{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T11:46:37Z","timestamp":1793533597912,"version":"4.5.0"},"reference-count":127,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,10,24]],"date-time":"2024-10-24T00:00:00Z","timestamp":1729728000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) are broad diagnoses that encompass a range of sudden-onset neuropsychiatric symptoms in children, which can include obsessive-compulsive disorder (OCD), tics, anxiety, emotional instability, and cognitive difficulties. Unlike PANDAS, PANS is not strictly linked to group A streptococcal infections but can be triggered by various infectious or environmental factors. Lights and shadows remain upon the management of children with PANS and PANDAS and there is no clear consensus regarding definition, diagnostic criteria, treatment, and follow-up. The aim of the present study was to evaluate the level of agreement on PANS and PANDAS definition, diagnostic criteria, treatment and follow-up and to assess on the basis of recent studies whether there is a need to modify the current recommendations used by primary care pediatricians and hospital pediatricians in clinical practice in order to improve outcomes. Using the Delphi method, this consensus provides shared indications on PANS and PANDAS management in pediatric age, based on the most updated literature. This work represents, in our opinion, the most complete and up-to-date information on the diagnosis of PANS and PANDAS, as well as consensus statements about several aspects of clinical care. Undoubtedly, more randomized and controlled trials are needed in the pediatric population to better define the best management, also in terms of adequate follow-up examinations and period of observation.<\/jats:p>","DOI":"10.3389\/fimmu.2024.1420663","type":"journal-article","created":{"date-parts":[[2024,10,24]],"date-time":"2024-10-24T04:51:58Z","timestamp":1729745518000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":13,"title":["Pediatric acute-onset neuropsychiatric syndrome and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections: a delphi study and consensus document about definition, diagnostic criteria, treatment and follow-up"],"prefix":"10.3389","volume":"15","author":[{"given":"Roberto","family":"Grandinetti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Mussi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Pilloni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greta","family":"Ramundo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Miniaci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuela","family":"Turco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedetta","family":"Piccolo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Elena","family":"Capra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Forestiero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Laudisio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Boscarino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Pedretti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Menoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuditta","family":"Pellino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Tagliani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Bergomi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Antodaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Cristina","family":"Cant\u00f9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Teresa","family":"Bersini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Mari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franco","family":"Mazzini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Biasucci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnese","family":"Suppiej","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanna","family":"Esposito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,10,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1038\/s41579-023-00865-7","article-title":"Pathogenesis, epidemiology and control of group A streptococcus infection","volume":"21","author":"Brouwer","year":"2023","journal-title":"Nat Rev Microbiol"},{"key":"B2","doi-asserted-by":"crossref","DOI":"10.1176\/ajp.155.2.264","article-title":"Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections: Clinical description of the first 50 cases","volume":"155","author":"Swedo","year":"1998","journal-title":"Am J Psychiatry"},{"key":"B3","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1089\/cap.2014.0073","article-title":"Clinical presentation of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections in research and community settings","volume":"25","author":"Swedo","year":"2015","journal-title":"J Child Adolesc Psychopharmacol"},{"key":"B4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4172\/2161-0665.1000113","article-title":": From research subgroup to clinical syndrome: Modifying the PANDAS criteria to describe PANS (pediatric acute-onset neuropsychiatric syndrome)","volume":"2","author":"Swedo","year":"2012","journal-title":"Pediatr Therapeut"},{"key":"B5","doi-asserted-by":"crossref","DOI":"10.1001\/archpsyc.1989.01810040041007","article-title":"Obsessive-compulsive