.4(A)-9.1(l)-9.9(-)-8.4(Z)-12(a)-8.2(i)-9.9(dy)-454.3(20)-18(15)-18(\))-8.4(,)-445.5(ha)-20.4(s)-443.3(b)-12.2(e)-8.2(e)-8.2(n)-448.4(l)-9.9(i)0(n)-15.7(k)0(e)-20.4(d)-442.1(t)-9.9(o)-448.4(s)-7(e)-8.2(v)-12.2(e)-8.2(r)-8.4(a)-8.3(l)-446.1(n)-12.2(e)-8.2(u)-12.2(r)-8.4(o)0(l)-15.7(o)-12.2(gi)-15.7(c)]TJ
0 -1.2266 TD
.0104 Tc
[(sy)10.4(n)-7.6(d)10.4(romes,)-352.9(in)10.4(clud)10.4(i)-5.3(n)-1.8(g)-349.5(e)2.2(n)10.4(c)-3.7(ep)10.4(h)-7.6(a)2.2(litis,)-346.6(a)2.2(cu)10.4(t)-5.3(e)-351.9(d)10.4(i)-5.3(ssemin)10.4(a)-10(t).5(ed)-349.5(en)10.4(c)-10(e)2.2(p)10.4(h)-7.6(a-)]TJ
0 -1.2203 TD
.0096 Tc
[(lomy)9.6(elitis,)-277.8(t)-.3(ran)9.6(s)-9.6(v)9.6(e)-4.5(rse)-276.9(m).2(yeliti)9.6(s)-7.3(,)-277.8(p)9.6(e)-10.8(rip)9.6(h)-8.4(eral)-278.5(nerve)-276.9(p)-2.6(alsy)9.6(,)-290(cerebellar)]TJ
28.0042 74.5598 TD
.0106 Tc
[(d)10.6(i)-5.1(seas)3.6(e,)-207.3(an)10.6(d)-216.1(m)1.2(yas)3.6(t).7(hen)10.6(i)-5.1(a)-212.6(g)10.6(ravis)3.6(.)]TJ
12.9493 0 TD
0 Tc
[(A)-9.1(m)-9.4(o)-12.2(n)0(g)-226.6(t)-9.9(he)-229.1(ne)-14.1(u)-12.2(r)-8.4(o)-12.2(l)0(o)-15.7(g)0(i)-15.7(c)-223.2(s)-7(y)-12.2(nd)-18(r)-8.4(o)0(m)-15.2(e)-8.2(s)]TJ
-12.9493 -1.2203 TD
.0107 Tc
[(as)3.7(so)10.7(ciated)-203.8(with)-203.8(PC)10.7(R-do)10.7(c)-9.7(u)10.7(mented)]TJ
/F7 1 Tf
13.8978 0 TD
0 Tc
[(M)-8(.)-217.9(pn)-18(e)-8.2(u)-12.2(m)-9.1(o)0(n)-18(i)-9.9(ae)]TJ
/F6 1 Tf
6.5 0 TD
.0104 Tc
[(in)10.4(fectio)10.4(n)-7.6(,)-201.2(cases)]TJ
-20.3977 -1.2266 TD
.0101 Tc
[(cou)10.1(l)-5.6(d)-558.5(b)-2.1(e)-560.9(s)3.1(eparat)10.1(e)-8(d)-558.5(clini)10.1(c)-8(ally)-558.5(in)10.1(t)-5.6(o)-564.8(activ)10.1(e)-573(i).2(n)10.1(f)-4.2(ecti)10.1(o)-5.6(n)-558.5(and)-558.5(p)-2.1(o)10.1(s)-9.1(t-)]TJ
0 -1.2203 TD
0 Tc
[(i)-9.9(n)0(f)-14.3(e)-14.6(c)-8.2(t)-9.9(i)-9.9(o)0(u)-18(s)-215.7(s)-7(y)-12.2(nd)-18(r)-8.4(o)0(m)-15.2(e)-14.6(s)-7(.)-217.9(Th)-17.8(e)-8.3(s)-13.3(e)-216.9(o)0(c)-20.4(c)-8.3(ur)-14.3(r)-14.8(e)-8.3(d,)-223.7(r)-8.4(e)-14.6(s)-7(p)-12.2(e)-8.2(c)-8.3(t)-9.8(i)-9.9(ve)-20.4(ly)-15.7(,)-217.9(w)-9.1(i)-9.9(t)-9.9(h)0(i)-15.7(n)-220.8(7)-214.5(d)-12.2(a)-8.2(y)0(s)]TJ
T*
[(or)-526.4(7)-524.3(d)-12.2(a)-8.3(y)0(s)-531.3(o)0(r)-526.4(l)-9.9(o)-12.1(n)0(g)-18(e)-8.3(r)-520.6(a)-8.2(f)-14.8(t)0(e)-18.1(r)-520.6(t)-9.9(h)0(e)-532.6(o)0(n)-18(s)-7(e)-8.2(t)-522(o)-12.2(f)-520.6(pr)-14.3(o)-12.2(d)0(r)-20.6(o)0(m)-15.2(a)-8.3(l)-522(r)-8.4(e)-14.6(s)-7(pi)-15.7(r)-8.4(a)-14.6(t)-9.9(o)0(r)-14.3(y)]TJ
0 -1.2266 TD
.0104 Tc
[(symp)10.4(t)-5.3(o)10.4(m)-4.8(s)-496.1(\(Al-Zaid)10.4(y)-500.8(e)2.2(t)-492.6(a)2.2(l.)-492(20)10.4(1)-7.6(5)10.4(\).)-492(Separately,)-492(T)10.4(o)-7.4(u)10.4(rett)10.4(e)-7.7()2(s)-489.8(s)-2.9(y)10.4(n)-7.6(-)]TJ
0 -1.2203 TD
0 Tc
[(dr)-14.3(o)-12.2(m)-9.4(e)-444.5(e)-8.3(xa)-20.4(c)-8.3(e)-8.3(r)-8.4(b)-12.2(a)-8.3(t)-9.9(i)-9.9(o)0(n)-18(s)-443.3(ha)-14.1(v)-12.2(e)-444.5(a)-8.3(l)-9.9(s)-7(o)-442.1(b)-12.2(e)-8.3(e)-8.3(n)-442.1(l)-9.9(i)-9.9(n)-12.2(ke)-14.1(d)-448.4(t)0(o)]TJ
/F7 1 Tf
20.1574 0 TD
[(M)-7.9(.)-439.2(p)-12.2(n)0(e)-20.4(u)0(m)-15(o)-12.2(ni)-15.7(ae)]TJ
/F6 1 Tf
-20.1574 -1.2203 TD
.0906 Tc
[(\(M)77.7(u)]TJ
1.4037 .0063 TD
0 Tc
()Tj
.4236 -.0063 TD
.011 Tc
[(ller)-357.8(e)2.8(t)-359.3(a)2.7(l.)-352.3(20)11(0)-7(0)11(\),)-358.6(and)]TJ
/F7 1 Tf
9.0354 0 TD
.0115 Tc
[(M.)-351.8(pn)11.5(e)-8.9(u)11.5(mon)11.5(i)-4.2(ae)]TJ
/F6 1 Tf
6.7971 0 TD
0 Tc
[(a)-14.6(n)0(t)-15.7(i)-9.9(bo)-18(di)-15.7(e)-14.6(s)-367.4(w)-9.1(e)-8.3(r)-8.4(e)-368.7(de)-20.4(m)-9.4(-)]TJ
-17.6599 -1.2266 TD
.0102 Tc
[(o)10.2(n)-7.8(strated)-254.9(f)1.8(ar)-257.5(mo)10.2(r)-10.4(e)-251(co)10.2(m)-5(m).8(on)10.2(l)-5.5(y)-254.9(in)-254.9(To)10.2(u)-7.8(r)1.8(ette)-257.3(syn)10.2(d)-7.8(ro)10.2(m)-5(e)-257.3(patients)-256.1(t).3(h)10.2(a)-3.9(n)]TJ
0 -1.2203 TD
.0101 Tc
[(in)-229.7(con)10.1(t)-5.6(rols)-230.9(\()-80.5(M)-2.8(u)]TJ
5.9688 .0126 TD
0 Tc
()Tj
.4236 -.0126 TD
[(l)-9.9(l)-9.9(e)-8.3(r)-248.7(e)-8.3(t)-243.8(a)-8.2(l)-9.9(.)-243.2(20)-18(04)-18(\))-8.4(.)-243.2(Th)-17.8(e)-8.3(s)-7(e)-248.5()0(n)-16.6(d)0(i)-15.7(n)-12.2(gs)-253.1(m)-9.4(a)-8.3(ke)-254.4(it)-247.3(l)-9.9(i)-9.9(k)-12.2(e)-8.3(l)-9.9(y)-239.8(t)-9.9(h)-12.2(a)-8.3(t)]TJ
/F7 1 Tf
-6.3925 -1.2203 TD
.0093 Tc
[(Mycop)9.3(l)-6.4(asma)]TJ
/F6 1 Tf
5.3998 0 TD
0 Tc
[(m)-9.4(i)-9.9(gh)-18(t)-205.9(a)-8.3(l)-9.9(s)-7(o)-208.2(i)-9.9(nd)-18(uc)-20.4(e)-204.3(P)-10.7(A)-9.1(N)-9.1(S)-10.7(,)-205.2(a)-8.3(l)-9.9(t)-9.9(h)0(o)-18(u)0(g)-18(h)-201.8(w)-15.5(e)-8.2(l)-9.9(l)-9.9(-)-8.4(do)-18(c)-8.2(u)0(m)-15.2(e)-14.6(nt)-15.7(e)-8.3(d)]TJ
-5.3998 -1.2203 TD
[(c)-8.3(a)-8.2(s)-13.3(e)-8.3(s)-291.6(h)0(a)-14.1(v)-12.2(e)-286.5(y)-12.2(e)-8.3(t)-288.1(t)-9.9(o)-290.4(be)-298.6(de)-20.4(s)-7(c)-8.3(r)-8.4(i)-9.9(b)-12.2(e)-8.3(d.)]TJ
/F7 1 Tf
1.1128 -1.2266 TD
[(M.)-510.4(pneumoniae)]TJ
/F6 1 Tf
7.0058 0 TD
[(pneumonia)-513.8(can)-515.5(be)-513.6(treated)-520.3(with)-515.2(macrolides,)]TJ
-8.1186 -1.2203 TD
[(azithromycin,)-401.9(or)-406.3(tetracyclines.)-401.6(Macrolide)-406.2(resistance)-409.8(has)-400.5(reached)]TJ
T*
[(about)-275.9(10%)-272.5(in)-274.9(recent)-282.8(years)-278.1(\(Diaz)-277.9(et)-277.3(al.)-273.9(2015\),)-275(whereas)-276.5(tetracycline)]TJ
0 -1.2266 TD
[(resistance)-283.4(remains)-284.6(low.)]TJ
/F11 1 Tf
0 -2.4406 TD
[(Lyme)-332.4(borreliosis)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(OCD)-338.7(sometimes)-346.7(occurs)-340.8(in)-338.2(patients)-343(with)-344.5(Lyme)-345.3(disease)-339(\(Fallon)]TJ
-1.1128 -1.2266 TD
[(et)-505(al.)-507.9(1993,)-506.8(1998;)-507.4(Fallon)-505.6(and)-506.8(Nields)-505.2(1994\).)-508.9(Other)-509.4(PANS-like)]TJ
0 -1.2203 TD
[(neuropsychiatric)-197.4(and)-203.3(cognitive)-195.9(symptoms)-199.2(of)-197.6(the)-194.7(post-Lyme)-198.9(disease)]TJ
T*
[(syndrome)-296.7(include)-300.3(distractibility,)-302(poor)-297.8(schoolwork,)-296.1(irritability,)-304.7(de-)]TJ
0 -1.2267 TD
[(pression,)-415.1(insomnia,)-418.9(and)-418.3(sensitivity)-424.2(to)-414(light)-420.6(and/or)-417.1(sound)-416.1(\(Tager)]TJ
0 -1.2203 TD
[(et)-277.3(al.)-286.6(2001\).)-275(Oppositional)-289(behavior,)-276(anxiety)-287.7(disorders,)-278.1(and)-285.5(ADHD)]TJ
T*
[(are)-398(also)-391.4(reported)-402.2(\(Fallon)-393.9(et)-397.5(al.)-394.1(1998\).)-395.1(In)-400(addition,)-392.9(a)-394(case)-398.5(report)]TJ
T*
[(described)-396.4(a)-394(child)-393.7(with)-395.1(Lyme)-395.8(disease)-395.9(who)-393.9(presented)-402.7(with)-395.1(acute-)]TJ
0 -1.2266 TD
[(onset)-416.2(Tourette)-416.1(syndrome)-416.8(that)-419.5(resolved)-419.7(with)-414.1(antibiotic)-418.4(treatment)]TJ
0 -1.2203 TD
[(\(Riedel)-326.6(et)-321.6(al.)-324.5(1998\).)-325.6(However,)-329.7(to)-325.5(date,)-326(we)-320.9(are)-328.4(unaware)-325.9(of)-324.1(an)-323.9(un-)]TJ
T*
[(equivocal)-282.8(case)-278.4(of)-279.8(PANS)-286.4(associated)-280.8(with)-281.3(Lyme)-282(disease.)]TJ
1.1128 -1.2266 TD
[(A)-211.5(diagnosis)-210.8(of)-216.6(post-Lyme)-211.5(PANS)-216.8(should)-210.9(be)-216.4(restricted)-216.8(to)-211.7(children)]TJ
-1.1128 -1.2203 TD
[(who:)-378.4(\(1\))-376.8(have)-382.3(diagnostic)-379.9(PANS)-381.2(symptoms)-382.6(after)-378.4(an)-380.8(illness)-380.2(com-)]TJ
T*
[(patible)-222.1(with)-218(clinical)-221.8(Lyme)-218.8(disease)-225.2(and)-222.3(\(2\))-218.7(live)-217.2(in)-218(regions)-221.8(where)-223.3(the)]TJ
0 -1.2267 TD
[(presence)-199.2(of)-197.6(Lyme)-193.5(disease)-199.9(is)-200.2(established.)-196.3(In)-197.6(the)-201(United)-194.2(States,)-202.3(this)-197(is)]TJ
0 -1.2203 TD
[(almost)-423.2(exclusively)-426.1(limited)-423.3(to)-420.4(the)-422.3(six)-421.1(New)-424.9(England)-420.1(states,)-426.2(New)]TJ
T*
[(York,)-316.7(New)-323.7(Jersey,)-326(Pennsylvania,)-321.9(Maryland,)-321(Virginia,)-322.9(Minnesota,)]TJ
0 -1.2266 TD
[(and)-197(Wisconsin.)-203(A)-198.8(few)-202.9(cases)-203.2(are)-202(also)-201.7(found)-196.2(in)-199.1(localized)-200.7(areas)-204.6(within)]TJ
0 -1.2203 TD
[(North)-431.1(Dakota,)-435.8(Iowa,)-439.2(Indiana,)-434.6(West)-437.6(Virginia,)-436.7(Illinois,)-436.2(and)-430.9(Cali-)]TJ
T*
[(fornia)-324.9(\(Centers)-325.9(for)-326.2(Disease)-329.7(Control)-328.1(and)-323.4(Prevention)-325.3(2016b\).)-325.1(Chil-)]TJ
T*
[(dren)-319.2(outside)-318.1(these)-317.4(regions)-316.6(are)-322.1(unlikely)-314.1(to)-319.2(have)-319(a)-318.1(Lyme)-320(infection,)]TJ
0 -1.2266 TD
[(even)-515(if)-511.5(they)-516.6(have)-515(a)-514.1(positive)-511.3(laboratory)-519(test.)-512.1(Positive)]TJ
/F7 1 Tf
23.3758 0 TD
(Borellia)Tj
-23.3758 -1.2203 TD
(burgdorferi)Tj
/F6 1 Tf
4.9761 0 TD
[(serology)-309.8(is)-314.1(more)-310.1(likely)-315(to)-306.5(be)-311.3(falsely)-316.7(positive)-308.9(in)-312.9(these)]TJ
-4.9761 -1.2203 TD
[(areas.)-340.3(The)-335.9(diagnosis)-337.2(of)-336.7(Lyme)-338.9(disease)-339(requires)-340.1(positive)-334.2(screening)]TJ
0 -1.2267 TD
[(serology)-417.3(that)-413.2(must)-417.8(be)-418.8(conrmed)-416.6(by)-416.3(Western)-415.8(blot)-417.1(testing,)-419.8(inter-)]TJ
0 -1.2203 TD
[(preted)-457.5(according)-458.4(to)-458.3(guidelines)-462.1(of)-456.9(the)-460.2(U.S.)-455.7(Centers)-462.9(for)-459(Disease)]TJ
8.9663 0 0 8.9663 310.8472 238.1102 Tm
[(Control)-277.5(\(Centers)-288(for)-275.6(Disease)-285.4(Control)-283.8(and)-279.2(Prevention)-281.1(2016c\).)]TJ
/F11 1 Tf
0 -2.447 TD
[(Other)-333.7(inciting)-336(infections)-333.9(and)-335.7(conditions)]TJ
/F6 1 Tf
1.1128 -1.8337 TD
[(A)-464.4(number)-460.9(of)-469.5(additional)-465(infections,)-467.6(including)-465.3(gastrointestinal)]TJ
-1.1128 -1.2203 TD
[(infections,)-214.7(dental)-218.6(infection,)-220.4(herpes)-220.7(simplex,)-217(varicella,)-218.9(Epstein-Barr)]TJ
0 -1.2266 TD
[(virus,)-425.6(enterovirus,)-427.8(and)-424.6(others,)-427.5(as)-426.3(well)-429.1(as)-426.3(Kawasaki)-426.2(disease)-427.5(and)]TJ
0 -1.2203 TD
[(anaphylactoid)-375.8(purpura,)-373.9(have)-375.9(been)-375.9(mentioned)-378.7(in)-369.8(association)-383(with)]TJ
T*
[(the)-232.6(onset)-232.8(or)-235.6(exacerbation)-238.2(of)-235.6(PANS)-229.5(symptoms)-237.2(in)-230.7(a)-235.9(small)-234(number)-239.6(of)]TJ
T*
[(cases)-342.3(\(Allen)-342.2(et)-340.6(al.)-343.5(1995;)-343(Swedo)-337(et)-340.6(al.)-343.5(1998;)-343(Murphy)-341.8(et)-340.6(al.)-343.5(2014;)]TJ
0 -1.2266 TD
[(Frankovich)-296(et)-296.3(al.)-299.2(2015\).)-293.9(Given)-298.2(their)-301.5(number)-296.5(and)-298.1(variety,)-293.2(it)-297.9(seems)]TJ
0 -1.2203 TD
[(likely)-346.7(that)-356.3(many)-345.4(apparent)-351.4(infectious)-357.2(triggers)-348.1(may)-352.3(activate)-352.9(symp-)]TJ
T*
[(toms)-310.3(through)-313(nonspecic)-316(immune)-307.8(activation)-315.6(mechanisms.)-315.9(All)-313.4(in-)]TJ
0 -1.2266 TD
[(tercurrent)-479.8(infections)-483.7(should)-476.5(be)-482(considered)-478.1(and)-481.5(managed)-481.6(on)-473.2(an)]TJ
0 -1.2203 TD
[(individual)-500.5(basis,)-502.5(according)-496.3(to)-502.6(existing)-498.6(guidelines.)-503(In)-501.1(some)-498.4(in-)]TJ
T*
[(stances,)-304(onset)-302.4(and)-304.5(exacerbations)-302.1(may)-301.7(occur)-308.5(in)-300.2(the)-302.2(absence)-304.6(of)-298.8(any)]TJ
0 -1.2266 TD
[(recognizable)-345.7(infection,)-340.5(suggesting)-343.1(that)-343.6(additional)-344.8(disease)-339(mecha-)]TJ
0 -1.2203 TD
[(nisms)-279.4(may)-282.7(be)-279.6(involved.)]TJ
/F4 1 Tf
-28.0042 77.228 TD
[(MANAGEMENT)-341.5(OF)-331.2(INFECTIONS)-341.8(IN)-328.8(PANS)]TJ
54.1178 0 TD
(7)Tj
ET
endstream
endobj
125 0 obj
<>stream
/GS1 gs
BT
/F4 1 Tf
8.9663 0 0 8.9663 62.022 725.7825 Tm
0 0 0 rg
0 Tc
0 Tw
[(Assessment)-334.5(of)-336.6(Infection)-334.3(at)-335.3(Initial)-329.8(Onset)-335.8(or)-335.1(During)]TJ
0 -1.2203 TD
