Focus on Cardiologic Findings in 30 Children With PANS/PANDAS: An Italian Single-Center Observational Study

Manuel Murciano,Davide Maria Biancone,Isabella Tristano,Anna Maria Zicari,Vanessa Martucci,Marzia Duse,Alberto Spalice,Lorenzo Loffredo,Giulia Capata,Silvia Anaclerio,Cristiana Alessia Guido

doi:10.3389/fped.2019.00395

Abstract

Objective: Cardiac involvement in PANS has not been clarified relying on the scientific literature available until today. It is known that streptococcal infections play a role in the etiology of a great number of diseases including Sydenham chorea and rheumatic fever, among others. Based on the suspected pathogenesis of PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) reported in the medical literature, we decided to investigate the cardiologic involvement in children with a recent PANS/PANDAS diagnosis.Methods: The study population satisfies PANS (1) and PANDAS (2) criteria of diagnoses. Cardiologic assessment was performed through clinical examination, electrocardiography, and echocardiography.Results: In the selected pediatric population, a significant number of children presented mitral valve involvement, systolic murmurs and electrocardiographic abnormalities. High ASLOT levels did not seem to be associated to a cardiac involvement.Conclusions: Often PANS is difficult to diagnose because it is little known by physicians and most of the cardiologic findings described in this study are common among the healthy pediatric population. Also, ASLOT levels seems not to be predictive of cardiac involvement. Furthermore, the existence of PANDAS as a clinical entity is associated with a group of anti-neuronal autoantibodies found in Sydenham chorea is still controversial. We recommend a complete cardiologic evaluation in those children who meet the PANS/PANDAS diagnostic criteria.

Highlights

Pediatric acute-onset neuropsychiatric syndrome (PANS) or idiopathic childhood acute neuropsychiatric symptoms are emerging in the last few years as a new clinical entity
Some of these clinical pictures could be grouped into what represents a sub-group of pediatric acute-onset neuropsychiatric syndrome (PANS), better known as PANDAS, which represents, at least in part, an attempt to provide a hypothesis about the origin of this symptoms complex
The concept of PANS is relatively recent and it is derived from subsequent researches on PANDAS, which now is considered like a specific subset within the broader clinical spectrum of PANS [6, 7]

Summary

Introduction

Pediatric acute-onset neuropsychiatric syndrome (PANS) or idiopathic childhood acute neuropsychiatric symptoms are emerging in the last few years as a new clinical entity. Some of these clinical pictures could be grouped into what represents a sub-group of PANS, better known as PANDAS, which represents, at least in part, an attempt to provide a hypothesis about the origin of this symptoms complex. The potential mechanisms for these diseases are known [8] and the first studies about the correlation between streptococcal infections and many clinical features [like streptococcal M protein and rheumatic fever [9] or Streptococcal antibody titers in Sydenham’s chorea [10]] took place in the sixties and seventies [11, 12]. Crossreactive antibodies produced against the group A streptococcus and heart and brain and molecular mimicry are the causes of these, with many studies to support this hypothesis [4, 16, 17, 19, 21,22,23]

Results

Discussion

Conclusion