disorder in children and adolescents: clinical phenomenology of 70 consecutive cases","volume":"46","author":"Swedo","year":"1989","journal-title":"Arch Gen Psych"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1097\/00004583-199503000-00015","article-title":"Case study: A new infection-triggered, autoimmune subtype of pediatric OCD and Tourette\u2019s syndrome","volume":"34","author":"Allen","year":"1995","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"B7","doi-asserted-by":"publisher","first-page":"100602","DOI":"10.1016\/j.bbih.2023.100602","article-title":"Case report: varicella associated neuropsychiatric syndrome (VANS) in two pediatric cases","volume":"28","author":"Dahiya","year":"2023","journal-title":"Brain Behav Immun Health"},{"key":"B8","doi-asserted-by":"publisher","first-page":"100074","DOI":"10.1016\/j.psycr.2022.100074","article-title":"SARS-coV-2\/COVID-19 associated pediatric acute-onset neuropsychiatric syndrome a case report of female twin adolescents","volume":"1","author":"Efe","year":"2022","journal-title":"Psychiatr Res Case Rep"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2017.0042","article-title":"Overview of treatment of pediatric acute-onset neuropsychiatric syndrome","volume":"27","author":"Swedo","year":"2017","journal-title":"J Child Adolesc Psychopharmacol"},{"key":"B10","article-title":"Post-streptococcal autoimmune sequelae: rheumatic fever and beyond","volume-title":"Basic biology to clinical manifestations","author":"Cunningham","year":"2016"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e204063","DOI":"10.1001\/jamanetworkopen.2020.4063","article-title":"Association of pediatric acute-onset neuropsychiatric syndrome with microstructural differences in brain regions detected via diffusion-weighted magnetic resonance imaging","volume":"3","author":"Zheng","year":"2020","journal-title":"JAMA Netw Open"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2023.1216282","article-title":"Immunological characterization of an italian PANDAS cohort","volume":"11","author":"Leonardi","year":"2024","journal-title":"Front Pediatr"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2549","DOI":"10.3390\/microorganisms11102549","article-title":"Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): myth or reality? The state of the art on a controversial disease","volume":"11","author":"La Bella","year":"2023","journal-title":"Microorganisms"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s00256-011-1145-z","article-title":"The delphi method: an efficient procedure to generate knowledge","volume":"40","author":"Steurer","year":"2011","journal-title":"Skeletal Radiol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.5662\/wjm.v11.i4.116","article-title":"Delphi methodology in healthcare research: how to decide its appropriateness","volume":"11","author":"Nasa","year":"2021","journal-title":"World J Methodol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1007\/s10578-021-01135-4","article-title":"A two-to-five year follow-up of a pediatric acute-onset neuropsychiatric syndrome cohort","volume":"53","author":"Gromark","year":"2022","journal-title":"Child Psychiatry Hum Dev"},{"key":"B17","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1089\/cap.2014.0081","article-title":"Multidisciplinary clinic dedicated to treating youth with pediatric acute-onset neuropsychiatric syndrome: presenting characteristics of the first 47 consecutive patients","volume":"25","author":"Frankovich","year":"2015","journal-title":"J Child Adolesc Psychopharmacol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2021.746639","article-title":"Diagnostic approach to pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): A narrative review of literature data","volume":"9","author":"Prato","year":"2021","journal-title":"Front Pediatr"},{"key":"B19","doi-asserted-by":"publisher","first-page":"155","DOI":"10.3390\/children9020155","article-title":"Obsessive-compulsive disorder in PANS\/PANDAS in children: in search of a qualified treatment-A systematic review and metanalysis","volume":"9","author":"Cocuzza","year":"2022","journal-title":"Children (Basel)"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2016.0105","article-title":"A survey of pediatric acute-onset neuropsychiatric syndrome characteristics and course","volume":"27","author":"Calaprice","year":"2017","journal-title":"J Child Adolesc Psychopharmacol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-014-2185-9","article-title":"Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: an overview","volume":"33","author":"Esposito","year":"2014","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/s2666-5247(21)00332-3","article-title":"Frequency of transmission, asymptomatic shedding, and airborne spread of Streptococcus pyogenes in schoolchildren exposed to scarlet fever: a prospective, longitudinal, multicohort, molecular epidemiological, contact-tracing study in England, UK","volume":"3","author":"Cordery","year":"2022","journal-title":"Lancet Microbe"},{"key":"B23","doi-asserted-by":"publisher","first-page":"ofac554","DOI":"10.1093\/ofid\/ofac554","article-title":"Younger