SARS-CoV-2 related paediatric acute-onset neuropsychiatric syndrome

Pavone, Piero; Ceccarelli, Manuela; Marıno, Silvia; Caruso, Daniela; Falsaperla, Raffaele; Berretta, Massimiliano; Rullo, Emmanuele Venanzi; Nunnari, Giuseppe

doi:10.1016/s2352-4642(21)00135-8

Cited by 34 publications

(44 citation statements)

References 21 publications

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“…From a clinical point of view, the involvement of the CNS is manifested through the appearance of more or less serious symptoms, from headache, disturbances of smell, and anosmia, to impaired consciousness, acute cerebrovascular disease, ataxia, and seizure [ 2 , 10 , 11 ]. Pavone and coworkers [ 13 ] reported two cases of pediatric patients showing a temporal correlation between the insurgence of COVID-19 infection and the onset of pediatric acute neuropsychiatric syndrome, an obsessive-compulsive disorder associated with other cognitive, behavioral, and/or neurological symptoms [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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The case of encephalitis in a COVID-19 pediatric patient

Urso¹,

Distefano²,

Cambula³

et al. 2021

Neurol Sci

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Background The COVID-19 pandemic, induced by the worldwide spreading of the SARS-CoV-2, is well known for its clinical picture consistent with respiratory symptoms. If pulmonary complications are the most common manifestation of the disease, neurological problems are also significantly present, with complications including acute cerebrovascular events, encephalitis, Guillain-Barré and Miller Fisher syndromes, acute necrotizing hemorrhagic encephalopathy and hemophagocytic lymphohistiocytosis. These medical signs can be considered direct effects of the virus on the nervous system, para-infectious or post-infectious immune-mediated diseases, and neurological complications of the systemic effects of the SARS-CoV-2. Case In the present article, the encephalitis case in a 5-year-old girl positive for COVID-19 admitted to the emergency department complaining of fever and swelling in the neck is described. At this time, her neurological examination was unremarkable. Over the next few days, the fever went down and she experienced acute behavioral changes, mild confusion, and drowsiness. The brain MRI and electroencephalography (EEG) showed CNS involvement, suggestive of encephalitis. Conclusion The dramatic improvement of the symptoms after immunotherapy with corticosteroids reinforced the hypothesis of an immune-related mechanism.

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Section: Introductionmentioning

confidence: 99%

“…How SARS-CoV-2 can cause neurological effects in pediatric patients is still unclear [ 13 ]. The direct viral injury to neural cells through the olfactory nerves, the endothelial vascular damage due to the interaction with angiotensin-converting enzyme 2 receptors, and the inflammatory response are the hypothesized mechanisms [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

The case of encephalitis in a COVID-19 pediatric patient

Urso¹,

Distefano²,

Cambula³

et al. 2021

Neurol Sci

View full text Add to dashboard Cite

show abstract

“…If PANS is suspected, it is recommended to consider other possible infectious agents such us Mycoplasma pneumoniae , EBV, and Borrelia burgdorferi . Two unrelated cases of PANS onset in patients with a COVID-19 infection have lately been reported ( 86 ). Furthermore, a recent study explored the effects of the COVID-19 pandemic during the lockdown on children affected by PANS and showed an increase in symptoms during the block in 71% of the sample ( 87 ).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Approach to Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS): A Narrative Review of Literature Data

et al. 2021

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Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are clinical conditions characterized by the sudden onset of obsessive–compulsive disorder and/or tics, often accompanied by other behavioral symptoms in a group of children with streptococcal infection. PANDAS-related disorders, including pediatric acute-onset neuropsychiatric syndrome (PANS), childhood acute neuropsychiatric symptoms (CANS), and pediatric infection triggered autoimmune neuropsychiatric disorders (PITANDs), have also been described. Since first defined in 1998, PANDAS has been considered a controversial diagnosis. A comprehensive review of the literature was performed on PubMed and Scopus databases, searching for diagnostic criteria and diagnostic procedures of PANDAS and related disorders. We propose a test panel to support clinicians in the workout of PANDAS/PANS patients establishing an appropriate treatment. However, further studies are needed to improve our knowledge on these acute-onset neuropsychiatric conditions.

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“…When HSV infection is suspected, cultures of skin lesion samples, if present, and PCR on blood samples should be performed [62]. Pediatric acute-onset neuropsychiatric syndrome (PANS), i.e., a newly defined symptombased condition that mainly occurs in children and adolescents, have described after viral infections, including SARS-CoV-2 [65,66]. It is an emerging immune-mediated encephalopathy characterized by sudden onset of seemingly inexplicable complex neuropsychiatric symptoms, including obsessions, compulsions, and heterogeneous tics [65].…”

Section: Diagnosismentioning

confidence: 99%

Update on Viral Infections Involving the Central Nervous System in Pediatric Patients

et al. 2021

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Infections of the central nervous system (CNS) are mainly caused by viruses, and these infections can be life-threatening in pediatric patients. Although the prognosis of CNS infections is often favorable, mortality and long-term sequelae can occur. The aims of this narrative review were to describe the specific microbiological and clinical features of the most frequent pathogens and to provide an update on the diagnostic approaches and treatment strategies for viral CNS infections in children. A literature analysis showed that the most common pathogens worldwide are enteroviruses, arboviruses, parechoviruses, and herpesviruses, with variable prevalence rates in different countries. Lumbar puncture (LP) should be performed as soon as possible when CNS infection is suspected, and cerebrospinal fluid (CSF) samples should always be sent for polymerase chain reaction (PCR) analysis. Due to the lack of specific therapies, the management of viral CNS infections is mainly based on supportive care, and empiric treatment against herpes simplex virus (HSV) infection should be started as soon as possible. Some researchers have questioned the role of acyclovir as an empiric antiviral in older children due to the low incidence of HSV infection in this population and observed that HSV encephalitis may be clinically recognizable beyond neonatal age. However, the real benefit-risk ratio of selective approaches is unclear, and further studies are needed to define appropriate indications for empiric acyclovir. Research is needed to find specific therapies for emerging pathogens. Moreover, the appropriate timing of monitoring neurological development, performing neuroimaging evaluations and investigating the effectiveness of rehabilitation during follow-up should be evaluated with long-term studies.

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SARS-CoV-2 related paediatric acute-onset neuropsychiatric syndrome

Cited by 34 publications

References 21 publications

The case of encephalitis in a COVID-19 pediatric patient

The case of encephalitis in a COVID-19 pediatric patient

Diagnostic Approach to Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS): A Narrative Review of Literature Data

Update on Viral Infections Involving the Central Nervous System in Pediatric Patients

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