[(PANS)-336.6(or)-335.1(PANDAS)-335.9(Exacerbations)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(Careful)-205.1(consideration)-206.4(of)-204(possible)-204.9(inciting)-204.3(infections)-205.5(is)-206.6(important)]TJ
-1.1128 -1.2266 TD
[(at)-492.3(both)-482.6(the)-491.8(initial)-487(onset)-492.1(and)-487.8(symptom)-489.4(exacerbations)-491.8(of)-488.5(PANS)]TJ
0 -1.2203 TD
[(or)-418.9(PANDAS.)-427.7(A)-420.1(detailed)-420.1(history)-425.7(of)-418.9(exposures)-422.7(to)-420.4(contagious)-420.2(ill-)]TJ
T*
[(nesses)-290(should)-286.8(be)-286(obtained,)-290.1(with)-287.6(cognizance)-289.4(of)-286.2(their)-288.8(associated)-287.1(in-)]TJ
0 -1.2266 TD
[(cubation)-464.2(periods.)-458.7(Of)-460.2(particular)-468.6(interest)-459.4(are)-461.2(recent)-466.2(exposures)-460.7(to)]TJ
0 -1.2203 TD
[(streptococcal)-293.5(pharyngitis)-291.1(or)-292.5(skin)-287.8(infections.)-290.6(Exposure)-293(to)-287.6(someone)]TJ
T*
[(with)-325.5(persistent)-326.8(cough)-328.8(in)-319.2(the)-327.4(previous)-328.8(14)-321(weeks)-329.4(raises)-327(the)-321.1(possi-)]TJ
T*
[(bility)-304(of)]TJ
/F7 1 Tf
3.5661 0 TD
[(M.)-301.7(pneumoniae.)]TJ
/F6 1 Tf
6.8287 0 TD
[(Acquisition)-308.5(of)-298.8(any)-304.5(respiratory)-307.4(or)-298.8(febrile)]TJ
-10.3949 -1.2266 TD
[(illness)-456(during)-452.6(periods)-449.4(of)-450.6(community)-455.7(inuenza)-454.9(activity)-453.3(strongly)]TJ
0 -1.2203 TD
[(suggests)-322.2(that)-318.3(diagnosis,)-314.9(even)-319(more)-322.7(so)-316.4(if)-315.5(there)-325.2(was)-315.3(a)-318.1(known)-317(close)]TJ
T*
[(exposure)-282.9(in)-281.3(the)-276.9(previous)-284.5(23)-276.7(days.)]TJ
1.1128 -1.2266 TD
[(Physical)-318.6(examination)-321(should)-312.1(focus)-319.9(on)-315.2(infection)-324.9(at)-315.3(any)-317.1(site,)-316.1(in-)]TJ
-1.1128 -1.2203 TD
[(cluding)-348.5(dental,)-348(pharyngeal,)-347(lymphatic,)-347.7(and)-342.4(perianal)-349.1(and)-348.7(all)-344.1(other)]TJ
T*
[(skin)-281.5(sites.)]TJ
1.1128 -1.2266 TD
[(Some)-230.2(options)-233.4(for)-225(microbial)-233.6(laboratory)-234.5(diagnosis)-229.7(during)-231.3(onset)-232.8(or)]TJ
-1.1128 -1.2203 TD
[(an)-286(exacerbation)-282.4(are)-284.2(given)-288.5(in)-281.3(Table)-284.4(5.)-280.6(These)-287.9(include)-281.3(throat)-288.3(or)-279.8(skin)]TJ
T*
[(site)-458.6(swab)-460.2(for)-459(GAS,)-455.6(and)-456.2(serial)-462.7(serum)-456.2(ASO)-459(and)-456.2(ADB)-458.8(levels)-460.1(as)]TJ
0 -1.2266 TD
[(compared)-534.3(with)-534.2(previous)-531.1(levels)-535.9(if)-530.4(available.)-538.7(Patients)-531.2(receiving)]TJ
27.9978 23.8374 TD
[(prophylactic)-502.9(antimicrobials)-495.7(should)-495.5(be)-494.6(included,)-492.4(as)-495.8(a)-495.1(means)-494(to)]TJ
0 -1.2203 TD
[(identify)-449.5(prophylactic)-446(regimen)-447.9(failure.)-447.5(Nasopharyngeal)-450.2(or)-444.2(throat)]TJ
0 -1.2266 TD
[(swab)-238.9(may)-232.1(be)-235.4(submitted)-229.8(for)]TJ
/F7 1 Tf
11.0208 0 TD
[(M.)-232.2(pneumoniae)]TJ
/F6 1 Tf
6.4431 0 TD
[(PCR)-234.2(together)-232.9(with)-237(IgG)]TJ
-17.4639 -1.2203 TD
[(and)-329.7(IgM)]TJ
/F7 1 Tf
3.819 0 TD
[(M.)-327(pneumoniae)]TJ
/F6 1 Tf
6.6327 0 TD
[(serology.)-325.4(The)-323.2(value)-328.9(of)-324.1(GAS)-326.2(and)]TJ
/F7 1 Tf
13.6575 0 TD
(Myco-)Tj
-24.1093 -1.2203 TD
(plasma)Tj
/F6 1 Tf
3.2753 0 TD
[(serologic)-398(studies)-388.8(is)-389.9(enhanced)-391.5(if)-391.3(previous)-392(serial)-393.1(antibody)]TJ
-3.2753 -1.2266 TD
[(levels)-453.7(are)-442.3(available)-453.6(for)-446.3(comparison.)-444.2(Older)-446.2(rapid)-449.2(immune-based)]TJ
0 -1.2203 TD
[(assays)-220.5(for)-218.7(inuenza)-220.9(antigen)-218.1(are)-221(specic)-216.3(but)-217.5(miss)-223(about)-212.7(one-third)-219.9(of)]TJ
T*
[(cases)-298(\(Chartrand)-294.7(et)-290(al.)-292.9(2012\);)-288.2(these)-298.5(assays)-290(are)-296.8(useful)-291.8(only)-286.6(if)-296.5(posi-)]TJ
0 -1.2266 TD
[(tive.)-296(Newer)-296.1(molecular-based)-294.6(tests)-294.9(for)-294.6(inuenza)-296.8(nucleic)-290.1(acid)-297.7(men-)]TJ
0 -1.2203 TD
[(tioned)-247.8(earlier)-251(are)-246.2(highly)-245.4(sensitive)-248.8(as)-249.2(well)-245.8(as)-249.2(rapid)-246.9(and)-247.5(specic)-247.9(\(see)]TJ
T*
[(Inuenza,)-285.7(above\).)]TJ
/F4 1 Tf
0 -3.054 TD
(Immunizations)Tj
/F6 1 Tf
1.1128 -1.8336 TD
[(Children)-481.8(with)-471(PANS)-482.4(and)-475.2(PANDAS)-475.3(should)-476.5(receive)-480.8(standard)]TJ
-1.1128 -1.2266 TD
[(childhood)-284.3(vaccines,)-285.8(following)-279.1(recommendations)-286.8(from)-278.7(the)-283.2(Centers)]TJ
0 -1.2203 TD
[(for)-433.7(Disease)-430.8(Control)-429.3(and)-424.6(Prevention,)-429.4(the)-428.6(American)-434.1(Academy)-428(of)]TJ
T*
[(Pediatrics,)-582.5(and)-576.3(the)-574(American)-579.5(Academy)-579.7(of)-570.7(Family)-578.7(Physicians)]TJ
0 -1.2266 TD
[(\(Centers)-357.5(for)-351.5(Disease)-355(Control)-353.4(and)-348.7(Prevention)-350.6(2016a\).)-352.8(The)-354.9(patient)]TJ
0 -1.2203 TD
[(and)-317.1(all)-318.8(family)-317.2(members)-315.8(should)-318.4(receive)-322.7(annual)-315.8(inuenza)-315.8(immuni-)]TJ
T*
[(zation)-281.8(as)-287.2(described)-282.6(under)-280.8(Inuenza)-282.7(\(described)-278.3(earlier\).)]TJ
1.1128 -1.2266 TD
[(We)-483.9(have)-477.1(found)-480.7(that)-476.4(symptom)-483.1(ares)-479(after)-479.5(routine)-483.9(childhood)]TJ
-1.1128 -1.2203 TD
[(immunization,)-315.9(or)-305.1(with)-312.9(pneumococcal)-311(polysaccharide)-307.9(vaccine,)-316.7(are)]TJ
T*
[(relatively)-444.7(uncommon,)-444.8(brief,)-442.1(and)-437.2(manageable)-444.7(with)-439.4(non-steroidal)]TJ
T*
[(anti-inammatory)-285.6(agents.)]TJ
/F4 1 Tf
0 -3.0603 TD
[(Role)-338.9(of)-330.2(Adenotonsillectomy)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
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T*
[(sug)12.9(gest)-442(tha)14(t)-458.8(imp)12.9(rove)15.9(me)14(nt)-452(may)-453.4(occ)15.6(ur)-450.6(aft)11.4(er)-453(ton)16.4(sill)14(ect)17.9(omy)-451(and)18(/or)]TJ
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[(aden)16.1(oid)16.4(ect)11.6(omy)-311.9(\(De)12.1(mes)13.3(h)-322(e)0(t)-321.6(al.)-311.9(201)14.1(5\),)-314.4(a)-324.4(com)14.5(par)15.4(ativ)16.8(e)-324.4(ret)11.4(ros)16.6(pect)18.4(ive)]TJ
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[(stud)15.7(y)-454.8(fou)17.8(nd)-448(tha)14(t)-458.8(nei)14(th)15.9(er)-453(neur)15.9(op)13.6(sy)12.4(chi)14(atr)11.4(ic)-448.1(symp)16.2(tom)-442.4(seve)14.9(ri)13.3(ty)-452(no)13.6(r)]TJ
T*
[(str)12.6(ept)14(ococ)16.1(cal)-380.4(ant)14(ibo)16.4(die)14(s)-392.7(dif)13.8(fer)12.8(ed)-380.8(amo)14.5(ng)-384.7(thos)15.7(e)-387.6(wit)15.4(h)-391.5(pri)13.8(or)-387.3(ade)15.6(noi)16.4(-)]TJ
0 -1.2266 TD
[(dect)12.1(omy)-248.7(and)18(/or)-251.8(ton)16.4(sill)20.3(ect)11.6(omy)-248.7(\()-84.3(M)0(u)12.9(rph)17.8(y)-265.1(e)0(t)-252.1(al.)-255(20)13.6(13\).)-244.3(In)-254.5(mos)15.7(t)-262.8(cas)14.4(es,)]TJ
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[(the)-226.3(pro)17.8(ced)15.6(ure)-224.9(had)-222.3(bee)15.6(n)-233.5(per)15.4(for)15.2(med)-219.5(pri)13.8(or)-222.9(to)-230.7(the)-220(PAN)15.2(DAS)-218.7(ons)12.9(et.)-223.4(In)-222.9(a)]TJ
T*
[(rec)13(ent)-359.1(pro)17.8(spec)14.9(tiv)18.7(e)-368.7(stu)15.2(dy)-359.4(of)-355.7(120)-352.6(chi)14(ldr)13.8(en)-361.8(wi)12.6(th)-357.1(PAND)12.4(AS,)-351.6(56)-359.4(who)]TJ
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[(und)14.1(erw)12.1(ent)-510.8(tons)15.7(ill)14.7(ect)17.9(omy)-514.2(and/)20.8(or)-520.1(ade)15.6(no)13.6(ide)14(cto)14(my)-521(we)14.2(re)-522.5(com)14.5(par)15.4(ed)]TJ
0 -1.2203 TD
[(with)-224.4(64)-239.3(un)13.6(-ope)15.9(rat)17.7(ed)-235.4(cont)20.8(rol)13.8(s.)-237.6(Dur)14.5(ing)-223.9(mor)14.3(e)-242.2(tha)14(n)-239.8(a)-235.9(2-ye)15.9(ar)-231.7(sequ)17.3(ent)14(ial)]TJ
T*
[(fol)13.8(low)13.1(-up,)-136.8(the)-137.8(surg)17.1(ica)11.6(l)-149(gro)17.8(up)-144.5(did)-141.7(no)13.6(t)-149(dif)13.8(fer)-145.3(fro)15.2(m)-148.5(cont)20.8(rol)13.8(s)-152.5(i)0(n)-142.2(sym)15.7(pto)16.4(m)]TJ
T*
[(prog)18.3(res)14.2(sio)15.2(n,)-356.5(str)12.6(ept)14(ococ)16.1(cal)-348.8(and)-355(neur)15.9(on)13.6(al)-359.5(ant)14(ibo)16.4(die)14(s,)-357.7(or)-355.7(sev)16.8(eri)11.4(ty)-357.1(of)]TJ
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[(neur)15.9(ops)12.9(ych)18(iatr)14.2(ic)-334.3(sy)12.4(mpt)12.9(oms)-325.7(\(Pav)17.3(one)-329.7(et)-334.3(al.)-330.8(201)14.1(4\).)-327(We)-338.5(bel)14(iev)14(e)-337(tha)14(t)]TJ
0 -1.2203 TD
[(indi)19.2(cat)11.6(ion)16.4(s)-272.6(for)-263(ton)16.4(sil)17.5(lec)11.6(tom)12.9(y)-271.4(and)18(/or)-264.4(ade)15.6(no)13.6(ide)14(cto)14(my)-268.1(sh)12.4(ould)-255(be)-267(lim)15.2(-)]TJ
T*
[(ited)-172.9(to)-180.1(thos)15.7(e)-185.3(rec)13(omm)13.4(end)18(ed)-184.8(for)-174.5(the)-175.7(gene)16.1(ral)-172(pop)14.1(ula)14(tio)12.4(n,)-179.5(su)12.4(ch)-184.8(as)-179.7(sle)12.8(ep-)]TJ
0 -1.2266 TD
[(diso)15.7(rde)15.4(red)-161.6(bre)15.4(ath)14(ing)-160.6(or)-166(fre)12.8(qu)13.6(ent)-163(GAS)-161.8(inf)13.8(ect)11.6(ion)16.4(s)-171.4(\()0(B)12.6(augh)-158.5(et)-163.5(al.)-160.1(201)14.1(1\).)]TJ
0 -1.2203 TD
[(If)-174.9(su)12.4(rge)15.4(ry)-172.3(is)-168.6(per)15.4(for)15.2(med)14.5(,)-173.6(exci)18.4(sed)-166.5(tiss)16.8(ues)-166.5(sh)12.4(oul)16.4(d)-176.6(b)0(e)-165.8(sub)12.9(mit)15.2(ted)-169.4(for)-161.8(GAS)]TJ
T*
[(cul)14(tur)13.8(e,)-371.6(sin)15.2(ce)-370.6(occ)15.6(ult)-360.7(ton)16.4(sil)-368.2(or)-362(aden)16.1(oid)-363(GAS)-364.1(inf)13.8(ect)17.9(ion)-363(is)-371(com)14.5(mon)]TJ
0 -1.2266 TD
[(\(Sas)16.1(law)-235.9(et)-239.4(al.)-236(196)14.1(2;)-243.3(Gul)-233.5(et)-239.4(al.)-236(200)14.1(7;)-243.3(Le)11.4(e)-248.5(e)0(t)-239.4(al.)-236(200)14.1(8\).)]TJ
/F4 1 Tf
0 -3.054 TD
[(Role)-338.9(of)-330.2(Probiotics)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(There)-352.6(is)-345.7(no)-353.1(clinical)-348.2(evidence)-351.2(that)-349.9(any)-348.7(probiotic)-347.8(affects)-355.7(neuro-)]TJ
-1.1128 -1.2203 TD
[(psychiatric)-321.2(symptomatology.)-309.7(This)-312.9(is)-314.1(an)-311.3(area)-311.4(of)-317.8(ongoing)-310.4(research,)]TJ
T*
[(however,)-421.2(as)-419.9(there)-420(is)-421.5(evidence)-420.8(from)-417.8(animal)-418.2(models)-419.2(and)]TJ
/F7 1 Tf
23.5781 0 TD
[(in)-414(vitro)]TJ
/F6 1 Tf
-23.5781 -1.2266 TD
[(studies)-433.1(that)-425.8(gut)-419.9(ora)-431.6(may)-421.8(modulate)-429.8(immune)-427.9(reactions)-425.7(and)-424.6(sus-)]TJ
0 -1.2203 TD
[(ceptibility)-225.9(to)-224.3(infection)-223.8(\(OMahony)-228.5(et)-220.4(al.)-223.4(2015;)-222.9(Ignacio)-223(et)-226.8(al.)-223.4(2016\).)]TJ
T*
[(Such)-315.2(probiotic)-309.9(research)-315.7(is)-314.1(still)-312(in)-306.5(its)-317.6(infancy,)-308.1(however,)-313.7(and)-310.8(infor-)]TJ
0 -1.2266 TD
[(mation)-333.5(is)-326.7(only)-330.9(now)-330.6(emerging)-333.6(to)-325.5(indicate)-331.6(the)-333.8(critical)-331.9(mechanisms)]TJ
0 -1.2203 TD
[(involved.)-192.8(At)-189.7(present,)-189.2(however,)-193.6(there)-192.4(is)-187.6(no)-188.7(clinical)-190.1(evidence)-193.2(that)-191.9(any)]TJ
T*
[(currently)-500.6(available)-497.9(probiotics)-493.9(modulate)-499.4(neuropsychiatric)-500.9(symp-)]TJ
0 -1.2266 TD
[(toms)-367.2(in)-363.4(children)-365.7(with)-363.5(PANS.)-365.1(Certain)-370.9(probiotics)-361.1(\()]TJ
/F7 1 Tf
20.442 0 TD
(Saccharomyces)Tj
-20.442 -1.2203 TD
[(boulardii,)-188.8(Lactobacillus)-185.1(rhamnosis)]TJ
/F6 1 Tf
13.9673 0 TD
[(\))-185.5(may)-187.8(be)-184.8(used)-185(to)-186.4(reduce)-190.3(diarrhea)]TJ
ET
62.022 466.469 239.131 .22675 re
f
62.022 69.619 239.131 .22675 re
f
BT
/F9 1 Tf
8.9663 0 0 8.9663 85.6629 482.1164 Tm
(Table)Tj
/F6 1 Tf
3.0034 0 TD
(5.)Tj
/F9 1 Tf
1.2456 0 TD
[(Laboratory)-335.6(Assessments)-337.2(of)-335.1(Infection)]TJ
