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Ryan S, Forster E, Griffin B. A scoping review study of patients with a primary immune deficiency who have presented to the paediatric emergency department with a fever. Australas Emerg Care 2024:S2588-994X(24)00053-8. [PMID: 39327126 DOI: 10.1016/j.auec.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 09/07/2024] [Accepted: 09/08/2024] [Indexed: 09/28/2024]
Abstract
AIM To identify, analyse, and synthesise existing research on the characteristics and risk factors associated with primary immune deficiencies (PIDs), with focus on understanding how factors impede patient outcomes. BACKGROUND There is currently limited research regarding the management of this cohort when they present to an emergency department with the presentation urgency often being overlooked. METHOD Three databases, google scholar, and citations were searched for relevant studies under the criteria. Included papers were analysed and reported following the PRISMA guideline, and then critically appraised using the Mixed Method Appraisal Tool. RESULTS After a review of 625 titles and abstracts, 20 studies met the inclusion criteria. The majority being mixed method (n = 8) and case studies (n = 8). All chosen studies reported some form of management of a child with a PID, and most made recommendations for improvement. CONCLUSIONS Further research is needed to facilitate an understanding of how to enhance emergency management, to increase positive outcomes. RELEVANCE TO PRACTICE There is a critical need for improved management strategies for children with a PID presenting to ED with fever. Creating protocols, increasing staff knowledge, and implementing patient specific interventions are essential in improving outcomes and reducing serious complications in this high-risk paediatric population.
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Affiliation(s)
- Samantha Ryan
- School of Nursing and Midwifery, Griffith University, Queensland, Australia; Department of Emergency Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia.
| | - Elizabeth Forster
- School of Nursing and Midwifery, Griffith University, Queensland, Australia.
| | - Bronwyn Griffin
- School of Nursing and Midwifery, Griffith University, Queensland, Australia.
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Olianti C, Trapani S, Secinaro A, Holm Reichkendler M. Fever of unknown origin in pediatrics: role of nuclear medicine. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2024; 68:48-57. [PMID: 38454877 DOI: 10.23736/s1824-4785.24.03546-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Fever of unknown origin (FUO) is a debated issue in numerous scientific studies in adult patients with a not jet-defined workflow in a clinical and diagnostic setting. Few works are published about pediatric patients even if FUO represents a challenging, not infrequent scenario in hospital and outpatient recovery. The fever might be the onset symptom of a transient mild infection or the beginning of a more difficult-to-diagnose and serious pathological condition. In the adult workflow 18FDG PET-CT is nowadays playing a relevant role, considering the limited spread of conventional 99mTc-HMPAO-White Blood Cells scintigraphy. It represents a robust tool for diagnosing the eventual site of infection, but it is limited by procedural complexity and long duration, up to 24 hours. The WBC-scintigraphy is also not suitable for children, only for young adults or adolescents, considering the relevant blood sample entity and the procedural risk for sensitive subjects. The most assessed clinical and diagnostic know-how on Pediatric FUO are summarized and a synthetic flow-chard is presented to support the clinical management and to choose the best diagnostic pathway.