children develop higher effector antibody responses to SARS-coV-2 infection","volume":"9","author":"Tomasi","year":"2022","journal-title":"Open Forum Infect Dis"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1080\/08916934.2016.1217999","article-title":"Repeat exposure to group A streptococcal M protein exacerbates cardiac damage in a rat model of rheumatic heart disease","volume":"49","author":"Gorton","year":"2016","journal-title":"Autoimmunity"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/s0006-3223(00)01127-6","article-title":"The question of PANDAS in adults","volume":"49","author":"Bodner","year":"2001","journal-title":"Biol Psychiatry"},{"key":"B26","doi-asserted-by":"publisher","first-page":"11106","DOI":"10.1038\/s41598-022-15279-3","article-title":"Identification of ultra-rare genetic variants in pediatric acute onset neuropsychiatric syndrome (PANS) by exome and whole genome sequencing","volume":"12","author":"Trifiletti","year":"2022","journal-title":"Sci Rep"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1097\/00004583-200009000-00011","article-title":"Psychiatric disorders in first-degree relatives of children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS)","volume":"39","author":"Lougee","year":"2000","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"B28","doi-asserted-by":"crossref","DOI":"10.1001\/jamapsychiatry.2017.0995","article-title":"Association of streptococcal throat infection with mental disorders: testing key aspects of the PANDAS hypothesis in a nationwide study","volume":"74","author":"Orlovska","year":"2017","journal-title":"JAMA Psychiatry"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1038\/nm892","article-title":"Mimicry and autoantibody-mediated neuronal cell signaling in Sydenham chorea","volume":"9","author":"Kirvan","year":"2003","journal-title":"Nat Med"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1016\/j.jneuroim.2006.06.017","article-title":"Antibody-mediated neuronal cell signaling in behavior and movement disorders","volume":"179","author":"Kirvan","year":"2006","journal-title":"J Neuroimmunol"},{"key":"B31","doi-asserted-by":"crossref","DOI":"10.1177\/0883073814543303","article-title":"Evaluation of basal ganglia and thalamic inflammation in children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection and tourette syndrome: A positron emission tomographic (PET) study using 11C-[R]-PK11195","volume":"30","author":"Kumar","year":"2015","journal-title":"J Child Neurol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1176\/appi.ajp.2020.19070698","article-title":"Antibodies from children with PANDAS bind specifically to striatal cholinergic interneurons and alter their activity","volume":"178","author":"Xu","year":"2021","journal-title":"Am J Psychiatry"},{"key":"B33","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1177\/0883073820951364","article-title":"Sydenham chorea: putaminal enlargement","volume":"36","author":"Karalok","year":"2021","journal-title":"J Child Neurol"},{"key":"B34","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1089\/cap.2014.0048","article-title":"Antineuronal antibodies in a heterogeneous group of youth and young adults with tics and obsessive-compulsive disorder","volume":"25","author":"Cox","year":"2015","journal-title":"J Child Adolesc Psychopharmacol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.1102592","article-title":"Brain human monoclonal autoantibody from sydenham chorea targets dopaminergic neurons in transgenic mice and signals dopamine D2 receptor: implications in human disease","volume":"191","author":"Cox","year":"2013","journal-title":"J Immunol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"e73516","DOI":"10.1371\/journal.pone.0073516","article-title":"Dopamine receptor autoantibodies correlate with symptoms in Sydenham's chorea","volume":"8","author":"Ben-Pazi","year":"2013","journal-title":"PloS One"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1172\/jci.insight.164762","article-title":"Dopamine receptor autoantibody signaling in infectious sequelae differentiates movement vs neuropsychiatric disorders","volume":"26","author":"Menendez","year":"2024","journal-title":"JCI Insight"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1097\/qco.0b013e3283511d27","article-title":"Streptococcal skin infection and rheumatic heart disease","volume":"25","author":"Parks","year":"2012","journal-title":"Curr Opin Infect Dis"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1038\/nature16549","article-title":"Schizophrenia risk from complex variation of complement component","volume":"530","author":"Sekar","year":"2016","journal-title":"Nature"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1159\/000531707","article-title":"Evaluation of C4 gene copy number in pediatric acute neuropsychiatric syndrome","volume":"45","author":"Kalinowski","year":"2023","journal-title":"Dev Neurosci"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1159\/000534261","article-title":"Postinfectious inflammation, autoimmunity, and obsessive-compulsive disorder: sydenham chorea, pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection, and