1.0306 -1.1128 TD
[(in)-331.6(Children)-331.8(with)-334.2(PANS)]TJ
/F6 1 Tf
-7.9163 -1.7451 TD
[(Laboratory)-337.8(tests)-332.9(at)-334.2(rst)-333.2(presentation)]TJ
.999 -1.1128 TD
[(Throat)-334.2(swab)-340.1(for)-332.5(GAS)-332.5(rapid)-335.4(test)-332.2(and/or)-334.9(culture)]TJ
0 -1.1065 TD
[(ASO,)-334.9(ADB;)-335.9(repeat)-333.4(in)-338.2(26)-333.6(weeks)-335.7(for)-332.5(antibody)-335.3(rise)-330.7(or)-336.7(fall)]TJ
0 -1.1128 TD
[(Throat)-334.2(or)-336.7(nasopharyngeal)-333.1(swab)-340.1(for)]TJ
/F13 1 Tf
15.1876 0 TD
[(M.)-333.3(pneumoniae)]TJ
/F6 1 Tf
6.6454 0 TD
(PCR)Tj
-21.833 -1.1128 TD
()Tj
/F13 1 Tf
.4995 0 TD
[(M.)-333.3(pneumoniae)]TJ
/F6 1 Tf
6.6454 0 TD
[(IgG,)-336.2(IgM)-330.6(\(conrmatory)-335.4(IgM)-337(uorescent)]TJ
-6.1459 -1.1065 TD
[(antibody)-335.3(if)-334.4(positive\))]TJ
-.999 -1.1128 TD
[(Tests)-271.3(for)-269.3(other)-272.2(infections)-268.7(suspected)-268.5(on)-270.9(the)-270.5(basis)-265.6(of)-267.2(history)-274(and)]TJ
.999 -1.1128 TD
[(physical)-338.9(examination)]TJ
-.999 -1.1128 TD
[(25OH)-333(vitamin)-337.1(D)-331.6(level)]TJ
0 -1.1065 TD
[(Other)-338.2(medical)-331.6(assessments)-337.8(\(immune,)-338.1(autoimmune,)-334.1(etc.,)-335.7(tests)]TJ
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[(as)-337.7(noted)-332.8(elsewhere\))]TJ
-.999 -1.1128 TD
[(Assess)-335.8(family)-336.1(members)-334.7(and)-336.1(other)-335.4(close)-336.4(contacts)]TJ
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[(Elective)-337.7(throat)-338.9(swab)-333.7(for)-332.5(GAS)]TJ
0 -1.1065 TD
[(Evaluation)-340.6(for)-332.5(other)-335.4(infections)-332(on)-334.1(the)-333.8(basis)-335.2(of)-336.7(history.)]TJ
-1.998 -1.4479 TD
[(Laboratory)-337.8(tests)-332.9(at)-334.2(routine)-338.4(follow-up)-334.6(visits)]TJ
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[(Elective)-267.7(throat)-263(swab)-264.2(for)-269.3(GAS)-263(if)-264.9(not)-261.8(receiving)-266.4(an)-260.7(antimicrobial)]TJ
.999 -1.1128 TD
[(effective)-341(against)-333.1(GAS)]TJ
-.999 -1.1128 TD
[(Elective)-337.2(ASO,)-335.4(ADB)]TJ
T*
(Elective)Tj
/F13 1 Tf
4.1352 0 TD
[(M.)-333.3(pneumoniae)]TJ
/F6 1 Tf
6.6454 0 TD
[(titers)-337.8(as)-331.4(described)-339.5(earlier)]TJ
-10.7806 -1.1065 TD
[(Elective)-337.2(25OH)-333.4(vitamin)-337.1(D)-331.6(level)]TJ
-.999 -1.4479 TD
[(Laboratory)-337.8(tests)-332.9(during)-332.5(neuropsychiatric)-342.8(symptom)-331.3(exacerbation)]TJ
.999 -1.1128 TD
[(Throat)-334.2(swab)-340.1(for)-332.5(GAS)]TJ
0 -1.1065 TD
[(Elective)-337.2(ASO,)-335.4(ADB)]TJ
0 -1.1128 TD
()Tj
/F13 1 Tf
.4995 0 TD
[(M.)-333.3(pneumoniae)]TJ
/F6 1 Tf
6.6454 0 TD
[(titers)-337.8(as)-331.4(described)-339.5(earlier)]TJ
-7.1449 -1.1128 TD
[(Elective)-337.2(throat)-332.6(or)-336.7(nasopharyngeal)]TJ
/F13 1 Tf
14.6059 0 TD
[(M.)-333.3(pneumoniae)]TJ
/F6 1 Tf
6.6391 0 TD
(PCR)Tj
-21.245 -1.1128 TD
[(Tests)-271.3(for)-269.3(other)-272.2(infections)-268.7(suspected)-268.5(on)-270.9(the)-270.5(basis)-265.6(of)-267.2(history)-274(and)]TJ
.999 -1.1065 TD
[(physical)-338.9(examination)]TJ
-.999 -1.1128 TD
[(Elective)-337.2(25OH)-333.4(vitamin)-337.1(D)-331.6(level)]TJ
T*
[(Assess)-335.8(family)-336.1(members)-334.7(and)-336.1(other)-335.4(close)-336.4(contacts)]TJ
.999 -1.1065 TD
[(Elective)-337.7(throat)-338.9(swab)-333.7(for)-332.5(GAS)]TJ
0 -1.1128 TD
[(Evaluation)-340.6(for)-332.5(other)-335.4(infections)-332(on)-334.1(the)-333.8(basis)-335.2(of)-336.7(history.)]TJ
-1.998 -1.4479 TD
[(Laboratory)-337.8(tests)-332.9(to)-331.8(follow)-339.8(up)-327.8(acute)-337.6(GAS)-332.5(infection)]TJ
.999 -1.1065 TD
[(ASO,)-334.9(ADB)-338.7(to)-331.8(diagnose)-334.9(bona)-335.6(de)-328.3(infection)]TJ
0 -1.1128 TD
[(Repeat)-335(throat)-338.9(swab;)-331(re-treat)-341.7(if)-334.4(still)-331(positive)]TJ
-.999 -1.4479 TD
[(Laboratory)-337.8(tests)-332.9(for)-332.5(close)-336.4(contacts)-335(with)-338.2(pharyngitis)]TJ
.999 -1.1065 TD
[(Throat)-264.7(swab)-264.2(for)-256.7(GAS)-263(rapid)-265.8(test)-262.6(and/or)-259(culture;)-262.2(treat)-266(if)-258.6(positive)]TJ
0 -1.1128 TD
[(If)-332.5(GAS)-338.8(was)-334.2(diagnosed)-334.4(and)-336.1(treated,)-333.5(repeat)-333.4(culture)-340.9(27)-333.7(days)]TJ
.999 -1.1128 TD
[(after)-340.4(treatment)-337.2(is)-333(complete;)-334.6(re-treat)-335.3(if)-334.4(still)-337.3(positive.)]TJ
7.9702 0 0 7.9702 70.0157 57.7701 Tm
[(PCR,)-327.2(polymera)11.9(se)-334.6(chain)-328.8(reaction.)]TJ
/F4 1 Tf
8.9663 0 0 8.9663 62.022 749.6502 Tm
(8)Tj
43.274 0 TD
[(COOPERSTOCK)-335.9(ET)-338.7(AL.)]TJ
ET
endstream
endobj
129 0 obj
<>stream
/GS1 gs
BT
/F6 1 Tf
8.9663 0 0 8.9663 59.7543 725.7825 Tm
0 0 0 rg
0 Tc
0 Tw
[(that)-337.3(is)-326.7(associated)-337.7(with)-331.9(antimicrobial)-337(treatment)-330.9(\(Goldenberg)-334.5(et)-334.3(al.)]TJ
0 -1.2203 TD
(2015\).)Tj
/F4 1 Tf
0 -2.447 TD
[(Vitamin)-339.8(D)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(Vitamin)-207.6(D)-198.8(receptors)-203(are)-208.3(present)-205.2(in)-199.1(most)-202.8(classes)-207.4(of)-197.6(immune)-206.6(cells.)]TJ
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[(Their)-322.6(action)-319.8(enhances)-316.8(several)-321.5(immune)-320.4(defenses,)-321.1(including)-319.9(potent)]TJ
0 -1.2266 TD
[(intracellular)-420.7(microbicidal)-415.6(activity)-415.4(mediated)-419.6(by)-416.3(cathelicidins)-416.6(and)]TJ
0 -1.2203 TD
[(LL-37)-353.9(\(Gunville)-351.1(et)-353.2(al.)-349.8(2013\).)-350.8(Many)-348.9(studies)-357.2(have)-350.6(reported)-351.6(an)-349.2(as-)]TJ
T*
[(sociation)-222.3(between)-226.1(low)-220.8(vitamin)-223.3(D)-217.8(levels)-226.1(and)-222.3(increased)-221.7(frequency)-223(of)]TJ
0 -1.2266 TD
[(various)-392.5(infections)-395.2(\(Thornton)-390.3(et)-397.5(al.)-387.8(2013\),)-395.1(including)-389.5(GAS)-395.7(\(Nseir)]TJ
0 -1.2203 TD
[(et)-327.9(al.)-318.2(2012\))-322.6(and)-323.4(recurrent)-324.5(tonsillopharyngitis)-329.8(\(Yildiz)-320.5(et)-327.9(al.)-318.2(2012\).)]TJ
T*
[(Prospective)-258.9(studies)-256(to)-256(demonstrate)-257.5(whether)-251.6(vitamin)-254.9(D)-255.7(prophylaxis)]TJ
0 -1.2266 TD
[(can)-294.2(prevent)-286.3(infections)-294(are)-290.5(few)-285.1(in)-287.6(number.)-293.1(However,)-291.8(a)-286.5(majority)-288.6(of)]TJ
0 -1.2203 TD
[(available)-188.1(pediatric)-181.9(trials)-179.7(demonstrate)-188(a)-179(reduction)-181.8(in)-180.1(respiratory)-187.2(tract)]TJ
T*
[(infections)-275(\(Charan)-276.9(et)-271(al.)-273.9(2012;)-267.1(Ali)-275.4(and)-272.8(McDevitt)-269.9(2015;)-273.5(Xiao)-273.3(et)-271(al.)]TJ
T*
[(2015\).)-376.1(This)-369.8(includes)-370.6(a)-375(study)-369.5(in)-376.1(which)-367.7(inuenza)-379(was)-372.2(reduced)-373.2(by)]TJ
0 -1.2266 TD
[(about)-484.5(half)-481.3(in)-483.6(schoolchildren)-484.2(taking)-481.7(1200)-478.6(IU)-479.1(vitamin)-482.5(D3)-482.9(daily)]TJ
0 -1.2203 TD
[(\(Urashima)-390.7(et)-384.8(al.)-387.8(2010\).)-382.5(A)-388.5(study)-382.1(of)-387.3(otitis-prone)-385.8(children)-384.6(showed)]TJ
T*
[(protection)-375(from)-367.2(further)-364.9(recurrences)-376.1(when)-370.5(they)-364.9(received)-372.8(1000)-371.1(IU)]TJ
0 -1.2266 TD
[(vitamin)-349.7(D3)-350.1(daily)-349.5(\()-78(Marchisio)-354.4(et)-346.9(al.)-349.8(2013\).)-344.5(In)-349.4(the)-346.4(latter)-351.7(study,)-347.1(the)]TJ
0 -1.2203 TD
[(degree)-323.1(of)-317.8(protection)-324.4(correlated)-321.5(with)-319.2(nal)-319.2(serum)-317.1(25-hydroxy)-316.5(vita-)]TJ
T*
[(min)-284.3(D)-281(levels)-283(through)-275.1(a)-280.1(range)-283.2(as)-280.8(high)-280.3(as)-280.8(40)-169.7(ng/mL)-276.8(or)-279.8(more.)]TJ
1.1128 -1.2267 TD
[(In)-305.1(addition)-301.4(to)-306.5(its)-304.9(role)-304.3(in)-306.5(defense)-304.8(against)-307.8(infection,)-302.6(there)-306.2(is)-307.7(also)]TJ
-1.1128 -1.2203 TD
[(evidence)-313.3(that)-312(vitamin)-305.4(D)-312.6(activates)-309.4(immunoregulatory)-312.2(mechanisms)]TJ
T*
[(with)-293.9(the)-289.5(potential)-294.7(to)-293.9(downregulate)-293.6(autoimmune)-293.3(processes)-293.6(\(Peelen)]TJ
T*
[(et)-422.8(al.)-419.4(2011;)-418.9(Antico)-421.8(et)-416.4(al.)-419.4(2012;)-418.9(Rolf)-420.4(et)-416.4(al.)-419.4(2014\).)-420.4(Six)-418.5(of)-418.9(seven)]TJ
0 -1.2266 TD
[(treatment)-489(trials)-483.2(in)-483.6(various)-487.4(inammatory)-483.7(conditions)-485(showed)-484.5(re-)]TJ
0 -1.2203 TD
[(ductions)-191.1(in)-186.4(inammatory)-192.8(markers)-188.4(with)-192.8(vitamin)-185.3(D3)-192(treatment,)-188.4(noted)]TJ
T*
[(particularly)-313.5(when)-300.9(initial)-310(vitamin)-305.5(D)-306.3(levels)-302(were)-312.3(low)-303(\(Cannel)-309.9(et)-302.6(al.)]TJ
0 -1.2266 TD
[(2015\).)-350.8(Notably,)-342.1(vitamin)-349.7(D3)-343.8(treatment)-349.8(improved)-350.1(outcomes)-344.8(in)-344.5(pa-)]TJ
0 -1.2203 TD
[(tients)-272(with)-262.3(multiple)-264.7(sclerosis,)-270.5(another)-267.3(condition)-263(of)-267.2(central)-267.4(nervous)]TJ
T*
[(system)-281.3(autoimmunity)-285.3(\(Rotstein)-284.2(et)-277.3(al.)-280.3(2015\).)]TJ
1.1128 -1.2267 TD
[(Taken)-198.2(together,)-197.9(the)-201(ndings)-196.4(provide)-195.3(indirect)-199(evidence)-199.5(to)-199.1(support)]TJ
-1.1128 -1.2203 TD
[(optimization)-338.8(of)-336.7(Vitamin)-340.4(D)-337.9(levels)-339.9(among)-338.6(children)-334(with)-338.2(infection-)]TJ
T*
[(triggered)-228.7(neuropsychiatric)-229(symptoms.)-221.1(The)-228.4(optimum)-226.7(level)-225.4(of)-222.9(serum)]TJ
0 -1.2266 TD
[(25-hydroxy)-259.6(vitamin)-261.2(D)-262.1(level)-257(has)-261.4(not)-261.8(been)-255.8(established.)-265.8(On)-255.2(the)-264.2(basis)]TJ
0 -1.2203 TD
[(of)-412.6(this)-405.6(limited)-417(evidence,)-411(we)-409.4(currently)-412(treat)-411.4(PANS)-406.5(patients)-412.5(with)]TJ
T*
[(vitamin)-394(D3)-388(as)-388.3(needed)-390(to)-388.7(maintain)-389.6(serum)-393(25-hydroxy)-386(vitamin)-387.6(D)]TJ
T*
[(level)-212.8(above)-211.1(30)-163.4(ng/mL)-207.3(\(75)-165.5(nmol/L\),)-209.5(similar)-214.4(to)-205.4(that)-210.8(recommended)-210(by)]TJ
0 -1.2266 TD
[(the)-397(Endocrine)-392.6(Society)-400.1(\(Holick)-392.3(et)-391.2(al.)-394.1(2011\).)-395.1(This)-395.1(can)-395.4(usually)-393.9(be)]TJ
0 -1.2203 TD
[(accomplished)-351.7(with)-344.5(a)-343.4(combination)-350.2(of)-343.1(a)-343.4(standard)-350.2(childhood)-341.2(multi-)]TJ
T*
[(vitamin)-242.2(plus)-237.2(a)-242.2(vitamin)-235.9(D3)-236.3(supplement)-240.3(of)-241.9(1000)-162.4(U)-243.1(daily)-235.6(for)-237.7(children)]TJ
0 -1.2267 TD
[(5)-340.9(years)-341.3(of)-336.7(age)-338.5(or)-336.7(less)-335.7(or)-336.7(2000)-168.8(U)-337.9(daily)-336.8(for)-338.9(those)-340.3(6)-334.6(years)-341.3(or)-336.7(older,)]TJ
0 -1.2203 TD
[(doses)-293.2(well)-296.3(within)-290.6(the)-289.5(Institute)-296.1(of)-292.5(Medicines)-293.1(recommended)-292.2(upper)]TJ
T*
[(limits)-194.9(for)-193.4(children)-188.6(older)-190(than)-194.2(age)-193.1(1)-189.2(\(Ross)-190.6(et)-195.1(al.)-191.7(2011\).)-186.4(Serum)-194.4(25-OH)]TJ
0 -1.2267 TD
[(vitamin)-280.2(D)-281(level)-282.3(may)-282.7(be)-279.6(monitored)-277.8(every)-283.2(312)-282.6(months,)-274.3(depending)]TJ
0 -1.2203 TD
[(on)-353.1(adequacy)-347.2(of)-349.4(levels.)-349.2(It)-353.4(is)-345.7(notable)-350.9(that)-349.9(wintertime,)-350.9(excess)-354.5(body)]TJ
T*
[(fat,)-320.3(and)-323.4(black,)-319.2(Hispanic,)-319.9(or)-324.1(Asian)-318.3(race)-324(are)-322.1(signicant)-321.6(risk)-315.7(factors)]TJ
T*
[(for)-357.8(vitamin)-362.4(D)-356.9(insufciency)-359.6(\(Saggese)-359.8(et)-359.5(al.)-356.1(2015\).)-357.2(Omega-3,)-361.5(sh)]TJ
0 -1.2266 TD
[(oils,)-294.7(and)-285.5(cod)-291.8(liver)-288.8(oil)-291.1(may)-289(contain)-287.7(substantial)-296.1(amounts)-286(of)-292.5(vitamin)]TJ