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Affiliation(s)
- Catia Olianti
- Unit of Nuclear Medicine, Department of Image Diagnostics, Careggi University Hospital, Florence, Italy -
| | - Sandra Trapani
- Department of Medical Pediatric, Meyer Children's University Hospital IRCCS, Florence, Italy
| | - Aurelio Secinaro
- Department of Radiology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Michala Holm Reichkendler
- Unit of Nuclear Medicine, Department of Image Diagnostic, Rigshospitalet University Hospital, Copenhagen, Denmark
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Liu D, Zhang YQ, Yu TY, Han SL, Xu YJ, Guan Q, Wang HR. Regulatory mechanism of the six-method massage antipyretic process on lipopolysaccharide-induced fever in juvenile rabbits: A targeted metabolomics approach. Heliyon 2024; 10:e23313. [PMID: 38148795 PMCID: PMC10750150 DOI: 10.1016/j.heliyon.2023.e23313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/23/2023] [Accepted: 11/30/2023] [Indexed: 12/28/2023] Open
Abstract
Objective To investigate the mechanism of the six-method massage antipyretic process (SMAP) and its influence on the body's metabolic state. Methods The random number table method was used to divide 24 New Zealand 2-month-old rabbits with qualified basal body temperature into a control group, model group and massage group (n = 8 per group). The model group and massage groups were injected with 0.5 μg/ml lipopolysaccharide (1 ml/kg) into the auricular vein, and the control group was injected with the same amount of normal saline at the same temperature. One hour after modelling, the massage group was given SMAP (opening Tianmen, pushing Kangong, rubbing Taiyang, rubbing Erhougaogu, clearing the Tianheshui and pushing the spine). The change of anal temperature 5 h after moulding was recorded to clarify the antipyretic effect. Results After modelling, the rectal temperature of the juvenile rabbits in the three groups increased. The rectal temperature of the model group was higher than that of the control group 5 h after modelling, and the rectal temperature of the massage group was lower than that of the model group (P < 0.05). The antipyretic mechanism is related to the regulation of the synthesis of phenylalanine, tyrosine and tryptophan, as well as the pentose phosphate pathway. Compared with the model group, the plasma interleukin (IL)-1, IL-6, interferon-gamma, toll-like receptor 4, nuclear factor κB, the mechanistic target of rapamycin complex 1, indoleamine 2,3-dioxygenase 1, aryl hydrocarbon receptor, liver aspartate transaminase (AST), alanine transaminase (ALT) and l-glutamate dehydrogenase (L-GLDH) expression in the massage group were significantly decreased (P < 0.05). Compared with the model group, the massage group had significantly reduced AST, ALT and L-GLDH expression in plasma (P < 0.05). Conclusion The mechanism of SMAP therapy is related to regulating the expression of peripheral inflammatory factors and metabolic pathways.
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Affiliation(s)
- Di Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 102401, China
- Department of Acupuncture-Moxibustion, Dongfang Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100078, China
| | - Ying-qi Zhang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 102401, China
| | - Tian-yuan Yu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 102401, China
| | - Si-long Han
- Department of Orthopedics II, Changping District Hospital of Integrated Traditional Chinese and Western Medicine, Beijing,102208, China
| | - Ya-jing Xu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 102401, China
| | - Qian Guan
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 102401, China
| | - Hou-rong Wang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 102401, China
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Trapani S, Fiordelisi A, Stinco M, Resti M. Update on Fever of Unknown Origin in Children: Focus on Etiologies and Clinical Approach. CHILDREN (BASEL, SWITZERLAND) 2023; 11:20. [PMID: 38255334 PMCID: PMC10814770 DOI: 10.3390/children11010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
Fever of unknown origin (FUO) can be caused by four etiological categories of diseases. The most common cause of FUO in children is represented by infections, followed by inflammatory conditions and neoplastic causes; a decreasing quote remains still without diagnosis. Despite the fact that several diagnostic and therapeutic approaches have been proposed since the first definition of FUO, none of them has been fully validated in pediatric populations. A focused review of the patient's history and a thorough physical examination may offer helpful hints in suggesting a likely diagnosis. The diagnostic algorithm should proceed sequentially, and invasive testing should be performed only in select cases, possibly targeted by a diagnostic suspect. Pioneering serum biomarkers have been developed and validated; however, they are still far from becoming part of routine clinical practice. Novel noninvasive imaging techniques have shown promising diagnostic accuracy; however, their positioning in the diagnostic algorithm of pediatric FUO is still not clear. This narrative review aims to provide a synopsis of the existent literature on FUO in children, with its major causes and possible diagnostic workup, to help the clinician tackle the complex spectrum of pediatric FUO in everyday clinical practice.