pediatric acute-onset neuropsychiatric disorder","volume":"45","author":"Vreeland","year":"2023","journal-title":"Dev Neurosci"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2018.00675","article-title":"Gut microbiota profiling and gut-brain crosstalk in children affected by pediatric acute-onset neuropsychiatric syndrome and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections","volume":"9","author":"Quagliariello","year":"2018","journal-title":"Front Microbiol"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1016\/s0006-3223(99)00020-7","article-title":"A pilot study of penicillin prophylaxis for neuropsychiatric exacerbations triggered by streptococcal infections","volume":"45","author":"Garvey","year":"1999","journal-title":"Biol Psychiatry"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1097\/01.chi.0000179056.54419.5e","article-title":"PANDAS with catatonia: a case report. Therapeutic response to lorazepam and plasmapheresis","volume":"44","author":"Elia","year":"2005","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1177\/08830738050200050601","article-title":"Treatment of Sydenham's chorea with intravenous immunoglobulin, plasma exchange, or prednisone","volume":"20","author":"Garvey","year":"2005","journal-title":"J Child Neurol"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2014.0056","article-title":"Five youth with pediatric acute-onset neuropsychiatric syndrome of differing etiologies","volume":"25","author":"Frankovich","year":"2015","journal-title":"J Child Adolesc Psychopharmacol"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2014.0067","article-title":"Use of intravenous immunoglobulin in the treatment of twelve youths with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections","volume":"25","author":"Kovacevic","year":"2015","journal-title":"J Child Adolesc Psychopharmacol"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2014.0080","article-title":"Therapeutic plasma apheresis as a treatment for 35 severely ill children and adolescents with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections","volume":"25","author":"Latimer","year":"2015","journal-title":"J Child Adolesc Psychopharmacol"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(98)12297-3","article-title":"Therapeutic plasma exchange and intravenous immunoglobulin for obsessive-compulsive disorder and tic disorders in childhood","volume":"354","author":"Perlmutter","year":"1999","journal-title":"Lancet"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2008.08.032","article-title":"Serum autoantibodies measured by immunofluorescence confirm a failure to differentiate PANDAS and Tourette syndrome from controls","volume":"276","author":"Morris","year":"2009","journal-title":"J Neurol Sci"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2018.0127","article-title":"Establishing a pediatric acute-onset neuropsychiatric syndrome clinic: baseline clinical features of the pediatric acute-onset neuropsychiatric syndrome cohort at karolinska institutet","volume":"29","author":"Gromark","year":"2019","journal-title":"J Child Adolesc Psychopharmacol"},{"key":"B52","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1089\/cap.2014.0063","article-title":"Disordered eating and food restrictions in children with PANDAS\/PANS","volume":"25","author":"Toufexis","year":"2015","journal-title":"J Child Adolesc Psychopharmacol"},{"key":"B53","doi-asserted-by":"publisher","first-page":"106250","DOI":"10.1016\/j.jcomdis.2022.106250","article-title":"Infection and speech: Disfluency and other speech symptoms in Pediatric Acute-onset Neuropsychiatric Syndrome","volume":"99","author":"Prosell","year":"2022","journal-title":"J Commun Disord"},{"key":"B54","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1542\/peds.2004-2058","article-title":"Association between streptococcal infection and obsessive-compulsive disorder, Tourette's syndrome, and tic disorder","volume":"116","author":"Mell","year":"2005","journal-title":"Pediatrics"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.1016\/s0006-3223(03)00704-2","article-title":"Detecting pediatric autoimmune neuropsychiatric disorders associated with streptococcus in children with obsessive-compulsive disorder and tics","volume":"55","author":"Murphy","year":"2004","journal-title":"Biol Psychiatry"},{"key":"B56","doi-asserted-by":"crossref","DOI":"10.1097\/00004703-199412000-00005","article-title":"Antineuronal antibodies: tics and obsessive-compulsive symptoms","volume":"15","author":"Kiessling","year":"1994","journal-title":"J Dev Behav Pediatr"},{"key":"B57","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.155.2.264","article-title":"Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases","volume":"155","author":"Swedo","year":"1998","journal-title":"Am J Psychiatry"},{"key":"B58","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1097\/00006454-200201000-00017","article-title":"Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS)","volume":"21","author":"Bottas","year":"2002","journal-title":"Pediatr Infect Dis J"},{"key":"B59","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2011.07.012","article-title":"Clinical