0 -1.2203 TD
[(D;)-284.6(their)-282.5(use)-280.3(can)-281.6(lead)-278.8(to)-281.3(hypervitaminosis.)]TJ
/F4 1 Tf
0 -2.447 TD
(Conclusion)Tj
/F6 1 Tf
1.1128 -1.8336 TD
[(This)-382.4(article)-385.2(is)-383.6(designed)-385.5(to)-382.4(provide)-385(an)-387.1(initial)-379.5(practical)-386.7(clinical)]TJ
-1.1128 -1.2203 TD
[(guideline)-221.2(for)-212.4(the)-213.6(management)-218.2(of)-216.6(infections)-211.8(in)-218(PANS)-216.8(and)-209.6(its)-216.4(subset,)]TJ
T*
[(PANDAS.)-358.1(Relationships)-356.8(linking)-356.4(PANS/PANDAS)-354.2(with)-350.8(GAS)-357.8(and)]TJ
0 -1.2266 TD
[(other)-449.2(infections)-445.8(are)-448.6(reviewed.)-446.2(Criteria)-446.6(for)-446.3(an)-444(operational)-446.5(retro-)]TJ
0 -1.2203 TD
[(spective)-297.1(diagnosis)-293(of)-292.5(GAS)-288.3(infection)-293.3(adequate)-294.3(for)-294.6(the)-289.5(diagnosis)-293(of)]TJ
T*
[(PANDAS)-488(are)-486.5(proposed.)-479.4(An)-482.9(initial)-487(course)-486.2(of)-482.2(anti-streptococcal)]TJ
0 -1.2266 TD
[(treatment)-425.7(for)-421.1(essentially)-425(all)-420(newly)-424.6(diagnosed)-423(cases)-424.5(of)-418.9(PANS)-419.1(is)]TJ
0 -1.2203 TD
[(suggested.)-332.2(Chronic)-332.8(secondary)-329.1(antimicrobial)-337(prophylaxis)-325(of)-330.4(strep-)]TJ
28.0042 74.5598 TD
[(tococcal)-355.2(infections)-350.9(is)-352(suggested)-354.6(for)-351.5(children)-353(with)-350.8(PANDAS)-355.2(who)]TJ
0 -1.2203 TD
[(have)-236.8(severe)-242.1(neuropsychiatric)-241.6(symptoms)-243.5(or)-235.6(recurrent)-242.3(exacerbations)]TJ
0 -1.2266 TD
[(associated)-293.4(with)-293.9(GAS)-294.6(infections.)-296.9(For)-290.6(all)-293.5(others,)-294.8(vigilance)-293.1(for)-294.6(GAS)]TJ
0 -1.2203 TD
[(infection)-350.2(in)-350.8(both)-356.2(the)-346.4(patient)-354.9(and)-355(close)-349(contacts)-354(is)-352(recommended.)]TJ
T*
[(Since)-226.3(any)-234.9(intercurrent)-229.9(infection)-230.1(may)-232.1(induce)-227.2(a)-229.5(symptom)-230.2(are,)-228.3(close)]TJ
0 -1.2266 TD
[(observation)-264.2(with)-268.6(appropriate)-268.1(therapy)-267.3(for)-269.3(any)-266.5(treatable)-266.5(intercurrent)]TJ
0 -1.2203 TD
[(infection)-274.3(is)-276.1(warranted.)-277.5(A)-274.7(guideline)-271.8(for)-275.6(the)-276.9(assessment)-273.9(of)-273.5(infection)]TJ
T*
[(at)-353.2(initial)-354.2(onset)-353(or)-349.4(exacerbations)-359(of)-349.4(neuropsychiatric)-361.8(symptoms)-351(is)]TJ
0 -1.2266 TD
[(provided.)-298.9(Routine)-302.6(childhood)-303.2(immunizations)-307.4(and)-298.1(attention)-307.4(to)-300.2(vita-)]TJ
0 -1.2203 TD
[(min)-195.8(D)-192.5(are)-195.7(encouraged.)-200(Current)-196.3(data)-190.3(suggesting)-197.6(the)-194.7(limited)-195.7(utility)-200(of)]TJ
T*
[(adenotonsillectomy)-285(and)-279.2(probiotics)-279(are)-284.2(also)-283.9(presented.)]TJ
1.1128 -1.2203 TD
[(Guidelines)-339(provided)-340.3(are)-341.1(supported)-341(by)-334.1(data)-342(whenever)-344.4(possible,)]TJ
-1.1128 -1.2266 TD
[(and)-462.5(by)-454.3(the)-466.5(best)-460.9(current)-459.6(judgment)-459(of)-463.2(experienced)-462.3(investigators,)]TJ
0 -1.2203 TD
[(as)-375.7(indicated)-381.6(in)-382.4(the)-378(text.)-378.2(Areas)-382.5(needing)-378.5(further)-383.9(study)-375.8(include)-382.5(the)]TJ
T*
[(identication)-234.6(of)-241.9(possible)-236.6(specic)-235.3(encephalitogenic)-244.1(strains)-233.3(of)-241.9(strep-)]TJ
0 -1.2266 TD
[(tococci,)-444.8(better)-448.8(serologic)-448.6(tests)-446.7(for)-446.3(the)-447.6(retrospective)-451.7(diagnosis)-444.7(of)]TJ
0 -1.2203 TD
[(GAS)-294.6(infections,)-290.6(prospective)-298.2(justication)-297.1(for)-288.3(secondary)-297.5(GAS)-294.6(anti-)]TJ
T*
[(microbial)-265.2(prophylaxis,)-264.7(and)-260.2(further)-263.8(clarication)-267.7(of)-260.9(the)-264.2(mechanisms)]TJ
0 -1.2266 TD
[(of)-336.7(GAS-induced)-333.8(autoimmunity.)-338.8(The)-335.9(clear)-340.2(implication)-339.2(of)-336.7(nonspe-)]TJ
0 -1.2203 TD
[(cic)-283.7(immune)-276.1(activation)-284(of)-286.2(symptoms)-281.4(highlights)-278(the)-283.2(need)-281.1(to)-281.3(eluci-)]TJ
T*
[(date)-196.6(the)-194.7(common)-196.2(pathways)-199.1(that)-198.2(might)-192.5(be)-197.5(involved.)-192.8(Also)-196.2(needed)-200.3(are)]TJ
T*
[(a)-431.9(search)-438.1(for)-433.7(additional)-433.4(neuropathologic)-438.2(autoantibodies)-435(and)-437.2(mo-)]TJ
0 -1.2266 TD
[(lecular)-235.8(mimicries)-238.3(implicating)-238.1(microbial)-233.6(or)-235.6(other)-234.2(antigenic)-236.2(sources,)]TJ
0 -1.2203 TD
[(and)-304.5(a)-311.7(clarication)-311.9(of)-311.5(the)-308.5(specic)-311.1(roles)-311.3(of)-305.1(inuenza,)]TJ
/F7 1 Tf
21.3019 0 TD
(Mycoplasma)Tj
/F6 1 Tf
5.1152 0 TD
(,)Tj
-26.4171 -1.2203 TD
[(and)-222.3(other)-215.3(infections)-224.5(in)-224.3(this)-215.9(disease.)-228.1(Finally,)-221.2(the)-220(safety)-218.4(and)-222.2(utility)-225.3(of)]TJ
0 -1.2266 TD
[(the)-384.3(suggested)-392.5(modes)-390.4(of)-387.3(infection)-388.2(prevention)-390(require)-390(prospective)]TJ
0 -1.2203 TD
(assessment.)Tj
/F4 1 Tf
0 -2.4976 TD
[(Clinical)-334.9(Signicance)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(The)-297.9(clinical)-304(management)-306.7(of)-305.1(children)-302.4(with)-300.2(PANS)-305.3(is)-301.4(often)-303.8(dif-)]TJ
-1.1128 -1.2203 TD
[(cult,)-517.3(and)-513.1(scientically)-522.7(established)-515.8(guidelines)-519(are)-518.1(not)-514.7(currently)]TJ
T*
[(available.)-361.7(This)-357.2(article,)-362.9(from)-354.5(the)-359.1(PANS)-355.9(PANDAS)-361.5(Research)-362(Con-)]TJ
0 -1.2266 TD
[(sortium,)-362.6(is)-364.6(an)-368.2(effort)-365.4(to)-363.4(provide)-366(a)-362.3(practical)-367.7(approach)-366.4(to)-363.4(the)-365.4(man-)]TJ
0 -1.2203 TD
[(agement)-258(of)-254.5(infection)-261.7(components)-255.3(based)-256.5(on)-258.3(current)-257.2(knowledge)-254.4(and)]TJ
T*
[(the)-472.9(experience)-481.7(of)-475.8(Consortium)-483.1(members.)-476.8(Accompanying)-480.2(papers)]TJ
0 -1.2266 TD
[(from)-341.9(the)-346.4(Consortium)-344(discuss)-341.7(psychiatric)-346.5(and)-342.4(immunomodulatory)]TJ
0 -1.2203 TD
(management.)Tj
/F4 1 Tf
0 -2.4975 TD
(Acknowledgment)Tj
/F6 1 Tf
1.1128 -1.8336 TD
[(The)-430.7(authors)-436.8(acknowledge)-435.3(the)-434.9(support)-440.7(rendered)-432.2(by)-435.3(PANDAS)]TJ
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[(Network,)-280.7(and)-279.2(the)-283.2(Leda)-280.9(J.)-281.8(Sears)-283(Trust.)]TJ
/F4 1 Tf
0 -2.4976 TD
(Disclosures)Tj
/F6 1 Tf
1.1128 -1.8336 TD
[(M.S.C.,)-355.7(MD,)-353.7(MPH,)-358.1(None.)-354.4(S.E.S.,)-354.9(MD,)-353.7(Employee)-356.1(of)-355.7(National)]TJ
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[(Institute)-264.5(of)-267.2(Mental)-269.9(Health.)-269.1(M.S.P.,)-261(MD,)-271.5(None.)-265.9(T.K.M.,)-266.9(MD,)-265.2(NIH/)]TJ
0 -1.2266 TD
[(NIMH:)-258.1(1RO1MH093381-01A1,)-252.8(1R21MH087849-01A1,)-255.9(1R01HD)]TJ
0 -1.2203 TD
[(080096-01A1,)-344.9(R34;)-354.5(Centers)-349.1(for)-351.5(Disease)-348.6(Control)-353.4(and)-348.7(Prevention:)]TJ
T*
[(5U01DD000509-02;)-312.2(International)-313(OCD)-313.4(Foundation;)-311.2(AstraZeneca)]TJ
0 -1.2266 TD
[(Pharmaceuticals;)-420.7(Sunovion)-416(Pharmaceuticals,)-420.1(Inc.;)-414.7(F.)-418.3(Hoffmann-)]TJ
0 -1.2203 TD
[(LaRoche)-375.1(Ltd;)-372.6(PANDAS)-380.5(Network;)-376.2(Neurocrine)-375.3(Biosciences,)-382.8(Inc.;)]TJ
T*
[(Auspex)-471.9(Pharmaceuticals;)-483.9(Teva)-476.9(Pharmaceuticals;)-477.6(Shire)-473.1(Pharma-)]TJ
T*
[(ceuticals;)-414.1(Pzer,)-409.7(Inc.;)-408.4(Massachusetts)-415.2(General)-412.1(Hospital;)-410.6(Psyadon)]TJ
0 -1.2266 TD
[(Pharmaceuticals,)-521.3(Inc.;)-515.8(Forest)-511.7(Research)-520.1(Institute,)-520.3(Inc.;)-515.8(Tourette)]TJ
0 -1.2203 TD
[(Syndrome)-281.4(Association.)]TJ
/F4 1 Tf
0 -2.4976 TD
(References)Tj
/F6 1 Tf
8.4682 0 0 8.4682 310.8472 88.6677 Tm
[(Al-Zaidy)-429.9(SA,)-434.9(MacGregor)-437.9(D,)-431.2(Mahant)-434.7(S,)-429.8(Richardson)-435.3(SE,)-431.8(Bitnun)-432(A:)]TJ
1.0042 -1.2385 TD
[(Neurological)-355.2(complications)-354.2(of)-345.3(PCR-Proven)]TJ
/F7 1 Tf
18.1563 0 TD
[(M.)-349.7(pneumoniae)]TJ
/F6 1 Tf
6.6747 0 TD
(Infec-)Tj
-24.831 -1.2318 TD
[(tions)-349.3(in)-357.1(Children:)-355.1(Prodromal)-352.3(illness)-358.9(duration)-353.5(may)-354.1(reect)-358.4(pathoge-)]TJ
0 -1.2385 TD
[(netic)-333.6(mechanism.)-336(Clin)-340.7(Infect)-330.2(Dis)-336.6(61:10921098,)-335.8(2015.)]TJ
/F4 1 Tf
8.9663 0 0 8.9663 59.7543 749.7069 Tm
[(MANAGEMENT)-341.5(OF)-331.2(INFECTIONS)-341.8(IN)-328.8(PANS)]TJ
54.1178 0 TD
(9)Tj
ET
endstream
endobj
135 0 obj
<>stream
/GS1 gs
BT
/F6 1 Tf
8.4682 0 0 8.4682 62.022 725.7825 Tm
0 0 0 rg
0 Tc
0 Tw
[(Ali)-420.5(SR,)-419.9(McDevitt)-417.9(H:)-420.3(Question)-425(1:)-417.4(Does)-420.4(vitamin)-417(D)-420.1(supplementation)]TJ
1.0042 -1.2318 TD
[(prevent)-406.4(acute)-401.9(lower)-398.9(respiratory)-406.6(tract)-400.2(infections)-403.3(in)-397.3(childre)-9.4(n?)-398.7(Arch)]TJ
0 -1.2385 TD
[(Dis)-336.6(Child)-336.1(100:892895,)-333.7(2015.)]TJ
-1.0042 -1.2318 TD
[(Allen)-491.1(AJ,)-488.1(Leonard)-488.4(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 -1.2385 TD
[(triggered,)-459.5(autoimmune)-458.4(subtype)-455.3(of)-459.1(pediatric)-459.7(OCD)-455.4(and)-454.3(Tourettes)]TJ
0 -1.2318 TD
[(syndrome.)-256.1(J)-251(A)0(m)-248.3(Acad)-258(Child)-249.1(Adolesc)-256.9(Psychiatry)-252.8(34:307311,)-251.2(1995.)]TJ
-1.0042 -1.2385 TD
[(American)-370.8(Academy)-377.7(of)-365.4(Pediatrics:)-371(Group)-374.6(A)-366.6(streptococcal)-374.5(infections.)]TJ
1.0042 -1.2318 TD
[(In:)-452.6(Red)-455.7(Book.)-449.4(Report)-453(of)-452.4(the)-452.4(Committee)-455.7(on)-452.8(Infectious)-451.7(Diseases,)]TJ
0 -1.2385 TD
[(2015a.)-335.8(Elk)-332.3(Grove)-340.6(Village,)-336.6(IL:)-331.9(American)-337.4(Academy)-337.6(of)-331.9(Pedia)-9.1(trics.)]TJ
-1.0042 -1.2318 TD
[(American)-270.4(Academy)-263.9(of)-264.9(Pediatrics:)]TJ
/F7 1 Tf
13.9251 0 TD
[(Mycoplasma)-264.9(pneumoniae)]TJ
/F6 1 Tf
10.5376 0 TD
[(and)-260.2(other)]TJ
/F7 1 Tf
-23.4585 -1.2385 TD
(Mycoplasma)Tj
/F6 1 Tf
5.7508 0 TD
[(species)-636.2(infections.)-642(In:)-633.3(Red)-636.5(Book.)-630.1(Report)-640.5(of)-633.2(the)]TJ
-5.7508 -1.2318 TD
[(Committee)-335.2(on)-339(Infectious)-337.9(Diseases,)-338.8(2015b.)]TJ
-1.0042 -1.2385 TD
[(Antico)-392.8(A,)-384.3(Tampoia)-393.3(M,)-391.4(Tozzoli)-391.2(R,)-389.5(Bizzaro)-387.1(N.)-391(Can)-388.7(supplementation)]TJ
1.0042 -1.2318 TD
[(with)-261.9(vitamin)-256.3(D)-259.4(reduce)-258.3(the)-258.2(risk)-255(or)-258.3(modify)-258.3(the)-258.2(course)-260.1(of)-258.3(autoimmune)]TJ
0 -1.2385 TD
[(diseases?)-433.5(A)-426.8(systematic)-431.3(review)-427.3(of)-425.6(the)-425.6(literature.)-430.5(Autoimmun)-426.8(Rev)]TJ
0 -1.2318 TD
[(12:12736,)-336.1(2012.)]TJ
-1.0042 -1.2385 TD
[(Ayoub)-401.8(E,)-394.6(Wannamaker)-401.8(L:)-403.8(Evaluation)-395.6(of)-398.8(the)-398.8(streptococcal)-408(desoxyr-)]TJ
1.0042 -1.2318 TD
[(ibonuclease)-259.3(B)-251.2(and)-253.5(diphosphopyridine)-258(nucleotidase)-259.5(antibody)-253.5(tests)-256.2(in)]TJ
0 -1.2385 TD
[(acute)-602.8(rheumatic)-609.1(fever)-597.8(and)-601.6(acute)-609.5(glomerulonephritis.)-601.3(Pediatrics)]TJ
T*
[(29:527538,)-338.2(1962.)]TJ
-1.0042 -1.2318 TD
[(Baugh)-326(RF,)-326.2(Archer)-328.4(SM,)-321.4(Mitchell)-332.7(RB,)-326(Rosenfeld)-326.1(RM,)-327.9(Amin)-324.3(R,)-322.5(Burns)]TJ
1.0042 -1.2385 TD
[(JJ,)-499.7(Darrow)-505.9(DH,)-503.2(Giordano)-499(T,)-501.7(Litman)-503.7(RS,)-500.3(Li)-497.5(KK,)-503.2(Mannix)-502.2(ME,)]TJ
0 -1.2318 TD
[(Schwartz)-265.1(RH,)-267.3(Setzen)-265(G,)-257.2(Wald)-268.6(ER,)-257.5(Wall)-266.7(E,)-260.7(Sandberg)-264.7(G,)-263.8(Patel)-261.5(MM;)]TJ
0 -1.2385 TD