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Affiliation(s)
- Sandra Trapani
- Department of Health Sciences, University of Florence, 50139 Florence, Italy
- Pediatric Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (A.F.); (M.R.)
| | - Adele Fiordelisi
- Pediatric Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (A.F.); (M.R.)
| | | | - Massimo Resti
- Pediatric Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (A.F.); (M.R.)
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Espin Diaz PC, Singh K, Kher P, Avanthika C, Jhaveri S, Saad Y, Gosh S. Periodic Fever in Children: Etiology and Diagnostic Challenges. Cureus 2022; 14:e27239. [PMID: 36035053 PMCID: PMC9399680 DOI: 10.7759/cureus.27239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/05/2022] Open
Abstract
Periodic fever in children is an autoinflammatory illness with an unknown cause. Symptoms include frequent episodes of fever that are followed by an increase in inflammatory markers. A genetic background for periodic fever of unknown origin has been hypothesized, based on its family clustering and parallels to other autoinflammatory illnesses such as familial Mediterranean fever. Genome analysis has been used in studies to look for related gene variations in periodic fever of unknown origin in the pediatric population. Children with periodic fevers might be a diagnostic challenge. After ruling out the most prevalent causes, a wide variety of other possibilities are investigated. Infectious and noninfectious causes of periodic fever in children are discussed in this article. Inflammasomes (intracellular proteins that activate interleukin (IL)-1b and IL-18) and genetic/hereditary variations are thought to be implicated in the pathogenesis of periodic fever. Evaluation and ruling out possible infective or noninfective causes is vital in the diagnosis of periodic fever in children. Investigations demonstrate that there isn't a single gene linked to it, suggesting that it may have a multifactorial or polygenic origin, with an environmental trigger causing inflammasome activation and fever flares. Treatment is usually symptomatic, with drugs such as colchicine and cimetidine having shown promising results in trials. We explored the literature on periodic fever in children for its epidemiology, pathophysiology, the role of various genes and how they influence the disease and associated complications, and its various treatment modalities.
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Fiorito TM, Krilov LR. Diurnal Temperature Variation: Addressing Once-Daily Nighttime Fevers in the Era of COVID-19. Pediatr Ann 2022; 51:e202-e205. [PMID: 35575539 DOI: 10.3928/19382359-20220314-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pediatric patients with "once-daily" fevers are often referred to pediatric infectious disease specialists for evaluation. Often, these fevers occur at nighttime in the absence of additional symptoms and come to the caregiver's attention after a viral illness. It is crucial for caregivers and providers to be able to define and measure fever accurately when trying to ascertain the true etiology of this clinical picture. Fever education is critical in providing reassurance to parents, and fever diaries should be encouraged. In a well-appearing child without any additional symptoms, at least a percentage of these fevers can be explained by normal diurnal variation of temperature. [Pediatr Ann. 2022;51(5):e202-e205.].