factors associated with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections","volume":"160","author":"Murphy","year":"2012","journal-title":"J Pediatr"},{"key":"B60","doi-asserted-by":"publisher","DOI":"10.1542\/peds.38.6.946","article-title":"Streptococcal antibody titers in Sydenham's chorea","volume":"38","author":"Ayoub","year":"1966","journal-title":"Pediatrics"},{"key":"B61","doi-asserted-by":"publisher","first-page":"15084","DOI":"10.1038\/nrdp.2015.84","article-title":"Acute rheumatic fever and rheumatic heart disease","volume":"2","author":"Carapetis","year":"2016","journal-title":"Nat Rev Dis Primers"},{"key":"B62","doi-asserted-by":"publisher","DOI":"10.1016\/j.psc.2014.06.001","article-title":"Pediatric acute-onset neuropsychiatric syndrome","volume":"37","author":"Murphy","year":"2014","journal-title":"Psychiatr Clin North Am"},{"key":"B63","doi-asserted-by":"publisher","DOI":"10.2174\/18756336mtaxanzqr1","article-title":"Pediatric acute-onset neuropsychiatric syndrome and mycoplasma pneumoniae infection: A case report analysis with a metabolomics approach","volume":"16","author":"Piras","year":"2020","journal-title":"Curr Pediatr Rev"},{"key":"B64","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1111\/imr.12091","article-title":"Virus infection, antiviral immunity, and autoimmunity","volume":"255","author":"Getts","year":"2013","journal-title":"Immunol Rev"},{"key":"B65","doi-asserted-by":"publisher","first-page":"762","DOI":"10.3390\/v11080762","article-title":"Viruses and autoimmunity: A review on the potential interaction and molecular mechanisms","volume":"11","author":"Smatti","year":"2019","journal-title":"Viruses"},{"key":"B66","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2023.1085948","article-title":"Steroid treatment response to post SARS-CoV-2 PANS symptoms: Case series","volume":"14","author":"Berloffa","year":"2023","journal-title":"Front Neurol"},{"key":"B67","doi-asserted-by":"publisher","DOI":"10.1001\/archpedi.156.4.356","article-title":"Prospective identification and treatment of children with pediatric autoimmune neuropsychiatric disorder associated with group A streptococcal infection (PANDAS)","volume":"156","author":"Murphy","year":"2002","journal-title":"Arch Pediatr Adolesc Med"},{"key":"B68","doi-asserted-by":"publisher","DOI":"10.1086\/650167","article-title":"The human immune response to streptococcal extracellular antigens: clinical, diagnostic, and potential pathogenetic implications","volume":"50","author":"Johnson","year":"2010","journal-title":"Clin Infect Dis"},{"key":"B69","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1038\/s41398-021-01700-4","article-title":"Immunological causes of obsessive-compulsive disorder: is it time for the concept of an \"autoimmune OCD\" subtype","volume":"12","author":"Endres","year":"2022","journal-title":"Transl Psychiatry"},{"key":"B70","article-title":"Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS)","volume-title":"Streptococcus pyogenes: basic biology to clinical manifestations","author":"Orefici","year":"2016"},{"key":"B71","doi-asserted-by":"publisher","DOI":"10.1016\/j.jneuroim.2017.09.002","article-title":"Biomarkers for diagnosis of Pediatric Acute Neuropsychiatric Syndrome (PANS) - Sensitivity and specificity of the Cunningham Panel","volume":"312","author":"Hesselmark","year":"2017","journal-title":"J Neuroimmunol"},{"key":"B72","doi-asserted-by":"crossref","first-page":"564","DOI":"10.3389\/fpsyt.2020.00564","article-title":"Autoantibody biomarkers for sydenham chorea and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS)","volume":"11","author":"Chain","year":"2020","journal-title":"Front Psychiatry"},{"key":"B73","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1016\/j.jaac.2016.06.017","article-title":"Randomized, controlled trial of intravenous immunoglobulin for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections","volume":"55","author":"Williams","year":"2016","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"B74","doi-asserted-by":"publisher","first-page":"577138","DOI":"10.1016\/j.jneuroim.2019.577138","article-title":"Evaluation of the Cunningham Panel in pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS): Changes in antineuronal antibody titers parallel changes in patient symptoms","volume":"339","author":"Shimasaki","year":"2020","journal-title":"J Neuroimmunol"},{"key":"B75","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2022.1020831","article-title":"Histone deacetylase inhibitors mitigate antipsychotic risperidone-induced motor side effects in aged mice and in a mouse model of Alzheimer's disease","volume":"13","author":"Rodriguez","year":"2023","journal-title":"Front Psychiatry"},{"key":"B76","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2004.12.035","article-title":"Antibiotic prophylaxis with azithromycin or penicillin for childhood-onset neuropsychiatric disorders","volume":"57","author":"Snider","year":"2005","journal-title":"Biol Psychiatry"},{"key":"B77","doi-asserted-by":"publisher","first-page":"P242","DOI":"10.1186\/1546-0096-11-s2-p242","article-title":"PReS-FINAL-2252: descriptive analysis of pediatric autoimmune neuropsychiatric disorder associated with streptococcus infection (PANDAS) in a cohort of 65 italian patients","volume":"11","author":"Falcini","year":"2013","journal-title":"Pediatr Rheumatol Online J"},{"key":"B78","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1089\/cap.2016.0151","article-title":"Clinical management of pediatric acute-onset neuropsychiatric syndrome: part III-treatment and prevention of infections","volume":"27","author":"Cooperstock","year":"2017","journal-title":"J Child Adolesc Psychopharmacol"},{"key":"B79","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-023-05211-w","article-title":"Acute pharyngitis in children and adults: descriptive comparison of current recommendations from national and international guidelines and future perspectives","volume":"182","author":"Pellegrino","year":"2023","journal-title":"Eur J Pediatr"},{"key":"B80","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCULATIONAHA.109.191959","article-title":"Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics","volume":"119","author":"Gerber","year":"2009","journal-title":"Circulation"},{"key":"B81","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2023.1174146","article-title":"Short-term antibiotic therapy for the most common bacterial respiratory infections in infants and children","volume":"14","author":"Principi","year":"2023","journal-title":"Front Pharmacol"},{"key":"B82","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2020.00745","article-title":"Improving the quality of hospital antibiotic use: impact on multidrug-resistant bacterial infections in children","volume":"11","author":"Fanelli","year":"2020","journal-title":"Front Pharmacol"},{"key":"B83","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2016.08.008","article-title":"PANDAS: A systematic review of treatment options","volume":"89","author":"Farhood","year":"2016","journal-title":"Int J Pediatr Otorhinolaryngol"},{"key":"B84","doi-asserted-by":"crossref","DOI":"10.1177\/039463201402700307","article-title":"Pediatric autoimmune neuropsychiatric disorder associated with group a streptococcal infection: the role of surgical treatment","volume":"27","author":"Pavone","year":"2014","journal-title":"Int J Immunopathol Pharmacol"},{"key":"B85","first-page":"Doc07","article-title":"Tonsillectomy remains a questionable option for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS)","volume":"15","author":"Windfuhr","year":"2016","journal-title":"GMS Curr Top Otorhinolaryngol Head Neck Surg"},{"key":"B86","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2016.0139","article-title":"Pediatric acute-onset neuropsychiatric syndrome response to oral corticosteroid bursts: an observational study of patients in an academic community-based PANS clinic","volume":"27","author":"Brown","year":"2017","journal-title":"J Child Adolesc Psychopharmacol"},{"key":"B87","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2016.0193","article-title":"Effect of early and prophylactic nonsteroidal anti-inflammatory drugs on flare duration in pediatric acute-onset neuropsychiatric syndrome: an observational study of patients followed by an academic community-based pediatric acute-onset neuropsychiatric syndrome clinic","volume":"27","author":"Brown","year":"2017","journal-title":"J Child Adolesc Psychopharmacol"},{"key":"B88","doi-asserted-by":"publisher","DOI":"10.1111\/apa.15875","article-title":"Clinical guidance for diagnosis and management of suspected Pediatric Acute-onset Neuropsychiatric Syndrome in the Nordic countries","volume":"110","author":"Pfeiffer","year":"2021","journal-title":"Acta Paediatr"},{"key":"B89","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2016.0145","article-title":"Clinical management of pediatric acute-onset neuropsychiatric syndrome: part I-psychiatric and behavioral interventions","volume":"27","author":"Thienemann","year":"2017","journal-title":"J Child Adolesc Psychopharmacol"},{"key":"B90","doi-asserted-by":"publisher","first-page":"94","DOI":"10.3892\/etm.2020.9526","article-title":"Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (Review)","volume":"21","author":"Dop","year":"2021","journal-title":"Exp Ther Med"},{"key":"B91","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2021.01.022","article-title":"Patients with abrupt early-onset OCD due to PANS tolerate lower doses of antidepressants and antipsychotics","volume":"135","author":"Thienemann","year":"2021","journal-title":"J Psychiatr Res"},{"key":"B92","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2018.0141","article-title":"Patient satisfaction and treatments offered to swedish patients with suspected pediatric acute-onset neuropsychiatric syndrome and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections","volume":"29","author":"Hesselmark","year":"2019","journal-title":"J Child Adolesc Psychopharmacol"},{"key":"B93","doi-asserted-by":"publisher","DOI":"10.1007\/s10880-022-09926-0","article-title":"Group psychotherapy for parents of youth with pediatric acute-onset neuropsychiatric syndrome","volume":"30","author":"Ellerkamp","year":"2023","journal-title":"J