[(American)-518.1(Academy)-518.3(of)-512.7(Otolaryngology-Head)-513.1(and)-514.6(Neck)-519.1(Surgery)]TJ
0 -1.2318 TD
[(Foundation:)-313(Clinical)-317.4(practice)-311.7(guideline:)-313.5(Tonsillectomy)-314.4(in)-316.9(children.)]TJ
0 -1.2385 TD
[(Otolaryngol)-340.8(Head)-331.6(Neck)-338.3(Surg)-331(144:S1S30,)-334.7(2011.)]TJ
-1.0042 -1.2318 TD
[(Bradley)-314(JS,)-319.3(Byington)-309(CL,)-317.8(Shah)-310.7(SS,)-313(Alverson)-319.4(B,)-315.8(Carter)-311.5(ER,)-317.8(Harrison)]TJ
1.0042 -1.2385 TD
[(C,)-356(Kaplan)-360.7(SL,)-351.4(Mace)-358.2(SE,)-358.1(McCracken)-362.5(GH)-358.2(Jr,)-350.9(Moore)-361.1(MR,)-354.7(St)-352(Peter)]TJ
0 -1.2318 TD
[(SD,)-374.6(Stockwell)-378.1(JA,)-374.3(Swanson)-374.7(JT;)-373.6(Pedia)-9.1(tric)-371.9(Infectious)-378.1(Diseases)-381.3(So-)]TJ
0 -1.2385 TD
[(ciety)-434(and)-434.2(the)-425.6(Infectious)-438.4(Diseases)-434.9(Society)-433.1(of)-432.3(America:)-435.9(The)-427.4(man-)]TJ
0 -1.2318 TD
[(agement)-279.2(of)-271.6(community-acquired)-284(pneumonia)-277.2(in)-270.1(infants)-279(and)-273.6(children)]TJ
0 -1.2385 TD
[(older)-476.3(than)-474.6(3)-477.4(months)-474(of)-479.2(age:)-474(Clinical)-478.1(practice)-479.1(guideli)-8.4(nes)-475.6(by)-472.9(the)]TJ
0 -1.2318 TD
[(Pediatric)-427.8(Infectious)-425(Diseases)-421.5(Societ)-9.3(y)-417.2(and)-420.9(the)-425.6(Infectious)-425(Diseases)]TJ
0 -1.2385 TD
[(Society)-339.4(of)-331.9(America.)-339.7(Clin)-334(Infect)-336.9(Dis)-329.9(53:e2)-8.1(5e76,)-329.1(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)-244.1(abnormalities)-246.7(after)-247.8(streptococcal)-247.3(exposure:)-244.4(A)-239.4(novel)-242.4(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(237:20762087,)-337.9(2012.)]TJ
-1.0042 -1.2318 TD
[(Cannell)-493.2(JJ,)-493(Grant)-499.3(WB,)-493.6(Holick)-493.2(MF:)-491.3(Vitamin)-500.3(D)-493.8(and)-487.8(inammation.)]TJ
1.0042 -1.2385 TD
[(Dermatoendocrinol)-338.2(6:e98)-8.1(3401,)-327.5(2015.)]TJ
-1.0042 -1.2318 TD
[(Casey)-239.6(JR,)-238.8(Kahn)-238.4(R,)-235.5(Gmoser)-243.7(D,)-237.1(Atlas)-237.9(E,)-233.9(Urbani)-240.4(K,)-237.1(Luber)-243.8(S,)-235.7(Pellman)-239.2(H,)]TJ
1.0042 -1.2385 TD
[(Pichichero)-478.7(ME:)-476.2(Frequency)-473.8(of)-479.2(symptomatic)-473.1(relapses)-483.9(of)-472.5(group)-472.1(A)]TJ
0 -1.2318 TD
[(beta-hemolytic)-314(streptococcal)-314.3(tonsillopharyngitis)-315.9(in)-310.3(children)-312.8(from)-309.2(4)]TJ
0 -1.2385 TD
[(pediatric)-412.9(practices)-415.4(following)-410.8(penicillin,)-409.7(amoxicillin,)-412(and)-407.5(cephalo-)]TJ
0 -1.2318 TD
[(sporin)-326.2(antibio)-8.4(tic)-323.3(treatment.)-337.1(Clin)-327.3(Pediatr)-325.6(\(Phila\))-332.5(47:549554,)-324.9(2008.)]TJ
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[(Centers)-388.8(for)-393.9(Disease)-391.4(Control)-386.8(and)-387.4(Prevention:)-392.4(Seasonal)-390.9(inuenza.)-387.5(In-)]TJ
1.0042 -1.2318 TD
[(formation)-295.2(for)-293.5(health)-288.9(profess)-9.2(ionals.)-288.3(2016a.)-295.6(https://www.cdc.gov/u/)]TJ
0 -1.2385 TD
[(professionals/index.htm)-343.8(\(Accessed)-336.4(March,)-338.1(2017\).)]TJ
-1.0042 -1.2318 TD
[(Centers)-522.7(for)-521.1(Disease)-525.3(Control)-520.7(and)-514.6(Prevention:)-526.3(Lyme)-516.7(disease)-522.4(maps.)]TJ
1.0042 -1.2385 TD
[(20)29.3(1)18(6)0(b)29.3(.)-312.4(h)18(t)13.2(t)13.2(p)18(s:)23.3(/)19.9(/)13.2(w)15(w)15(w)0(.)24(c)18.5(dc)23.1(.)15.7(g)18(ov)29.3(/)13.2(l)13.2(y)18(m)17.8(e)0(/)25(s)16.8(t)13.2(a)0(t)31.7(s)0(/)23.3(m)17.8(ap)29.8(s.)25.8(h)18(t)13.2(m)17.8(l)13.2(.)-312.4(\()18.3(A)15(c)0(c)23.7(e)0(s)28.6(s)16.8(ed)-298.2(M)14.7(a)0(r)30.2(c)0(h)29.8(,)]TJ
T*
[(20)29.3(1)18(7)0(\))29.6(.)]TJ
-1.0042 -1.2318 TD
[(Centers)-281.7(for)-280.1(Disease)-284.3(Control)-279.7(and)-280.3(Prevention:)-285.3(Lyme)-282.4(disease:)-281.5(two-Two-)]TJ
1.0042 -1.2385 TD
[(step)-328.5(laboratory)-323.4(testing)-331(process.)-649.4(2016c.)-329.1(https://www.cdc.gov/lyme/)]TJ
0 -1.2318 TD
.0092 Tc
[(di)-4.4(agn)-6.3(o).4(si)9.2(s)-7.7(t)-4.4(est)-4.4(i)9.2(n)-13.2(g).4(/)9.2(L)-13(abTe)-5.7(st)9.2(/)-11.2(T).6(woSt)-4.4(ep/)-4.4(i)9.2(n)-13.2(d).4(ex.ht)-4.4(m).2(l)-4.4(.)-443.8(\(Acc)-5.7(esse)-5.7(d)-441.5(M)-2.9(ar)-5.9(ch,)]TJ
0 -1.2385 TD
.0087 Tc
[(201)-6.8(7\).)]TJ
-1.0042 -1.2318 TD
0 Tc
[(Chang)-352.8(K,)-350.9(Frankovich)-354(J,)-349.1(Cooperstock)-357.1(M,)-351.2(Cunningham)-354.9(MW,)-348.2(Latimer)]TJ
1.0042 -1.2385 TD
[(ME,)-547.3(Murphy)-551.2(TK,)-546.9(Pasternack)-554.9(M,)-552.1(Thienemann)-553.1(M,)-545.4(Williams)-553.8(K,)]TJ
0 -1.2318 TD
[(Walter)-437.3(J,)-436.2(Swedo)-429.6(SE:)-434.2(Clinical)-437.9(evaluation)-435.4(of)-432.3(youth)-437.1(with)-436(pediatric)]TJ
0 -1.2385 TD
[(acute-onset)-272.4(neuropsychiatric)-273.9(syndrome)-265(\(PANS\):)-268.8(Recommendations)]TJ
0 -1.2318 TD
[(from)-335.9(the)-338.6(2013)-336.5(PANS)-338.8(Consensus)-338(Conference.)-345.3(PANS)-338.8(Collaborative)]TJ
0 -1.2385 TD
[(Consortium.)-338.7(J)-331.3(Child)-336.1(Adolesc)-337.2(Psychopharmacol)-338(25:313,)-331.9(2015.)]TJ
28.6403 76.5883 TD
[(Charan)-293.7(J,)-288.9(Goyal)-292.2(JP,)-285.9(Saxena)-293.7(D,)-283.9(Yadav)-293.5(P:)-285(Vitamin)-292.7(D)-286.2(for)-286.8(prevention)-297(of)]TJ
1.0042 -1.2318 TD
[(respiratory)-286.1(tract)-279.7(infections:)-283(A)-279.5(systematic)-284(review)-280(and)-280.3(meta-analysis.)]TJ
0 -1.2385 TD
[(J)-338(Pharmacol)-338.1(Pharmacother)-336.8(3:300303,)-336.1(2012.)]TJ
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[(Chart)-9.1(rand)-295.4(C,)-295.8(Leeang)-295.7(MM,)-303.1(Minion)-293.3(J,)-295.6(Brewer)-303(T,)-294.2(Pai)-300(M:)-293.5(Accuracy)-305.1(of)]TJ
1.0042 -1.2385 TD
[(rapid)-362.5(inuenza)-363(diagnostic)-363.5(tests:)-356.8(A)-359.9(meta-analysis.)-367.5(Ann)-357.4(Intern)-357.6(Med)]TJ
0 -1.2318 TD
[(156:500511,)-340.4(2012.)]TJ
-1.0042 -1.2385 TD
[(Clegg)-531.6(HW,)-521.9(Giftos)-528.1(PM,)-529(Anderson)-528.9(WE,)-525.5(Kaplan)-528(EL,)-523.7(Johnson)-526(DR:)]TJ
1.0042 -1.2318 TD
[(Clinical)-283.9(perineal)-278.8(streptococcal)-280.8(infection)-279.5(in)-276.8(children:)-279.5(Epidemiologic)]TJ
0 -1.2385 TD
[(feature)-10.4(s,)-315.7(low)-315.3(symptomatic)-319.1(recurrence)-318.5(rate)-319.7(after)-314.7(treatment,)-323.7(and)-313.7(risk)]TJ
0 -1.2318 TD
[(factors)-340.2(for)-333.6(recurrence.)-343(J)-331.3(Pediatrics)-337.4(167:687693,)-333.7(2015.)]TJ
-1.0042 -1.2385 TD
[(Cox)-362.5(CJ,)-359.3(Sharma)-361(M,)-357.9(Leckman)-361.2(JF,)-352.8(Zuccolo)-359.7(J,)-362.5(Zuccolo)-359.7(A,)-357.6(Kovoor)-356.7(A,)]TJ
1.0042 -1.2318 TD
[(Swedo)-369.3(SE,)-358.1(Cunningham)-368.3(MW:)-357.4(Brain)-363.9(huma)-8.1(n)-356.9(monoclonal)-364.5(autoanti-)]TJ
0 -1.2385 TD
[(body)-604.3(from)-610.4(Sydenham)-606.7(chorea)-606.5(targets)-606.5(dopaminergic)-608.8(neurons)-604.2(in)]TJ
0 -1.2318 TD
[(transgenic)-304.3(mice)-300.2(and)-293.7(signals)-300.6(dopamine)-295.2(D2)-295(receptor:)-300.6(Implications)-298.7(in)]TJ
0 -1.2385 TD
[(huma)-8.1(n)-330.2(disease.)-339.3(J)-331.3(Immunol)-334.2(191:55245541,)-337.9(2013.)]TJ
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[(Cox)-422.8(CJ,)-426.3(Zuccolo)-426.6(AJ,)-421.1(Edwards)-426.2(EV,)-419.8(Mascaro-Blanco)-431.6(A,)-424.5(Alvarez)-422.1(K,)]TJ
1.0042 -1.2385 TD
[(Stoner)-279.2(J,)-275.5(Chang)-272.5(K,)-270.5(Cunningham)-281.3(MW:)-270.4(Antineuronal)-282.1(antibodies)-276.5(in)-270.1(a)]TJ
0 -1.2318 TD
[(hetero)-9.2(geneous)-557.1(group)-559.2(of)-559.5(youth)-557.6(and)-554.7(young)-559.5(adults)-558.4(with)-563.2(tics)-560.9(and)]TJ
0 -1.2385 TD
[(obsess)-9(ive-compulsive)-377.9(disorder.)-380.8(J)-378.2(Child)-376.3(Adolesc)-384.1(Psychopharmacol)]TJ
T*
[(25:7685,)-340.7(2015.)]TJ
-1.0042 -1.2318 TD
[(Cunningham)-234.4(MW,)-227.7(Cox)-228.6(CJ:)-227.9(Autoimmunity)-228.5(against)-225.2(dopamine)-235(receptors)]TJ
1.0042 -1.2385 TD
[(in)-203.1(neuropsychiatric)-207(and)-206.6(movement)-201.7(disorders:)-205.8(A)-205.9(review)-206.3(of)-198(Sydenham)]TJ
0 -1.2318 TD
[(chore)-9.1(a)-249.3(and)-246.8(beyond.)-257.5(Acta)-249.3(Physiol)-254.7(\(Oxf)-84.3(\))-249.4(216:90100,)-251.2(2016.)]TJ
-1.0042 -1.2385 TD
[(Danchin)-396.3(MH,)-396.5(Rogers)-395.9(S,)-389.7(Kelpie)-398.9(L,)-394.6(Selvaraj)-394.1(G,)-391(Curtis)-392.6(N,)-397.7(Carlin)-390.9(JB,)]TJ
1.0042 -1.2318 TD
[(Nolan)-325.6(TM,)-313(Carapetis)-323.6(JR:)-321.6(Burden)-314.4(of)-318.5(acute)-321.6(sore)-323.4(throat)-315.8(and)-320.4(group)-318.1(A)]TJ
0 -1.2385 TD
[(strept)-9.1(ococcal)-285.1(pharyngitis)-278.8(in)-283.5(school-aged)-288.2(children)-279.3(and)-287(their)-280.3(families)]TJ
0 -1.2318 TD
[(in)-337(Australia.)-334.9(Pediatrics)-344.1(120:950957,)-333.7(2007.)]TJ
-1.0042 -1.2385 TD
[(Demesh)-417.5(D,)-411.1(Virbalas)-417.4(JM,)-408.1(Bent)-415.7(JP:)-408.8(The)-414(role)-407.3(of)-412.2(tonsillectomy)-413.1(in)-410.7(the)]TJ
1.0042 -1.2318 TD
[(treatment)-426.4(of)-425.6(pediatric)-426.2(autoimmune)-424.9(neuropsychiatric)-427.9(disorders)-426.5(as-)]TJ
0 -1.2385 TD
[(sociate)-10.4(d)-397.1(with)-402.5(streptococcal)-401.3(infections)-403.3(\(PANDAS\).)-403.6(JAMA)-400.4(Otolar-)]TJ
0 -1.2318 TD
[(yngol)-336.7(Head)-338.3(Neck)-331.6(Surg)-337.7(141:272275,)-333.7(2015.)]TJ
-1.0042 -1.2385 TD
[(Diaz)-410(MH,)-409.8(Benitez)-405.6(AJ,)-407.7(Winchell)-413.2(JM:)-403.9(Investigations)-411(of)]TJ
/F7 1 Tf
23.1238 0 TD
(Mycoplasma)Tj
-22.1196 -1.2318 TD
(pneumoniae)Tj
/F6 1 Tf
5.3224 0 TD
[(infections)-423.4(in)-424.1(the)-425.6(United)-419.6(States:)-425.7(Trends)-427.8(in)-417.4(molecular)]TJ
-5.3224 -1.2385 TD
[(typing)-343.5(and)-333.8(macrolide)-341.3(resistance)-345.1(from)-335.9(2006)-336.5(to)-337(2013.)-334.2(J)-338(Clin)-334(Micro-)]TJ
0 -1.2318 TD
[(biol)-339.3(53:124130,)-331.6(2015.)]TJ
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[(Dileepan)-268.7(T,)-260.7(Smith)-262.8(ED,)-259.1(Knowland)-268(D,)-257.2(Hsu)-264.9(M,)-264.2(Platt)-260.2(M,)-257.5(Bittner)-9.4(-Eddy)-257.7(P,)]TJ
8.4682 0 0 8.4682 321.5621 349.2283 Tm
[(Cohen)-332.7(B,)-329.2(Southern)-323.5(P,)-329.4(Latimer)-330.8(E,)-327.7(Harley)-326.8(E,)-327.7(Agalliu)-332.7(D,)-324.1(Cleary)-332(PP:)]TJ
T*
[(Group)-468.4(A)]TJ
/F7 1 Tf
4.1976 0 TD
(Streptococcus)Tj
/F6 1 Tf
6.0923 0 TD
[(intranasal)-463(infection)-467(promotes)-464(CNS)-467.4(inl-)]TJ
-10.2899 -1.2318 TD
[(tration)-302.6(by)-292.1(streptococcal-specic)-303.1(Th17)-296.1(cells.)-299(J)-291.2(Clin)-293.8(Invest)-298.9(126:303)]TJ
0 -1.2385 TD
[(317,)-338.8(2016.)]TJ
-1.0042 -1.2318 TD
[(Dranitzki)-369.5(Z,)-354.5(Steiner)-365.8(I:)-356.7(PANDAS)-362.2(in)-363.8(siblings:)-361.8(A)-359.9(common)-360.6(risk?)-357(Eur)-360.6(J)]TJ
1.0042 -1.2385 TD
[(Neurol)-340.8(14:e4,)-333.8(2007.)]TJ
-1.0042 -1.2318 TD
[(Eshel)-350.5(G,)-337.5(Lahat)-348.8(E,)-341.1(Azizi)-349.9(E,)-341.1(Gross)-343.5(B,)-342.6(Aladjem)-347.7(M:)-340.3(Chorea)-347.3(as)-346.3(a)-343(mani-)]TJ
1.0042 -1.2385 TD
[(festation)-307.5(of)-305.1(rheumatic)-307.9(fevera)-309(30-year)-307.5(survey)-300.8(\(19601990\).)-308.1(Eur)-300.3(J)]TJ
0 -1.2318 TD
[(Pedia)-9.1(tr)-330(152:645646,)-333.7(1993.)]TJ
-1.0042 -1.2385 TD
[(Falcin)-9.3(i)-294.8(F)0(,)-302.6(Lepri)-295.4(G,)-304(Rigante)-299.1(D,)-297.3(Bertin)-9.3(i)-294.8(F)0(,)-302.6(Matucci)-300.4(Cerinic)-298.7(M:)-300.2(FPReS-)]TJ
1.0042 -1.2318 TD
[(FINA)-8.8(L-2252:)-440.8(Descriptive)-454.7(analysis)-442.8(of)-445.7(pediatric)-446.3(autoim)-8.4(mune)-443.2(neu-)]TJ
0 -1.2385 TD
[(ropsychia)-10.1(tric)-720(disorder)-724.5(associated)-727(with)]TJ
/F7 1 Tf
17.3127 0 TD
(Streptococcus)Tj
/F6 1 Tf
6.3467 0 TD
(infection)Tj