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Niveles de ferritina en artritis idiopática juvenil de inicio sistémico comparada con otras fiebres de origen desconocido: estudio multicéntrico de pruebas diagnósticas. BIOMÉDICA 2021; 41:787-802. [PMID: 34936261 PMCID: PMC8769591 DOI: 10.7705/biomedica.5849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Indexed: 11/23/2022]
Abstract
Introducción. No se dispone de pruebas sensibles ni específicas para diagnosticar la artritis idiopática juvenil sistémica. Objetivo. Evaluar la utilidad diagnóstica de niveles de ferritina total cinco veces por encima del valor normal (ferritina total>5N) y el porcentaje disminuido (menor de o igual a 20 % de la ferritina total) de la ferritina glucosilada (ferritina glucosilada<20 %) para el diagnóstico de artritis idiopática juvenil sistémica en pacientes con fiebre de origen desconocido evaluados por Reumatología pediátrica. Materiales y métodos. Se hizo un estudio observacional de pruebas diagnósticas de corte transversal en menores de 16 años hospitalizados entre el 2010 y el 2014. El patrón diagnóstico de referencia fue el cumplimiento de los criterios de clasificación o diagnóstico confirmado en el seguimiento. Se determinaron las medidas de utilidad de las pruebas. Resultados. Se incluyeron 40 pacientes con fiebre de origen desconocido: 11 con artritis idiopática juvenil sistémica y 29 con otros diagnósticos. La mediana de la ferritina total fue mayor en la artritis idiopática juvenil sistémica (3.992 ng/ml) comparada con otras causas de fiebre de origen desconocido (155 ng/ml) (p=0,0027), así como la ferritina total>5N (90,91 % Vs. 51,72 %) (p=0,023). El porcentaje de ferritina glucosilada≤20 % fue de 96,5 % en otras fiebres de origen desconocido en comparación con la artritis idiopática juvenil sistémica (81,8 %) (p=0,178). La ferritina total>5N tuvo una sensibilidad del 91 %, una especificidad del 48 %; un cociente de probabilidades (Likelihood Ratio, LR) positivo de 1,76 y uno negativo de 0,19, demostrando mayor utilidad para el diagnóstico que la combinación de la ferritina total>5N y ferritina glucosilada<20 %, cuya sensibilidad fue del 81,8 %, la especificidad del 48,3 %, un cociente de probabilidades LR positivo de 1,58 y un LR negativo de 0,38. Conclusión. En pacientes con fiebre de origen desconocido evaluados por reumatología pediátrica, la ferritina total>5N demostró ser útil como prueba de tamización para el diagnóstico de artritis idiopática juvenil sistémica.
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Heng KYC, Lee JH, Thomas T. Anti-N-Methyl-D-aspartate receptor encephalitis masquerading as fever of unknown origin. Clin Case Rep 2021; 9:2323-2327. [PMID: 33936687 PMCID: PMC8077294 DOI: 10.1002/ccr3.4025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 12/05/2020] [Accepted: 01/24/2021] [Indexed: 11/24/2022] Open
Abstract
Fever of unknown origin (FUO) is a diagnostic challenge. Anti-N-methyl-D-aspartate receptor encephalitis should be considered in children with FUO and new-onset neurological symptoms without significant encephalopathy.
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Affiliation(s)
- Katrina Yi Ching Heng
- Department of Child DevelopmentDepartment of Paediatric MedicineKK Women's and Children's HospitalSingapore CitySingapore
| | - Jan Hau Lee
- Department of Children's Intensive Care UnitDepartment of Paediatric SubspecialtiesKK Women's and Children's HospitalSingapore CitySingapore
| | - Terrence Thomas
- Paediatric Neurology ServiceDepartment of Paediatric MedicineKK Women's and Children's HospitalSingapore CitySingapore
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Lovšin E, Kovač J, Tesovnik T, Toplak N, Perko D, Rozmarič T, Debeljak M, Avčin T. PIK3AP1 and SPON2 Genes Are Differentially Methylated in Patients With Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis (PFAPA) Syndrome. Front Immunol 2020; 11:1322. [PMID: 32793186 PMCID: PMC7390842 DOI: 10.3389/fimmu.2020.01322] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/26/2020] [Indexed: 12/22/2022] Open
Abstract
Periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome is the most common autoinflammatory disease in children and is often grouped together with hereditary periodic fever syndromes, although its cause and hereditary nature remain unexplained. We investigated whether differential DNA methylation was present in DNA from peripheral blood mononuclear cells (PBMC) in patients with PFAPA vs. healthy controls. A whole-epigenome analysis (MeDIP and MBD) was performed using pooled DNA libraries enriched for methylated genomic regions and identified candidate genes, two of which were further evaluated with methylation-specific restriction enzymes coupled with qPCR (MSRE-qPCR). The analysis showed that the PIK3AP1 and SPON2 gene regions are differentially methylated in patients with PFAPA. MSRE-qPCR proved to be a quick, reliable, and cost-effective method of confirming results from MeDIP and MBD. Our findings indicate that a B-cell adapter protein (PIK3AP1), as the PI3K binding inhibitor of inflammation, and spondin-2 (SPON2), as a pattern recognition molecule and integrin ligand, could play a role in the etiology of PFAPA. Their role and the impact of changed DNA methylation in PFAPA etiology and autoinflammation need further investigation.