Clin Psychol Med Settings"},{"key":"B94","article-title":"Risperidone in the treatment of choreiform movements and aggressiveness in a child with \"PANDAS","volume":"52","author":"Kleinsasser","year":"1999","journal-title":"S D J Med"},{"key":"B95","doi-asserted-by":"publisher","first-page":"297","DOI":"10.3390\/nu16020297","article-title":"Probiotics in infancy and childhood for food allergy prevention and treatment","volume":"16","author":"Di Costanzo","year":"2024","journal-title":"Nutrients"},{"key":"B96","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2017.12.013","article-title":"Gut dysbiosis and irritable bowel syndrome: The potential role of probiotics","volume":"76","author":"Principi","year":"2018","journal-title":"J Infect"},{"key":"B97","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1186\/s12967-016-1058-7","article-title":"Microbiota and neurologic diseases: potential effects of probiotics","volume":"14","author":"Umbrello","year":"2016","journal-title":"J Transl Med"},{"key":"B98","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2017.01.021","article-title":"Choosing wisely: the top-5 recommendations from the italian panel of the national guidelines for the management of acute pharyngitis in children","volume":"39","author":"Chiappini","year":"2017","journal-title":"Clin Ther"},{"key":"B99","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2018.04.035","article-title":"A pediatric neurology perspective on pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection and pediatric acute-onset neuropsychiatric syndrome","volume":"199","author":"Gilbert","year":"2018","journal-title":"J Pediatr"},{"key":"B100","doi-asserted-by":"publisher","DOI":"10.1007\/s00787-017-1077-9","article-title":"Longitudinal outcomes of children with pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS)","volume":"27","author":"Leon","year":"2018","journal-title":"Eur Child Adolesc Psychiatry"},{"key":"B101","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1186\/s12888-021-03450-5","article-title":"Measuring clinical outcomes in children with pediatric acute-onset neuropsychiatric syndrome: data from a 2-5\u2009year follow-up study","volume":"21","author":"De Visscher","year":"2021","journal-title":"BMC Psychiatry"},{"key":"B102","doi-asserted-by":"publisher","first-page":"e4","DOI":"10.1111\/j.1468-1331.2007.01577.x","article-title":"PANDAS in siblings: a common risk","volume":"14","author":"Dranitzki","year":"2007","journal-title":"Eur J Neurol"},{"key":"B103","doi-asserted-by":"crossref","DOI":"10.1089\/cap.2010.0085","article-title":"Pediatric autoimmune neuropsychiatric disorders associated with Streptococcus in identical siblings","volume":"21","author":"Lewin","year":"2011","journal-title":"J Child Adolesc Psychopharmacol"},{"key":"B104","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2020.00361","article-title":"Do vaccines have a role as a cause of autoimmune neurological syndromes","volume":"8","author":"Principi","year":"2020","journal-title":"Front Public Health"},{"key":"B105","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1177\/2051013613480770","article-title":"Influenza vaccination in children at high risk of respiratory disease","volume":"1","author":"Patria","year":"2013","journal-title":"Ther Adv Vaccines"},{"key":"B106","doi-asserted-by":"publisher","first-page":"235","DOI":"10.3390\/jpm13020235","article-title":"Use of telemedicine healthcare systems in children and adolescents with chronic disease or in transition stages of life: consensus document of the italian society of telemedicine (SIT), of the italian society of preventive and social pediatrics (SIPPS), of the italian society of pediatric primary care (SICuPP), of the italian federation of pediatric doctors (FIMP) and of the syndicate of family pediatrician doctors (SIMPeF)","volume":"13","author":"Esposito","year":"2023","journal-title":"J Pers Med"},{"key":"B107","doi-asserted-by":"crossref","DOI":"10.2147\/NSS.S300818","article-title":"Artificial Neural Networks Analysis of polysomnographic and clinical features in Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): from sleep alteration to \"Brain Fog","volume":"13","author":"Gagliano","year":"2021","journal-title":"Nat Sci Sleep"},{"key":"B108","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.7222","article-title":"Continued presence of period limb movements during REM sleep in patients with chronic static pediatric acute-onset neuropsychiatric syndrome (PANS)","volume":"14","author":"Santoro","year":"2018","journal-title":"J Clin Sleep Med"},{"key":"B109","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2014.05.009","article-title":"Altered brain iron homeostasis and dopaminergic function in Restless Legs Syndrome (Willis-Ekbom Disease)","volume":"15","author":"Earley","year":"2014","journal-title":"Sleep Med"},{"key":"B110","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1007\/s10067-014-2698-8","article-title":"Acute rheumatic fever and streptococci: the quintessential pathogenic trigger of autoimmunity","volume":"33","author":"Chakravarty","year":"2014","journal-title":"Clin