-23.6594 -1.2318 TD
[(\(PAN)-8.8(DAS\))-276.6(in)-276.8(a)-276(cohort)-277.6(of)-278.3(65)-272(Italian)-282(patients.)-276.7(Pediatr)-278.8(Rheumatol)-283.4(11)]TJ
0 -1.2385 TD
[(\(Suppl)-340(2\):242,)-329.4(2013.)]TJ
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[(Fallon)-344.5(B,)-335.9(Nields)-340.4(J,)-335.7(Parsons)-339.1(B,)-335.9(Liebowitz)-342.9(MR,)-334.6(Klein)-343.8(DF:)-336.9(Psychiatric)]TJ
1.0042 -1.2385 TD
[(manife)-9.4(stations)-334.3(of)-331.9(Lyme)-342.6(borreliosis.)-337.6(J)-331.3(Clin)-340.7(Psychiatry)-333.2(54:263268,)]TJ
T*
(1993.)Tj
-1.0042 -1.2318 TD
[(Fallon)-244.1(BA,)-247.2(Nields)-240(JA:)-242.8(Lyme)-242.2(disease:)-248.1(A)-239.4(neuropsychiatric)-247.1(illness.)-242.8(Am)-241.6(J)]TJ
1.0042 -1.2385 TD
[(Psychiatry)-339.9(151:15711583,)-337.9(1994.)]TJ
-1.0042 -1.2318 TD
[(Fallon)-304.4(BA,)-294.1(Kochevar)-299(JM,)-301(Gaito)-296.9(A,)-297.3(Nields)-300.2(JA:)-296.4(The)-300.2(underdiagnosis)-294.4(of)]TJ
1.0042 -1.2385 TD
[(neuropsychiatr)-11.1(ic)-483.8(Lyme)-489.9(disease)-488.9(in)-491(children)-486.9(and)-487.8(adults.)-489.2(Psychiatr)]TJ
0 -1.2318 TD
[(Clin)-340.7(North)-332.5(Am)-335.4(21:693703,)-331.6(1998.)]TJ
-1.0042 -1.2385 TD
[(Frankovich)-240.2(J,)-235.3(Thienemann)-238.4(M,)-230.7(Pearlstein)-243.7(J,)-228.6(Crable)-238.2(A,)-237.1(Brown)-235.4(K,)-230.4(Chang)]TJ
1.0042 -1.2318 TD
[(K:)-219.5(Multidisciplinary)-219.5(clinic)-220(dedicated)-220.4(to)-216.5(treating)-223.9(youth)-216.2(with)-215.1(pediatric)]TJ
0 -1.2385 TD
[(acute-onset)-192(neuropsychiatric)-193.6(syndrome:)-184.9(Presenting)-192.6(characteristics)-196.3(of)]TJ
0 -1.2318 TD
[(the)-291.7(rst)-290.1(47)-292.1(consecutive)-292.8(patients.)-290.1(J)-291.2(Child)-289.2(Adolesc)-297(Psychopharmacol)]TJ
0 -1.2385 TD
[(25:3847,)-253.7(2015.)]TJ
/F4 1 Tf
8.9663 0 0 8.9663 62.022 749.6502 Tm
(10)Tj
43.274 0 TD
[(COOPERSTOCK)-335.9(ET)-338.7(AL.)]TJ
ET
endstream
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8.4682 0 0 8.4682 59.7543 725.7825 Tm
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[(Fra)-5.5(nkovic)-5.5(h)-347.5(J,)-349.8(Swe)-5.5(d).6(o)-347.5(S)-1(,)-343.1(M)-2.7(urph)-6.1(y)-347.5(T).8(,)-349.8(D)4.4(a)-5.5(l)2.5(e)-347(RC,)-349.8(Agalliu)-347.5(D)4.4(,)-349.8(W)-1(illiams)]TJ
1.0042 -1.2318 TD
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[(K,)-376.4(Da)-5.3(ines)-375.3(M,)-369.7(Hornig)-367.4(M,)-369.7(Chuga)-5.3(ni)-372.2(H,)-369.7(Sange)-5.3(r)-367(T)-5.7(,)-369.7(M)-2.5(uscal)-372.2(E)-5.7(,)-369.7(Pas-)]TJ
0 -1.2385 TD
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[(terna)-5.5(c)1.2(k)-367.6(M)-2.7(,)-369.9(C)-.8(oope)-5.5(rstoc)-5.5(k)-367.6(M,)-369.9(Gans)-368.8(H,)-369.9(Zh)-6.1(ang)-367.6(Y)-2.3(,)-369.9(C)-.8(unningham)-374.5(M)-2.7(,)]TJ
0 -1.2318 TD
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[(Be)-6(rnste)-6(i)2(n)-488.6(G)-2.8(,)-490.9(B)-1.3(romber)-6.2(g)-488.6(R)-1.3(,)-490.9(W)-1.4(ill)-4.7(et)-4.7(t)-486.7(T).3(,)-490.9(B)-1.3(rown)-488.6(K,)-490.9(Farha)-6(d).1(ian)-495.3(B)-1.3(,)]TJ
0 -1.2385 TD
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[(C)403.4(h)404.8(a)398.7(n)404.8(gK)401.9(,G)401.9(e)405.4(l)400(l)406.7(e)405.4(rD)401.9(,H)408.6(e)398.7(r)405.2(n)404.8(a)405.4(n)404.8(d)398.1(e)405.4(z)3.7(J)403.6(,)-5.9(S)409.9(h)398.1(e)405.4(r)405.2(rJ)403.6(,S)409.9(h)398.1(a)405.4(wR)403.4(,L)405(a)398.7(t)406.7(i)406.7(m)404.6(e)398.7(r)3.5(E)398.3(,)]TJ
0 -1.2318 TD
.0148 Tc
[(L)-7.2(eckma)-6.8(n)-455.9(J)-1.9(,)-458.2(T)-.5(h)-7.4(i)1.2(ene)-6.8(m)-.9(ann)-462.6(M)2.7(:)-460.7(C)-2.1(li)-5.5(nic)-6.8(a)-.1(l)-460.7(m)-.9(anag)-7.4(ement)-460.7(o)-.7(f)-462.3(p)-.7(edi)-5.5(a)-.1(tr)-7(ic)]TJ
0 -1.2385 TD
.0156 Tc
[(a)-6(c).7(ute)-6(-).5(onset)-419.7(n)-6.6(e).7(uropsyc)-6(hiatric)-421.1(s)-1.1(ynd)-6.6(rome)-421.1(\(PANS\):)-419.7(P)-1.5(a)-6(r).5(t)-419.7(IIUse)-421.1(o).1(f)]TJ
0 -1.2318 TD
[(immunomod)-6.5(ulatory)-649.2(t)-4.6(hera)-5.9(pies.)-651.5(J)-657.1(Child)-649.2(A)-2.7(dole)-5.9(s)-1(c)-648.6(P)-1.4(sycho)-6.5(pharm)]TJ
0 -1.2385 TD
.0158 Tc
[(20)-6.4(17)-334.4([E-pub)-334.4(ah)-6.4(ead)-334.4(of)-334.1(print])-334.1(DOI:)-332.5(10.1089/cap.2016.0148)-6.4(.)]TJ
-1.0042 -1.2318 TD
0 Tc
[(Garvey)-188.2(MA,)-188.9(Perlmutter)-182.6(SJ,)-185.4(Allen)-189.8(AJ,)-180.1(Hamburger)-187.6(S,)-188.8(Lougee)-185.4(L,)-180.4(Leonard)]TJ
1.0042 -1.2385 TD
[(HL,)-212.2(Witowski)-210.9(ME,)-205.9(Dubbert)-209(B,)-208.7(Swedo)-208.6(SE:)-206.6(A)-205.9(pilot)-205.6(study)-210.7(of)-204.7(penicillin)]TJ
0 -1.2318 TD
[(prophylaxis)-374.4(for)-373.8(neuropsychiatric)-374.3(exacerbations)-376.4(triggered)-374.8(by)-365.7(strep-)]TJ
0 -1.2385 TD
[(tococcal)-285.3(infections.)-287.2(Biol)-280.4(Psychiatry)-286.3(45:15641571,)-275.5(1999.)]TJ
-1.0042 -1.2318 TD
[(Gerber)-602.9(MA,)-590.6(Baltimore)-602.4(RS,)-594(Eaton)-597(CB,)-593.8(Gewitz)-596(M,)-599(Rowley)-596.9(AH,)]TJ
1.0042 -1.2385 TD
[(Shulman)-402.3(ST,)-398.3(Taubert)-399.5(KA:)-405.3(Prevention)-398.9(of)-398.8(rheumatic)-401.6(fever)-403.7(and)-394.1(di-)]TJ
0 -1.2318 TD
[(agnosis)-382.9(and)-387.4(treatment)-379.6(of)-385.5(acute)-381.9(streptococcal)-387.9(pharyngitis.)-383.6(Circula-)]TJ
0 -1.2385 TD
[(tion)-339.3(119:15411551,)-331.2(2009.)]TJ
-1.0042 -1.2318 TD
[(Goldenberg)-375.5(JZ,)-371.1(Lytvyn)-365.4(L,)-367.8(Steurich)-374.6(J,)-369.2(Parkin)-366.2(P,)-369.6(Mahant)-367.7(S,)-369.6(Johnston)]TJ
1.0042 -1.2385 TD
[(BC:)-328.5(Probiotics)-318.4(for)-326.9(the)-318.5(prevention)-323.7(of)-325.2(pediatric)-325.8(antibiotic-associated)]TJ
T*
[(diarrhea.)-338.3(Cochrane)-337.6(Database)-338.2(Syst)-337.3(Rev)-335.2(22:12,)-334.4(2015.)]TJ
-1.0042 -1.2318 TD
[(Gul)-429.1(M,)-431.6(Okur)-426.1(E,)-428.1(Ciragil)-431.2(P,)-429.8(Yildirim)-427(I,)-427.9(Aral)-430.3(M,)-424.9(Akif)-430.8(Kilic)-428.9(M:)-427.4(The)]TJ
1.0042 -1.2385 TD
[(comparison)-353.8(of)-352(tonsillar)-353(surface)-355(and)-353.9(core)-355.1(cultures)-354.2(in)-350.4(recurrent)-355.7(ton-)]TJ
0 -1.2318 TD
[(sillitis.)-340.1(Am)-335.4(J)-331.3(Otolaryngol)-334.1(28:1731717326)-7.5(,)-332.4(2007.)]TJ
-1.0042 -1.2385 TD
[(Gunville)-495.5(CF,)-493.6(Mourani)-497.2(PM,)-495.5(Ginde)-493(AA:)-492.3(The)-494.3(role)-494.3(of)-499.3(vitamin)-490.6(D)-493.8(i)0(n)]TJ
1.0042 -1.2318 TD
[(prevention)-357.2(and)-347.2(treatment)-352.8(of)-352(infection.)-350.9(Inamm)-348.4(Allergy)-354.4(Drug)-352.4(Tar-)]TJ
0 -1.2385 TD
[(gets)-335.2(12:239245,)-338.2(2013.)]TJ
-1.0042 -1.2318 TD
[(Hamilos)-543.5(DL:)-542.7(Chronic)-542.2(rhinosinusitis:)-538.8(Management.)-547(In:)-539.6(UpToDate.)]TJ
1.0042 -1.2385 TD
[(Edited)-336.1(by)-339(Post,)-328.3(TW.)-338(Waltham,)-337.3(MA,)-336.2(UpToDate,)-338.6(2016.)]TJ
-1.0042 -1.2318 TD
[(Hoffman)-411.6(KL,)-406.4(Hornig)-401.6(M,)-404.8(Yaddanapudi)-410.8(K,)-404.4(Jabado)-407.7(O,)-404.4(Lipkin)-410.3(WI:)-400.6(A)]TJ
1.0042 -1.2385 TD
[(murine)-304.6(model)-302.8(for)-306.9(neuropsychiatric)-307.4(disorders)-306(associated)-305.3(with)-302.1(group)]TJ
0 -1.2318 TD
[(A)-600.9(beta-hemolytic)-601.9(streptococcal)-602.1(infection.)-598.6(J)-592.4(Neurosci)-600(24:1780)]TJ
0 -1.2385 TD
[(1791,)-334.2(2004.)]TJ
-1.0042 -1.2318 TD
[(Holick)-386.1(MF,)-381.7(Binkley)-386.6(NC,)-381.1(Bischoff-Ferrari)-391.7(HA,)-382.7(Gordon)-383.4(CM,)-381.5(Hanley)]TJ
1.0042 -1.2385 TD
[(DA,)-516.6(Heaney)-522.7(RP,)-513.7(Murad)-515(MH,)-517(Weaver)-514.3(CM;)-517.9(Endocrine)-517.5(Society:)]TJ
0 -1.2318 TD
[(Evaluation,)-326.4(treatment,)-330.4(and)-320.4(preve)-9.1(ntion)-321.4(of)-325.2(vitamin)-323.3(D)-319.7(deciency:)-331.2(An)]TJ
0 -1.2385 TD
[(endocrine)-537.2(society)-533.2(clinical)-529.7(practice)-539.3(guideline.)-532(J)-525.5(Clin)-534.8(Endocrinol)]TJ
0 -1.2318 TD
[(Metab)-338.9(96:19111930,)-335.8(2011.)]TJ
-1.0042 -1.2385 TD
[(Ignacio)-352.8(A,)-350.9(Morales)-357.3(CI,)-344.4(Ca)]TJ
10.638 .0402 TD
()Tj
.3883 -.0402 TD
[(mara)-348.6(NO,)-355.9(Almeida)-347.7(RR:)-355.3(Innate)-350.7(sensing)-349.4(of)]TJ
-10.0221 -1.2318 TD
[(the)-392.1(gut)-379.3(microbiota:)-389.1(Modulatio)-9.3(n)-383.7(o)0(f)-385.5(inammatory)-388(and)-387.4(autoimmune)]TJ
0 -1.2385 TD
[(diseases.)-342.6(Front)-331.2(Immunol)-334.2(7:5465,)-338.6(2016.)]TJ
-1.0042 -1.2318 TD
[(Johnson)-331.8(DR,)-327.6(Kurlan)-327.4(R,)-329.2(Leckman)-327.8(J,)-329.1(Kaplan)-327.2(EL:)-332.1(The)-326.9(human)-324.8(immune)]TJ
1.0042 -1.2385 TD
[(response)-359.2(to)-350.4(streptococcal)-354.4(extracellular)-357.6(antigens:)-354.7(Clinical,)-355.3(diagnos-)]TJ
0 -1.2318 TD
[(tic,)-240.6(and)-240.1(potential)-244.5(pathogenetic)-238.2(implications.)-248(Clin)-233.6(Infect)-243.2(Dis)-242.8(50:481)]TJ
0 -1.2385 TD
[(490,)-338.8(2010.)]TJ
-1.0042 -1.2318 TD
[(Kaplan)-441(E,)-441.5(Ferrieri)-440.8(P,)-436.5(Wannamaker)-448.7(L:)-437.3(Comparison)-442.8(of)-432.3(the)-439(antibody)]TJ
1.0042 -1.2385 TD
[(response)-245.4(to)-236.6(streptococcal)-240.6(cellular)-243.4(and)-233.4(extracellular)-243.8(antigens)-240.7(in)-236.6(acute)]TJ
0 -1.2318 TD
[(pharyngitis.)-336.8(J)-338(Pediatr)-332.3(84:2128,)-334(1974.)]TJ
-1.0042 -1.2385 TD
[(Kaplan)-374.1(EL,)-369.8(Huew)-375.3(BB:)-368.7(The)-373.8(sensitivity)-370.2(and)-367.3(specicity)-377.9(of)-365.4(an)-371.9(aggluti-)]TJ
1.0042 -1.2318 TD
[(nation)-322.9(test)-326.6(for)-320.2(antibodies)-330.1(to)-316.9(streptococcal)-327.6(extracellular)-330.9(antigens:)-327.9(A)]TJ
0 -1.2385 TD
[(quantitative)-355.5(analysis)-355.7(and)-353.9(comparison)-353.8(of)-352(the)-352(Streptozyme)-360.5(test)-353.3(with)]TJ
0 -1.2318 TD
[(the)-258.2(anti-streptolysin)-259.2(O)-252.7(and)-253.5(anti-deoxyribonuclease)-256.8(B)-257.9(tests.)-253.9(J)-251(Pediatr)]TJ
0 -1.2385 TD
[(96:367373,)-338.2(1980.)]TJ
-1.0042 -1.2385 TD
[(Kaplan)-293.7(EL,)-282.7(Rothermel)-296.4(CD,)-287.4(Johnson)-284.9(DR:)-289.9(Antistreptolysin)-287.7(O)-286.2(and)-287(anti-)]TJ
1.0042 -1.2318 TD
[(deoxyribonuclease)-271.1(B)-257.9(titers:)-268.4(Normal)-260.6(values)-265.2(for)-260(children)-259.3(ages)-262.9(2)-263.2(t)0(o)-263.4(1)0(2)]TJ
0 -1.2385 TD
[(in)-337(the)-331.9(United)-339.2(States.)-336.2(Pediatrics)-337.4(101:8688,)-336.1(1998.)]TJ
-1.0042 -1.2318 TD
[(Ka)26.9(pl)31.2(an)-331.7(EL)29.6(,)-345.8(T)18.2(op)-332.3(F)16.4(H)-346.5(J)16.8(r)0(,)-327.5(D)0(u)26.3(d)18(di)24.5(n)18(g)-343.5(BA)25(,)-339.1(W)0(a)28.3(n)0(n)29.3(a)0(m)29.6(a)0(k)23.1(e)18.5(r)-343.2(L)0(W)27.9(:)-348.3(D)15(i)13.2(a)18.5(g)0(n)29.3(o)0(s)28.1(i)13.2(s)-344.7(o)18(f)]TJ
1.0042 -1.2385 TD
[(st)30(re)23.5(p)18(t)13.2(o)18(c)0(o)23.1(c)18.5(ca)23.7(l)-288.1(p)18(ha)29.8(ry)29.6(ng)29.3(i)13.2(t)13.2(i)19.9(s:)-278(D)15(i)13.2(f)18.3(f)0(e)30.2(r)0(e)23.5(n)18(t)13.2(i)13.2(a)18.5(t)13.2(i)13.2(o)18(n)-290(o)0(f)-271.6(a)0(c)23.7(t)19.9(i)13.2(v)0(e)-278.1(i)19.9(nf)29.6(ec)23.7(t)13.2(i)19.9(on)-272(fr)23.3(o)18(m)-290.2(t)13.2(h)18(e)]TJ
0 -1.2318 TD
[(ca)23.7(r)18.3(r)0(i)24.9(e)18.5(r)-216(s)0(t)30(a)0(t)25(e)-215.8(i)13.2(n)-216.3(t)19.9(h)0(e)-204.5(s)16.8(ym)29.1(pt)31.2(om)29.1(at)25(i)13.2(c)-215.8(c)18.5(h)0(i)24.5(l)19.9(d.)-200.7(J)-217.5(I)0(n)29.6(f)0(e)30.2(c)0(t)-202.6(D)15(i)13.2(s)-217.5(1)18(2)0(3)29.3(:)13.2(4)18(9)0(0)29.3()0(5)29.3(0)0(1)29.3(,)-218.6(1)18(9)0(7)29.3(1)0(.)]TJ
-1.0042 -1.2385 TD
[(Kirvan)-381(CA,)-381.1(Swedo)-382.7(SE,)-378.2(Heuser)-383.5(JS,)-379.6(Cunningham)-381.7(MW:)-384.2(Mimicry)-381.7(and)]TJ
1.0042 -1.2318 TD
[(autoantibody-mediated)-433.4(neuronal)-421.9(cell)-425.2(signaling)-422.2(in)-424.1(Sydenham)-425.9(cho-)]TJ
0 -1.2385 TD
[(rea.)-337.3(Nat)-334.8(Med)-337.1(9:914920,)-336.1(2003.)]TJ