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Affiliation(s)
- Ema Lovšin
- Department of Allergology, Rheumatology and Clinical Immunology, University Medical Centre Ljubljana, University Children's Hospital, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jernej Kovač
- Department for Special Laboratory Diagnostics, University Medical Centre Ljubljana, University Children's Hospital, Ljubljana, Slovenia
| | - Tine Tesovnik
- Department for Special Laboratory Diagnostics, University Medical Centre Ljubljana, University Children's Hospital, Ljubljana, Slovenia
| | - Nataša Toplak
- Department of Allergology, Rheumatology and Clinical Immunology, University Medical Centre Ljubljana, University Children's Hospital, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Daša Perko
- Department for Special Laboratory Diagnostics, University Medical Centre Ljubljana, University Children's Hospital, Ljubljana, Slovenia
| | - Tomaž Rozmarič
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Maruša Debeljak
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department for Special Laboratory Diagnostics, University Medical Centre Ljubljana, University Children's Hospital, Ljubljana, Slovenia
| | - Tadej Avčin
- Department of Allergology, Rheumatology and Clinical Immunology, University Medical Centre Ljubljana, University Children's Hospital, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Santana LFE, Rodrigues MDS, Silva MPDA, Brito RJVCD, Nicacio JM, Duarte RMSDC, Gomes OV. Fever of unknown origin in special groups. ACTA ACUST UNITED AC 2019; 65:1308-1313. [PMID: 31721964 DOI: 10.1590/1806-9282.65.10.1308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/31/2019] [Indexed: 11/22/2022]
Abstract
Fever of undetermined origin (FUO) is a challenging entity with a striking presence in hospitals around the world. It is defined as temperature ≥ 37.8 ° C on several occasions, lasting ≥ three weeks, in the absence of diagnosis after three days of hospital investigation or 3 outpatient visits. The main etiologies are infectious, neoplastic, and non-infectious inflammatory diseases. The diagnosis is based on the detailed clinical history and physical examination of these patients, in order to direct the specific complementary tests to be performed in each case. The initial diagnostic approach of the FUO patient should include non-specific complementary exams. Empirical therapy is not recommended (with few exceptions) in patients with prolonged fever, as it may disguise and delay the diagnosis and conduct to treat the specific etiology. The prognosis encompasses mortality of 12-35%, varying according to the baseline etiology.