Rheumatol"},{"key":"B111","doi-asserted-by":"publisher","DOI":"10.1172\/jci7132","article-title":"Cytotoxic mAb from rheumatic carditis recognizes heart valves and laminin","volume":"106","author":"Galvin","year":"2000","journal-title":"J Clin Invest"},{"key":"B112","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2019.00395","article-title":"Focus on cardiologic findings in 30 children with PANS\/PANDAS: an italian single-center observational study","volume":"7","author":"Murciano","year":"2019","journal-title":"Front Pediatr"},{"key":"B113","doi-asserted-by":"crossref","DOI":"10.1016\/S0140-6736(15)60865-0","article-title":"Iron deficiency anaemia","volume":"387","author":"Lopez","year":"2016","journal-title":"Lancet"},{"key":"B114","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2016.0069","article-title":"Serum ferritin levels are lower in children with tic disorders compared with children without tics: A cross-sectional study","volume":"27","author":"Avrahami","year":"2017","journal-title":"J Child Adolesc Psychopharmacol"},{"key":"B115","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1186\/1471-244x-13-161","article-title":"Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based study","volume":"13","author":"Chen","year":"2013","journal-title":"BMC Psychiatry"},{"key":"B116","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbagen.2010.03.011","article-title":"Serum ferritin: Past, present and future","volume":"1800","author":"Wang","year":"2010","journal-title":"Biochim Biophys Acta"},{"key":"B117","doi-asserted-by":"publisher","DOI":"10.1038\/s41390-020-1103-3","article-title":"Hypoferritinemia and iron deficiency in youth with pediatric acute-onset neuropsychiatric syndrome","volume":"89","author":"Chan","year":"2021","journal-title":"Pediatr Res"},{"key":"B118","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1186\/s12879-015-1196-1","article-title":"Vitamin D and respiratory tract infections in childhood","volume":"15","author":"Esposito","year":"2015","journal-title":"BMC Infect Dis"},{"key":"B119","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/039463201302600101","article-title":"Role of vitamin D in children with respiratory tract infection","volume":"26","author":"Esposito","year":"2013","journal-title":"Int J Immunopathol Pharmacol"},{"key":"B120","doi-asserted-by":"publisher","DOI":"10.1016\/s2213-8587(21)00051-6","article-title":"Vitamin D supplementation to prevent acute respiratory infections: a systematic review and meta-analysis of aggregate data from randomised controlled trials","volume":"9","author":"Jolliffe","year":"2021","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B121","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1111\/nyas.12440","article-title":"Vitamin D effects on B cell function in autoimmunity","volume":"1317","author":"Rolf","year":"2014","journal-title":"Ann N Y Acad Sci"},{"key":"B122","doi-asserted-by":"publisher","first-page":"e167","DOI":"10.1212\/nxi.0000000000000167","article-title":"Effect of vitamin D on MS activity by disease-modifying therapy class","volume":"2","author":"Rotstein","year":"2015","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"B123","doi-asserted-by":"crossref","DOI":"10.1210\/jc.2011-0385","article-title":"Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline","volume":"96","author":"Holick","year":"2011","journal-title":"J Clin Endocrinol Metab"},{"key":"B124","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-015-2524-6","article-title":"Vitamin D in childhood and adolescence: an expert position statement","volume":"174","author":"Saggese","year":"2015","journal-title":"Eur J Pediatr"},{"key":"B125","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2011.08.003","article-title":"Controlled comparison of family cognitive behavioral therapy and psychoeducation\/relaxation training for child obsessive-compulsive disorder","volume":"50","author":"Piacentini","year":"2011","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"B126","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2014.0149","article-title":"A pilot trial of cognitive-behavioral therapy augmentation of antibiotic treatment in youth with pediatric acute-onset neuropsychiatric syndrome-related obsessive-compulsive disorder","volume":"25","author":"Nadeau","year":"2015","journal-title":"J Child Adolesc Psychopharmacol"},{"key":"B127","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2023.0088","article-title":"Psychometric properties of the PANS 31-item symptom rating scale","volume":"34","author":"Bernstein","year":"2024","journal-title":"J Child Adolesc Psychopharmacol"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2024.1420663\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,24]],"date-time":"2024-10-24T04:52:05Z","timestamp":1729745525000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2024.1420663\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,24]]},"references-count":127,"alternative-id":["10.3389\/fimmu.2024.1420663"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2024.1420663","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,24]]},"article-number":"1420663"}}