-1.0042 -1.2318 TD
[(Kirvan)-280.5(CA,)-280.7(Swedo)-282.3(SE,)-277.8(Kurahara)-278.5(D,)-283.9(Cunningham)-281.3(MW:)-277.1(Streptococcal)]TJ
1.0042 -1.2385 TD
[(mimicry)-365.2(and)-360.6(antibody-mediated)-367.2(cell)-365(signaling)-362(in)-357.1(the)-358.7(pathogenesis)]TJ
0 -1.2318 TD
[(of)-338.6(Sydenhams)-337.2(chorea.)-336.4(Autoimmunity)-335.6(39:2129,)-334(2006a.)]TJ
28.647 77.8202 TD
[(Kirvan)-555(CA,)-548.5(Swedo)-556.8(SE,)-552.3(Snider)-553.6(LA,)-546.9(Cunningham)-555.8(MW:)-551.5(Antibody)]TJ
1.0042 -1.2318 TD
[(mediated)-426.6(neuronal)-435.3(cell)-425.2(signaling)-428.9(in)-430.8(behavior)-428.6(and)-427.5(movement)-429.3(dis-)]TJ
0 -1.2385 TD
[(orders.)-331.6(J)-338(Neuroimmunol)-338.5(179:173179,)-333.7(2006b.)]TJ
-1.0042 -1.2318 TD
[(Kirvan)-514.8(CA,)-515(Cox)-509.8(CJ,)-513.3(Swedo)-516.6(SE,)-512.1(Cunningham)-515.6(MW:)-518.1(Tubulin)-512.8(is)-512.3(a)]TJ
1.0042 -1.2385 TD
[(neuronal)-254.5(target)-255(of)-251.6(autoantibodies)-255.7(in)-256.7(Sydenhams)-256.9(chorea.)-256(J)-251(Immunol)]TJ
0 -1.2318 TD
[(178:74127421,)-331.2(2007.)]TJ
-1.0042 -1.2385 TD
[(Kronman)-318.2(MP,)-321.4(Zhou)-322.9(C,)-315.8(Mangione-Smith)-328.6(R:)-318.3(Bacterial)-326.6(prevalence)-324(and)]TJ
1.0042 -1.2318 TD
[(antimicrobial)-451.1(prescribing)-453.9(trends)-446.2(for)-447.4(acute)-455.5(respiratory)-453.5(tract)-447.1(infec-)]TJ
0 -1.2385 TD
[(tions.)-333.6(Pediatrics)-337.4(134:e956e965,)-336.8(2014.)]TJ
-1.0042 -1.2318 TD
[(Kurlan)-354.2(R,)-356(Johnson)-358.6(D,)-357.6(Kaplan)-360.7(EL;)-352.2(Tour)-7.9(ette)-351.6(Syndro)-7.2(me)-352(Study)-358.3(Group:)]TJ
1.0042 -1.2385 TD
[(Streptococcal)-508.8(infection)-507.1(and)-507.9(exacerbations)-510.3(of)-506(childhood)-503.3(tics)-507.3(and)]TJ
0 -1.2318 TD
[(obsessive-compulsive)-627.9(symptoms:)-633.8(A)-621(prospective)-627.7(blinded)-626.3(cohort)]TJ
0 -1.2385 TD
[(study.)-335.6(Pediatrics)-337.4(121:11881197,)-331.2(2008.)]TJ
-1.0042 -1.2318 TD
[(Lean)-301.7(WL,)-304.6(Arnup)-307.7(S,)-302.6(Danchin)-302.5(M,)-304.4(Steer)-303.3(AC:)-303.3(Rapid)-304(diagnostic)-310(tests)-303.1(for)]TJ
1.0042 -1.2385 TD
[(group)-606(A)-607.6(streptococcal)-608.8(pharyngitis:)-613.7(A)-600.9(meta-analysis.)-615.2(Pediatrics)]TJ
0 -1.2318 TD
[(134:771781,)-333.7(2014.)]TJ
-1.0042 -1.2385 TD
[(Leckman)-354.5(JF,)-352.8(King)-350.9(RA,)-347.7(Gilbert)-359.1(DL,)-352.8(Coffey)-347.5(BJ,)-352.6(Singer)-352.8(HS,)-354.5(Dure)-351.9(LS)]TJ
1.0042 -1.2318 TD
[(4th,)-470.7(Grantz)-474.1(H,)-471.4(Katsovich)-473.4(L,)-475(Lin)-466.2(H,)-471.4(Lombroso)-473(PJ,)-473.3(Kawikova)-475(I,)]TJ
0 -1.2385 TD
[(Johnson)-412.1(DR,)-414.6(Kurlan)-414.4(RM,)-415(Kaplan)-414.2(EL:)-412.4(Streptococcal)-421.7(upper)-411.3(respi-)]TJ
T*
[(ratory)-585.2(tract)-581(infections)-584.1(and)-588.2(exacerbations)-584(of)-586.3(tic)-584.4(and)-581.5(obsessive-)]TJ
0 -1.2318 TD
[(compulsive)-533(symptoms:)-533.4(A)-527.2(prospective)-534(longitudinal)-530.6(study.)-536.4(J)-525.5(A)0(m)]TJ
0 -1.2385 TD
[(Acad)-331.6(Child)-336.1(Adolesc)-337.2(Psychiatry)-339.9(50:108118,)-331.5(2011.)]TJ
-1.0042 -1.2318 TD
[(Lee)-266.1(JH,)-260.4(Uhl)-268.4(JR,)-265.6(Cockerill)-267.5(FR)-261.5(3rd,)-264.8(Weaver)-266.6(AL,)-265.8(Orvidas)-270.4(LJ:)-259.8(Real-time)]TJ
1.0042 -1.2385 TD
[(PCR)-586.4(vs)-581.2(standard)-583.7(culture)-585.2(detection)-587.3(of)-586.3(group)-585.9(A)-580.8(beta-hemolytic)]TJ
0 -1.2318 TD
[(streptococci)-520.2(at)-517.2(various)-515.2(anatomic)-520.3(sites)-517.3(in)-511.1(tonsillectomy)-520.2(patients.)]TJ
0 -1.2385 TD
[(Arch)-331.8(Otolaryngol)-340.8(Head)-331.6(Neck)-338.3(Surg)-337.7(134:11771181,)-331.2(2008.)]TJ
-1.0042 -1.2318 TD
[(Les)13.3(li)13(e)-336.3(DL,)-326(Kozm)15.8(a)-336.3(L)0(,)-327.7(M)0(a)13.1(rtin)-325.6(A,)-324.1(Land)12.4(ero)14.7(s)-331.3(A)0(,)-330.8(Kat)13.3(sovi)19.1(ch)-331.7(L,)-327.7(Kin)12.8(g)-330.2(RA,)]TJ
1.0042 -1.2385 TD
[(Lec)15.1(kma)14.1(n)-497.5(JF:)-489.2(Neur)16.3(op)15.9(syc)13.1(hiat)16.1(ric)-485.5(dis)14.5(ord)14.1(ers)-488.6(ass)11.9(ocia)14.7(ted)-485.9(wit)14.7(h)-497.5(str)14.9(epto)20.8(-)]TJ
0 -1.2318 TD
[(coc)14.9(cal)-565.7(inf)16.1(ecti)16.6(on:)-560.1(A)-567.4(case)12.1(-co)14.7(ntr)16.1(ol)-564.7(stud)19.1(y)-571.2(amo)14.1(ng)-566.6(priv)13.9(ate)16.8(ly)-564.7(ins)14.5(ured)]TJ
0 -1.2385 TD
[(chi)16.2(ldr)16(en.)-229(J)-237.6(A)0(m)-235(Aca)11.9(d)-236.4(Chi)14.3(ld)-236.6(Ad)12.9(oles)12.9(c)-235.9(Psyc)16.1(hia)16.2(try)-231.6(47)15.9(:116)13.6(61)20.4(172)13.7(,)-238.7(200)13.8(8.)]TJ
-1.0042 -1.2318 TD
[(Lewin)-472.8(AB,)-481.6(Storch)-473.3(EA,)-473.3(Murphy)-477.5(TK:)-475.8(Pediatric)-481.4(autoimmune)-478.4(neuro-)]TJ
1.0042 -1.2385 TD
[(psychiatric)-565.6(disorders)-567.1(associated)-566.4(with)]TJ
/F7 1 Tf
16.2282 0 TD
(Streptococcus)Tj
/F6 1 Tf
6.186 0 TD
[(in)-564.7(identical)]TJ
-22.4141 -1.2318 TD
[(siblings.)-332.5(J)-338(Child)-329.4(Adolesc)-337.2(Psychopharmacol)-344.7(21:177182,)-331.5(2011.)]TJ
-1.0042 -1.2385 TD
[(Lin)-305.5(H,)-304(Williams)-312.8(KA,)-309.1(Katsovich)-306(L,)-307.6(Findley)-306.5(DB,)-307.5(Grantz)-306.8(H,)-310.7(Lombroso)]TJ
1.0042 -1.2318 TD
[(PJ,)-587.1(King)-591.9(RA,)-595.4(Bessen)-591(DE,)-593.8(Johnson)-592.9(D,)-585.2(Kaplan)-595(EL,)-590.7(Landeros-)]TJ
8.4682 0 0 8.4682 319.3511 359.6598 Tm
[(Weisenberger)-424.9(A,)-411.1(Zhang)-418.2(H,)-417.8(Leckman)-421.5(JF:)-422.2(Streptococcal)-421.7(upper)-418(re-)]TJ
T*
[(spiratory)-363.2(tract)-360(infections)-363.2(and)-360.6(psychosocial)-363.6(stress)-361.5(predict)-364.3(future)-357.6(tic)]TJ
0 -1.2385 TD
[(and)-394.1(obsessive-compulsive)-407(symptom)-402.7(severity)-394.3(in)-397.3(childre)-9.4(n)-397.1(and)-394.1(ado-)]TJ
0 -1.2318 TD
[(lescents)-395.3(with)-389.1(Tourette)-393(syndrome)-392.2(and)-394.1(obsessive-compulsive)-400.3(disor-)]TJ
0 -1.2385 TD
[(der.)-331.2(Biol)-334(Psychiatry)-339.9(67:684691,)-331.5(2010.)]TJ
-1.0042 -1.2318 TD
[(Logan)-297.7(LK,)-292.5(McAuley)-299.1(JB,)-299.1(Shulman)-295.2(ST:)-300.4(Macrolide)-297.6(treatment)-299.2(failure)-303.6(in)]TJ
1.0042 -1.2385 TD
[(streptococcal)-481.6(pharyngitis)-479.6(resulting)-475.4(in)-477.6(acute)-482.3(rheumatic)-481.9(fever.)-475(Pe-)]TJ
0 -1.2318 TD
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1.0042 -1.2318 TD
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1.0042 -1.2318 TD
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[(cohort.)-335.6(Dev)-336.8(Med)-330.4(Child)-336.1(Neurol)-334.1(53:951957,)-338.2(2011.)]TJ
-1.0042 -1.2318 TD
[(McCarty)-444.5(M:)-440.8(The)-440.7(antibody)-440.9(response)-446.2(to)-437.5(streptococcal)-448.2(infections.)-447.9(In:)]TJ
1.0042 -1.2385 TD
[(Streptococcal)-435.1(Infections.)-436.1(Edited)-436.5(by)-432.7(McCarty)-437.8(M.)-431.6(New)-433.4(York:)-433(Co-)]TJ
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[(lumbia)-336.5(University)-333.2(Press,)-339.3(1954,)-334.2(pp.)-330(130142.)]TJ
/F4 1 Tf
8.9663 0 0 8.9663 59.7543 749.7069 Tm
[(MANAGEMENT)-341.5(OF)-331.2(INFECTIONS)-341.8(IN)-328.8(PANS)]TJ
53.5677 0 TD
(11)Tj
ET
endstream
endobj
272 0 obj
<>stream
/GS1 gs
BT
/F6 1 Tf
8.4682 0 0 8.4682 62.022 725.7825 Tm
0 0 0 rg
0 Tc
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1.0042 -1.2318 TD
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[(Mycoplasma)-706.8(pneumoniae)]TJ
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-16.3888 -1.2385 TD
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[(laboratory)-336.7(diagnosis.)-336(Ital)-338.4(J)-331.3(Pediatr)-339(40:104,)-329.8(2014.)]TJ
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1.0042 -1.2318 TD
[(infection)-313(and)-313.7(obsessive-compulsive)-320(disorder,)-320.5(Tourettes)-311(syndrome,)]TJ
0 -1.2385 TD
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-1.0042 -1.2318 TD
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26.1498 .0402 TD
()Tj
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0 -1.2385 TD
[(Clin)-334(Immunol)-334.2(98:671677,)-338.2(1996.)]TJ
-1.0042 -1.2318 TD
(Mu)Tj
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()Tj
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[(M:)-266.7(Childhood)-264.2(Tourettes)-264.1(syndrome)-265(and)-266.9(infection)-266.1(with)]TJ
/F7 1 Tf
22.1196 0 TD
(Mycoplasma)Tj
-22.1196 -1.2318 TD
(pneumoniae)Tj
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4.9006 0 TD
[(.)-332.4(A)0(m)-335.4(J)-331.3(Psychiatry)-339.9(157:481482,)-333.7(2000.)]TJ
-5.9048 -1.2385 TD
(Mu)Tj
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()Tj
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(M:)Tj
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1.6201 0 TD
[(Mycoplasma)-452.4(pneumoniae)]TJ
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10.9125 0 TD
[(infection)-453.6(and)-454.3(Tourettes)-451.6(syndrome.)]TJ
-12.5326 -1.2385 TD
[(Psychiatry)-339.9(Res)-336.4(129:119125,)-333.7(2004.)]TJ
-1.0042 -1.2318 TD
[(Murphy)-370.4(ML,)-366.6(Pichichero)-371.6(M:)-373.8(Prospective)-368.2(identication)-372.5(and)-374(treatment)]TJ
1.0042 -1.2385 TD
[(of)-472.5(children)-466.8(with)-469.5(pediatric)-473.1(autoimmune)-471.7(neuropsychiatric)-474.8(disorder)]TJ
T*
[(associated)-365.5(with)-355.6(group)-358.3(A)-359.9(streptococcal)-361.1(infection)-359.9(\(PANDAS\).)-363.4(Arch)]TJ
0 -1.2318 TD
[(Pediatr)-339(Adolesc)-337.2(Med)-330.4(156:356361,)-340.4(2002.)]TJ
-1.0042 -1.2385 TD
[(Murphy)-403.9(TK,)-399.7(Sajid)-396(M,)-398.1(Soto)-403.1(O,)-397.7(Shapira)-401.2(N,)-397.7(Edge)-402.7(P,)-403.1(Yang)-399.1(M,)-398.1(Lewis)]TJ
1.0042 -1.2318 TD
[(MH,)-510.3(Goodman)-506.1(WK:)-504.3(Detecting)-509.9(pediatric)-513.3(autoimmune)-505.2(neuropsy-)]TJ
0 -1.2385 TD
[(chiatric)-457.6(disorders)-453.3(associated)-452.6(with)]TJ
/F7 1 Tf
14.4005 0 TD
(Streptococcus)Tj
/F6 1 Tf
6.0722 0 TD
[(in)-450.8(children)-453.4(with)]TJ
-20.4727 -1.2318 TD
[(obsessive-compulsive)-353.4(disorder)-349.6(and)-347.2(tics.)-344.4(Biol)-347.4(Psychiatry)-346.6(55:6168,)]TJ
0 -1.2385 TD
(2004.)Tj
-1.0042 -1.2318 TD
[(Murphy)-370.4(TK,)-372.9(Snider)-366.2(LA,)-372.9(Mutch)-366.2(PJ,)-372.9(Harden)-368.9(E,)-374.5(Zaytoun)-366.9(A,)-371(Edge)-369.2(PJ,)]TJ
1.0042 -1.2385 TD
[(Storch)-433.1(EA,)-426.4(Yang)-432.6(MC,)-428.4(Mann)-426.3(G,)-431.2(Goodman)-432.4(WK,)-428.2(Swedo)-429.6(SE:)-427.5(Re-)]TJ
0 -1.2318 TD
[(lationship)-355.5(of)-345.3(movements)-352.2(and)-353.9(behaviors)-351.5(to)-343.7(Group)-354.5(A)]TJ
/F7 1 Tf
21.6041 0 TD
(Streptococcus)Tj
/F6 1 Tf
-21.6041 -1.2385 TD
[(infections)-376.5(in)-377.2(elementary)-383(school)-372.9(children.)-377.5(Biol)-380.9(Psychiatry)-373.3(61:279)]TJ
0 -1.2318 TD
[(284,)-332.1(2007.)]TJ
-1.0042 -1.2385 TD
[(Murphy)-296.8(TK,)-299.2(Eric)-293.3(A,)-297.3(Storch)-292.6(EA,)-299.2(Lewin)-298.7(AB,)-294.1(Edge)-295.6(PJ,)-299.2(Goodman)-298.5(WK:)]TJ
1.0042 -1.2318 TD
[(Clinical)-350.9(factors)-346.9(associated)-352.1(with)-342.3(PANDAS.)-353.3(J)-344.7(Pediatr)-345.7(160:314319,)]TJ
0 -1.2385 TD
(2012.)Tj
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[(Murphy)-490.9(TK,)-486.7(Lewin)-486.1(AB,)-488.3(Parker-Athill)-490.6(EC,)-491.8(Storch)-486.7(EA,)-486.7(Mutch)-486.7(PJ:)]TJ
1.0042 -1.2385 TD
[(Tonsillectomies)-397.6(and)-394.1(adenoidectomies)-406.1(do)-392.5(not)-392.7(prevent)-393(the)-392.1(onset)-397.6(of)]TJ
0 -1.2318 TD
[(pediatric)-566.8(autoimmune)-565.5(neuropsychiatric)-568.5(disorder)-563.8(associated)-566.4(with)]TJ
0 -1.2385 TD
[(group)-331.5(A)]TJ