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Affiliation(s)
| | - Mateus de Sousa Rodrigues
- . Discente de Medicina na Universidade Federal do Vale do São Francisco (UNIVASF), Petrolina, PE, Brasil
| | | | | | - Jandir Mendonça Nicacio
- . Médico Hematologista. Preceptor da Residência Médica de Clínica Médica do Hospital Universitário da Unifasf. Professor efetivo das disciplinas de Doenças hematológicas e de Oncologia da UNIVASF, Petrolina, PE, Brasil
| | - Rita Marina Soares de Castro Duarte
- . Médica Reumatologista. Preceptora da Residência Médica de Clínica Médica do Hospital Universitário da UNIVASF. Professora efetiva da disciplina de Reumatologia da UNIVASF, Petrolina, PE, Brasil
| | - Orlando Vieira Gomes
- . Médico Nefrologista. Preceptor da Residência Médica de Clínica Médica do Hospital Universitário da UNIVASF. Professor MSC efetivo da disciplina de Medicina de Urgência da UNIVASF, Petrolina, PE, Brasil
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Santana LFE, Rodrigues MDS, Silva MPDA, Brito RJVCD, Nicacio JM, Duarte RMSDC, Gomes OV. Fever of unknown origin - a literature review. ACTA ACUST UNITED AC 2019; 65:1109-1115. [PMID: 31531611 DOI: 10.1590/1806-9282.65.8.1109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/31/2019] [Indexed: 11/21/2022]
Abstract
Fever of undetermined origin (FUO) is a challenging entity with a striking presence in hospitals around the world and can be associated with a myriad of differential diagnoses. It is defined as axillary temperature ≥ 37.8 ° C on several occasions, lasting ≥ three weeks, in the absence of diagnosis after three days of hospital investigation or three outpatient visits. The main etiologies are: infectious, neoplastic, and rheumatic. The diagnosis is based on the detailed clinical history and physical examination of these patients, in order to direct the specific complementary tests to be performed in each case. Empirical therapy is not recommended (with few exceptions) in patients with prolonged fever, as it may disguise and delay the diagnosis and conduct to treat the specific etiology. The prognosis encompasses mortality of 12% - 35%, varying according to the underlying etiology. In this sense, the objective of this study is to review the main topics about fever of undetermined origin, bringing historical and scientific aspects, national and international.
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Affiliation(s)
| | - Mateus de Sousa Rodrigues
- Discente de Medicina na Universidade Federal do Vale do São Francisco (UNIVASF), Petrolina, PE, Brasil
| | | | | | - Jandir Mendonça Nicacio
- Médico Hematologista. Preceptor da Residência Médica de Clínica Médica do Hospital Universitário da UNIVASF. Professor efetivo das disciplinas de Doenças hematológicas e de Oncologia da UNIVASF, Petrolina, PE, Brasil
| | - Rita Marina Soares de Castro Duarte
- Médica Reumatologista. Preceptora da Residência Médica de Clínica Médica do Hospital Universitário da UNIVASF. Professora efetiva da disciplina de Reumatologia da UNIVASF, Petrolina, PE, Brasil
| | - Orlando Vieira Gomes
- Médico Nefrologista. Preceptor da Residência Médica de Clínica Médica do Hospital Universitário da UNIVASF. Professor MSC efetivo da disciplina de Medicina de Urgência da UNIVASF, Petrolina, PE, Brasil
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Renko M, Lantto U, Tapiainen T. Towards better diagnostic criteria for periodic fever, aphthous stomatitis, pharyngitis and adenitis syndrome. Acta Paediatr 2019; 108:1385-1392. [PMID: 30901126 DOI: 10.1111/apa.14792] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/04/2019] [Accepted: 03/19/2019] [Indexed: 12/13/2022]
Abstract
AIM Periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome is the most common cause of a periodic fever in childhood. The exact pathogenesis and the aetiology of PFAPA are still unknown. METHODS We conducted a non-systematic review of published articles about PFAPA syndrome and summarised the evidence for diagnostic criteria and treatment options for PFAPA. RESULTS The first proposed diagnostic criteria for PFAPA, in addition to periodic fever, included aphthous stomatitis, pharyngitis or cervical lymphadenitis in children younger than five years at the beginning of the symptoms. C-reactive protein (CRP) levels and leucocyte counts increase in most patients during episodes. Recent research reveals that tonsillectomy provides an immediate and long-lasting cure for PFAPA, even in the absence of classic criteria of aphthous stomatitis, pharyngitis or cervical adenitis and in children older than five years. CONCLUSION We suggest that PFAPA can be diagnosed in children with at least five regularly occurring fever episodes without any other explanation, even in the absence of aphthous stomatitis, pharyngitis or cervical lymphadenitis and also in children older than five years.
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Affiliation(s)
- Marjo Renko
- Department of Paediatrics University of Eastern Finland and Kuopio University Hospital Kuopio Finland
- PEDEGO Research Unit University of Oulu Oulu Finland
| | - Ulla Lantto
- PEDEGO Research Unit University of Oulu Oulu Finland
- Department of Otorhinolaryngology Oulu University Hospital Oulu Finland
| | - Terhi Tapiainen
- PEDEGO Research Unit University of Oulu Oulu Finland
- Department of Children and Adolescents Oulu University Hospital Oulu Finland
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Wekell P. Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis syndrome - PFAPA syndrome. Presse Med 2019; 48:e77-e87. [PMID: 30683466 DOI: 10.1016/j.lpm.2018.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 08/07/2018] [Indexed: 01/04/2023] Open
Abstract
Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is a complex autoinflammatory disease with a clinical phenotype characterised by recurrent episodes of fever, systemic inflammation and symptoms and signs depicted in disease acronym. Although PFAPA is the most common autoinflammatory disease among children in many parts of the world, the condition is still an enigma, which include the regular episodes, the prompt responses to corticosteroids, the genetic bases for the familial clustering and therapeutic effects of tonsillectomy. This review explores PFAPA syndrome with the aim of describing the current clinical and scientific understanding of the condition.
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Affiliation(s)
- Per Wekell
- Department of Pediatrics, NU-Hospital Group, 45180 Uddevalla, Sweden; Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Glinton KE, Sharp EA, Mendelsohn MJ. An 8-Year-Old Male With Fever of Unknown Origin. Clin Pediatr (Phila) 2018; 57:1239-1242. [PMID: 29557188 DOI: 10.1177/0009922818765518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
Fever is a common symptom in children. Some children may present to their primary care physician with undifferentiated fever; that is, fever for which there is no obvious source from the history or physical examination. Undifferentiated fevers may be prolonged or recurrent. Distinguishing between the two is helpful for narrowing the differential diagnosis, which can be broad and include infections and inflammatory diseases and, rarely, malignancies and autoinflammatory disorders. The evaluation of such children requires a step-wise approach. Taking a detailed history, performing a thorough physical examination, and reviewing a fever and symptom diary is crucial in recognizing clues that may ultimately lead to a diagnosis. Some children who look good and whose fever disappears may never have a diagnosis, whereas referral to a specialist may be prudent for others. [Pediatr Ann. 2018;47(9):e347-e353.].
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Grimwood C, Kone-Paut I, Piram M, Rossi-Semerano L, Hentgen V. Health-related quality of life in children with PFAPA syndrome. Orphanet J Rare Dis 2018; 13:132. [PMID: 30092788 PMCID: PMC6085641 DOI: 10.1186/s13023-018-0878-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 07/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Conventionally, PFAPA syndrome is considered as a benign disease compared to other recurrent fevers because it completely passes before adulthood. However, in our clinical practice, fever episodes have a huge impact on daily activities. METHODS Observational cohort study using the Pediatric Quality of Life Inventory (PedsQL™ 4.0) Generic Core and Fatigue Scales. PedsQL™ uses a modular approach to measure the HRQOL in children with acute and chronic health conditions. We used pediatric FMF patients as the control group. RESULTS We included 33 children with PFAPA and compared them to 27 FMF patients matched for age: preschool-age children (2 to 7 years) and school-age children and youths (8 to18 years). PedsQL™ self-reported scores of children with PFAPA were systematically lower than those of FMF peers for general quality of life and physical and psychosocial functioning (significant only in the preschool-age group). PedsQL™ self-reported fatigue scores of children with PFAPA were significantly lower than those of FMF peers for both preschoolers and school-age children and youths. Parent proxy-reports were not significantly different, even though scores were systematically lower for the parents of PFAPA children. CONCLUSION Our study demonstrates, for the first time, that the wellbeing of PFAPA children is poor, with a major impact on psychosocial functioning and increased fatigue. The quality of life of PFAPA children appears to be even lower than that of FMF patients, for whom a lower than normal HRQOL has already been demonstrated.