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3.7223 0 TD
(Streptococcus)Tj
/F6 1 Tf
5.6236 0 TD
[(.)-332.4(Pediatr)-339(Infect)-336.9(Dis)-329.9(J)-338(32:834838,)-331.5(2013.)]TJ
-10.3501 -1.2318 TD
[(Murphy)-350.3(TK,)-352.8(Gerardi)-355.4(DM,)-349.6(Leckman)-347.8(JF:)-355.3(Pediatric)-354.2(acute-onset)-352.7(neuro-)]TJ
1.0042 -1.2385 TD
[(psychiatric)-337.9(syndrome.)-336.4(Psychiatr)-337.8(Clin)-334(N)-333.1(A)0(m)-335.4(37:353374,)-338.2(2014.)]TJ
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[(Murphy)-490.9(TK,)-486.7(Parker-Athill)-490.6(EC,)-485.1(Lewin)-492.8(AB,)-488.3(Storch)-486.7(EA,)-486.7(Mutch)-486.7(PJ:)]TJ
1.0042 -1.2385 TD
[(Cefdinir)-495.1(for)-487.6(recent-onset)-495(pediatric)-493.2(neuropsychiatric)-494.8(disorders:)-493.7(A)]TJ
0 -1.2318 TD
[(pilot)-245.8(randomized)-251.6(trial.)-249.3(J)-244.3(Child)-242.4(Adolesc)-250.2(Psychopharmacol)-251(25:5764,)]TJ
0 -1.2385 TD
(2015.)Tj
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[(Murphy)-450.8(TK,)-446.5(Patel)-455.7(PD,)-448.3(McGuire)-452.8(JF,)-446.5(Kennel)-454.4(A,)-444.6(Mutch)-453.2(PJ,)-446.5(Parker-)]TJ
1.0042 -1.2385 TD
[(Athill)-610.4(EC,)-605.6(Hanks)-609.9(CE,)-605.6(Lewin)-613.3(AB,)-608.8(Storch)-607.2(EA,)-607.2(Toufexis)-610.9(MD,)]TJ
0 -1.2318 TD
[(Dadlani)-615.3(GH,)-617(Rodriguez)-612.8(CA:)-617.9(Characterization)-619.2(of)-613.1(the)-619.8(pediatric)]TJ
0 -1.2385 TD
[(acute-onset)-285.7(neuropsychiatr)-11.1(ic)-282.9(syndrome)-285.1(phenotype.)-281.5(J)-284.5(Child)-282.6(Adolesc)]TJ
0 -1.2318 TD
[(Psychopharmacol)-338(25:1425,)-334(2015.)]TJ
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[(Nseir)-440.3(W,)-443.2(Mograbi)-443.7(J,)-436.2(Abu-Rahmeh)-445.9(Z,)-434.8(Mahamid)-443.7(M,)-438.3(Abu-Elheja)-447(O,)]TJ
1.0042 -1.2318 TD
[(Shalata)-305.4(A:)-299.8(The)-300.2(association)-306(between)-302(vitamin)-303.2(D)-299.6(levels)-303.5(and)-300.3(recurrent)]TJ
0 -1.2385 TD
[(group)-298.1(A)-306.3(streptococcal)-300.9(tonsillopharyngitis)-309.2(in)-296.9(adults.)-301.7(Int)-298.6(J)-304.6(Infect)-303.5(Dis)]TJ
T*
[(16:e735e738,)-334.7(2012.)]TJ
-1.0042 -1.2318 TD
[(ODwyer)-283.4(K,)-277.2(Hackel)-286.5(M,)-277.6(Hightower)-281.2(S,)-282.6(Hoban)-280.7(D,)-277.2(Bouchillon)-283.9(S,)-275.9(Qin)-281.8(D,)]TJ
1.0042 -1.2385 TD
[(Aubart)-360.9(K,)-364.3(Zalacain)-365.4(M,)-357.9(Butler)-364.1(D:)-360(Comparative)-367(analysis)-362.4(of)-365.4(the)-358.7(an-)]TJ
0 -1.2318 TD
[(tibacterial)-727.3(activity)-724.4(of)-720.2(a)-717.9(novel)-724.4(peptide)-719.5(deformylase)-729.9(inhibitor,)]TJ
0 -1.2385 TD
[(GSK1322322.)-260.6(Antimicrob)-265.2(Agents)-255.3(Chemother)-264.8(57:23332342,)-255.4(2013.)]TJ
-1.0042 -1.2318 TD
[(O)-328.1(Mahony)-330.1(SM,)-334.8(Stilling)-330.2(RM,)-327.9(Dinan)-332.3(TG,)-326(Cryan)-332.3(JF:)-328.5(The)-326.9(microbiome)]TJ
1.0042 -1.2385 TD
[(and)-293.7(childh)-8.3(ood)-294.2(diseases:)-298.2(Focus)-293.9(on)-298.8(brain-gut)-295(axis.)-299.4(Birth)-295.6(Defects)-302.8(Res)]TJ
0 -1.2318 TD
[(C)-331.5(Embr)-8.1(yo)-332.3(Today)-331.2(105:296313,)-333.7(2015.)]TJ
-1.0042 -1.2385 TD
[(Obregon)-304.7(D,)-304(Parker-Athill)-309.9(EC,)-304.4(Tan)-300.2(J,)-302.3(Murphy)-303.5(T:)-303.4(Psychotropic)-310.6(effects)]TJ
1.0042 -1.2318 TD
[(of)-432.3(antimicrobials)-441(and)-434.2(immune)-439(modulation)-436.7(by)-432.7(psychotropics:)-439.7(Im-)]TJ
0 -1.2385 TD
[(plications)-448.6(for)-440.8(neuroimmune)-441.9(disorders.)-444.3(Neuropsychiatry)-451.3(\(London\))]TJ
0 -1.2318 TD
[(2:331343,)-336.1(2012.)]TJ
28.6403 77.8202 TD
[(Pavone)-187.2(P,)-175.4(Rapisarda)-185(V,)-176.8(Serra)-184.3(A,)-183.5(Nicita)-176.1(F,)-182.1(Spalice)-184.9(A,)-176.8(Parano)-180.1(E,)-180.4(Rizzo)-182.9(R,)]TJ
1.0042 -1.2318 TD
[(Maiolino)-268.2(L,)-260.7(Di)-259.6(Mauro)-260.6(P,)-262.5(Vitaliti)-262.1(G,)-263.8(Coco)-263.7(A,)-257.1(Falsaperla)-265.1(A,)-263.8(Triletti)]TJ
0 -1.2385 TD
[(RR,)-466.6(Cocuzza)-475.9(S:)-465.8(Pediatric)-468(autoimmune)-465.1(neuropsychiatric)-474.8(disorder)]TJ
0 -1.2318 TD
[(associated)-258.4(with)-248.5(group)-251.2(a)-256(streptococcal)-254(infection:)-252.9(The)-253.3(role)-253.3(of)-244.9(surgical)]TJ
0 -1.2385 TD
[(treatment.)-256.8(Int)-251.7(J)-251(Immunopathol)-255.2(Pharmacol)-251.1(27:371378,)-251.2(2014.)]TJ
-1.0042 -1.2318 TD
[(Peelen)-532.8(E,)-528.5(Knippenberg)-531.5(S,)-530.3(Muris)-528.2(AH,)-530(Thewissen)-536.6(M,)-525.3(Smolders)-532.5(J,)]TJ
1.0042 -1.2385 TD
[(Tervae)-10.4(rt)-350.1(JW,)-352.8(Hupperts)-352.9(R,)-349.3(Damoiseaux)-356.5(J:)-351.6(Effects)-353.4(of)-352(vitamin)-356.7(D)-353.2(o)0(n)]TJ
0 -1.2318 TD
[(the)-258.3(peripheral)-255.9(adaptive)-252.4(immune)-251.6(system:)-253.9(A)-252.7(review.)-257.6(Autoimmun)-252.8(Rev)]TJ
0 -1.2385 TD
[(10:733743,)-338.2(2011.)]TJ
-1.0042 -1.2318 TD
[(Perrin)-499.7(EM,)-500.5(Murphy)-497.6(ML,)-500.5(Casey)-500.7(JR,)-493.2(Pichichero)-505.5(ME,)-493.8(Runyan)-502.2(DK,)]TJ
1.0042 -1.2385 TD
[(Miller)-377.5(WC,)-373.1(Snider)-379.6(LA,)-372.9(Swedo)-376(SE:)-367.3(Does)-380.2(group)-371.7(A)-373.2(beta-hemolytic)]TJ
0 -1.2318 TD
[(strept)-9.1(ococcal)-385.5(infection)-393.3(increase)-388.5(risk)-388.9(for)-387.2(behavioral)-390.1(and)-387.4(neuropsy-)]TJ
0 -1.2385 TD
[(chiatric)-484.4(symptoms)-486.3(in)-477.6(children?)-481.7(Arch)-479.1(Pediatr)-486.3(Adolesc)-477.8(Med)-484.4(158:)]TJ
0 -1.2318 TD
[(848856,)-340.5(2004.)]TJ
-1.0042 -1.2385 TD
[(Riedel)-256.8(M,)-250.8(Straube)-247.2(A,)-250.5(Schwarz)-258.2(MJ,)-247.4(Wilske)-252(B,)-248.9(Mu)]TJ
19.4885 .0134 TD
()Tj
.4151 -.0134 TD
[(ller)-251.4(N:)-252.9(Lyme)-248.9(disease)]TJ
-18.8994 -1.2318 TD
[(presenting)-338.3(as)-339.6(Tourettes)-337.7(syndrome.)-336.4(Lancet)-336.9(351:418419,)-333.7(1998.)]TJ
-1.0042 -1.2385 TD
[(Rolf)-248.5(L,)-240.6(Muris)-240.4(AH,)-248.8(Hupperts)-239.1(R,)-242.2(Damoiseaux)-249.4(J:)-244.5(Vitamin)-239.2(D)-246.1(effects)-245.9(on)-238.5(B)]TJ
1.0042 -1.2318 TD
[(cell)-197.6(function)-192.9(in)-196.4(autoimmunity.)-195.9(Ann)-190(N)-199.2(Y)-192.5(Acad)-191(Sci)-192.9(1317:8491,)-197.7(2014.)]TJ
-1.0042 -1.2385 TD
[(Ross)-367(CA,)-361.1(Taylor)-364.4(CL,)-364.6(Yaktine)-360.9(AL,)-366.2(Del)-361.6(Valle)-363.3(HB)-363.3(\(eds\).)-363(Dietary)-367.2(Re-)]TJ
1.0042 -1.2385 TD
[(ferenc)-10.3(e)-349.7(Intakes)-354(for)-353.7(Calcium)-359.5(and)-353.9(Vitamin)-353(D.)-357.6(Institute)-353(of)-358.7(Medicine)]TJ
8.4682 0 0 8.4682 321.5621 516.5857 Tm
[(\(US\))-206.3(Committee)-208(to)-203.1(Review)-208.1(Dietary)-206.5(Reference)-204.3(Intakes)-206.7(for)-206.4(Vitamin)-205.7(D)]TJ
T*
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[(MS)-631.7(activity)-624(by)-626.8(disease-modifying)-632.8(therapy)-627.3(class.)-623.5(Neurol)-628.7(Neu-)]TJ
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[(roimmuno)-8.3(l)-328.2(Neuroinamm)-339.3(2:e167,)-335.9(2015.)]TJ
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1.0042 -1.2318 TD
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1.0042 -1.2318 TD
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3.6955 0 TD
[(Streptococcus)-351.8(pyogenes)]TJ
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[(Asthma)-442.9(and)-434.2(Immunology.)-438.7(The)-434.1(diagnosis)-438.7(and)-434.2(management)-439.1(of)-439(si-)]TJ
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13.1553 .0201 TD
()Tj
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8.402 .0201 TD
()Tj
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[(biol)-339.3(Infect)-336.9(Dis)-329.9(34:21312136,)-335.8(2015.)]TJ
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8.9663 0 0 8.9663 62.022 749.6502 Tm
(12)Tj
43.274 0 TD
[(COOPERSTOCK)-335.9(ET)-338.7(AL.)]TJ
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[(Smith)-490.5(T:)]TJ
/F7 1 Tf
4.2713 0 TD
[(Mycoplasma)-485.9(pneumoniae)]TJ
/F6 1 Tf
10.9861 0 TD
[(infections:)-490.5(Diagnosis)-488.5(based)-486(on)]TJ
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[(Proc)-337.1(61:830831,)-338.2(1986.)]TJ
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1.0042 -1.2385 TD
[(prophylaxis)-528.4(with)-529.7(azithromycin)-533.2(or)-526(penicillin)-525.9(for)-527.8(childhood-onset)]TJ
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[(neuropsychiatr)-11.1(ic)-329.8(disorders.)-337.2(Biol)-334(Psychiatry)-339.9(57:788792,)-331.5(2005.)]TJ
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[(pub)-334.4(ahead)-336.9(of)-331.9(print])-8.1(;)-328.2(DOI:)-340(10.1089/cap.2016.0145.)]TJ
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[(Winchell)-353(JM:)-357(Comparison)-349(of)-352(laboratory)-350.1(diagnostic)-356.8(procedures)-354.6(for)]TJ
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5.5901 0 TD
[(Mycoplasma)-539.4(pneumoniae)]TJ
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11.0799 0 TD
[(in)-531.2(community)-537.1(outbreaks.)]TJ
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[(Clin)-334(Neuros)-9.2(ci)-329.8(26:164168,)-338.2(2014.)]TJ
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28.647 48.1757 TD
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[(or-Sierra)-585.1(A,)-578.5(Katahira)-583(E,)-582.1(Jaramillo-Valdivia)-583.4(AN,)-583.5(Barajas-)]TJ
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()Tj
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[(a)-262.6(Mde)-263.5(L,)-260.7(Bryant)-265.6(A,)-257.1(Morf)]TJ
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[(n-Otero)-262.2(R,)-262.3(Ma)]TJ
5.5031 .0402 TD
()Tj
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3.2604 .0402 TD
()Tj
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[(az)-264.2(F,)-255.8(Tinoco)]TJ
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[(JC,)-372.7(Sa)]TJ
2.2896 .0402 TD
()Tj
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[(nchez-Corona)-378.6(J,)-375.9(Stevens)-376(DL:)-368.7(Phenotypes)-375.6(and)-374(genotypes)-378.7(of)]TJ
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(erythromycin-resistant)Tj
/F7 1 Tf
9.848 0 TD
[(Streptococcus)-766.9(pyogenes)]TJ
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10.879 0 TD
[(strains)-762.2(isolated)]TJ
-20.7271 -1.2385 TD
[(from)-456.4(invasive)-461.7(and)-461(non-invasive)-463(infections)-463.6(from)-456.4(Mexico)-461.5(and)-461(the)]TJ
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[(Weinberg)-369.9(ST;)-367.3(American)-370.9(Academy)-371(of)-372.1(Pediatrics:)-371(Clinical)-371(practice)]TJ
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[(guideline)-366.9(for)-367.1(the)-372.1(diagnosis)-365.1(and)-367.3(management)-372.1(of)-372.1(acute)-368.5(bacterial)-372.1(si-)]TJ
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[(nusitis)-399.7(in)-404(children)-406.5(aged)-402.3(1)-403.8(t)0(o)-397.3(1)0(8)-405.9(years.)-403(Pediatrics)-404.3(132:e262e280,)]TJ
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[(Wannamaker)-482.2(LW,)-485.3(Ayoub)-482.1(EM:)-482.8(Antibody)-484.6(titers)-482.5(in)-477.6(acute)-489(rheumatic)]TJ
1.0042 -1.2318 TD
[(fever.)-334.5(Circulation)-336.7(21:598614,)-338.2(1960.)]TJ
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1.0042 -1.2318 TD
[(Vitamin)-366.4(D)-366.6(supplementation)-371.8(for)-367.1(the)-365.4(prevention)-370.6(of)-365.4(childhood)-369.4(acute)]TJ
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1.0042 -1.2385 TD
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13.7042 0 TD
(Streptococcus)Tj
/F6 1 Tf
5.6236 0 TD
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