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Affiliation(s)
- Claire Grimwood
- Department of Pediatrics, Ambroise Paré hospital, University of Versailles SQY, 9 avenue Charles de Gaulle, 92100 Boulogne Billancourt, France
| | - Isabelle Kone-Paut
- CEREMAIA, Pediatric rheumatology, Bicêtre hospital, APHP, university of Paris Sud, Le Kremlin Bicêtre, France
| | - Maryam Piram
- CEREMAIA, Pediatric rheumatology, Bicêtre hospital, APHP, university of Paris Sud, Le Kremlin Bicêtre, France
| | - Linda Rossi-Semerano
- CEREMAIA, Pediatric rheumatology, Bicêtre hospital, APHP, university of Paris Sud, Le Kremlin Bicêtre, France
| | - Véronique Hentgen
- CEREMAIA, departement of pediatrics, Versailles hospital, Versailles Le Chenay, France
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18
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Vanoni F, Federici S, Antón J, Barron KS, Brogan P, De Benedetti F, Dedeoglu F, Demirkaya E, Hentgen V, Kallinich T, Laxer R, Russo R, Toplak N, Uziel Y, Martini A, Ruperto N, Gattorno M, Hofer M. An international delphi survey for the definition of the variables for the development of new classification criteria for periodic fever aphtous stomatitis pharingitis cervical adenitis (PFAPA). Pediatr Rheumatol Online J 2018; 16:27. [PMID: 29669569 PMCID: PMC5907175 DOI: 10.1186/s12969-018-0246-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 04/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diagnosis of Periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) is currently based on a set of criteria proposed in 1999 modified from Marshall's criteria. Nevertheless no validated evidence based set of classification criteria for PFAPA has been established so far. The aim of this study was to identify candidate classification criteria PFAPA syndrome using international consensus formation through a Delphi questionnaire survey. METHODS A first open-ended questionnaire was sent to adult and pediatric clinicians/researchers, asking to identify the variables thought most likely to be helpful and relevant for the diagnosis of PFAPA. In a second survey, respondents were asked to select, from the list of variables coming from the first survey, the 10 features that they felt were most important, and to rank them in descending order from most important to least important. RESULTS The response rate to the first and second Delphi was respectively 109/124 (88%) and 141/162 (87%). The number of participants that completed the first and second Delphi was 69/124 (56%) and 110/162 (68%). From the first Delphi we obtained a list of 92 variables, of which 62 were selected in the second Delphi. Variables reaching the top five position of the rank were regular periodicity, aphthous stomatitis, response to corticosteroids, cervical adenitis, and well-being between flares. CONCLUSION Our process led to identification of features that were felt to be the most important as candidate classification criteria for PFAPA by a large sample of international rheumatologists. The performance of these items will be tested further in the next phase of the study, through analysis of real patient data.
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Affiliation(s)
- Federica Vanoni
- Department of Pediatrics, Ospedale San Giovanni, 6500, Bellinzona, Switzerland. .,Unité Romande d'Immuno-rhumatologie Pédiatrique, CHUV, University of Lausanne, Lausanne, and HUG, Geneva, Switzerland.
| | - Silvia Federici
- 0000 0004 1760 0109grid.419504.dIstituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Genoa, Italy
| | - Jordi Antón
- Pediatric Rheumatology, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona Spain
| | - Karyl S. Barron
- 0000 0001 2164 9667grid.419681.3NIH-NIAID, Division of Intramural Research, Bethesda, MD USA
| | - Paul Brogan
- Department of Infection, Inflammation and Rheumatology, Great Ormond St Hospital, London, UK
| | - Fabrizio De Benedetti
- 0000 0001 0727 6809grid.414125.7IRCCS Ospedale Pediatrico Bambino Gesù, Division of Rheumatology, Rome, Italy
| | - Fatma Dedeoglu
- 0000 0004 0378 8438grid.2515.3Division of Immunology, Rheumatology Program, Harvard Medical School Boston, Boston Children’s Hospital, Boston, MA USA
| | - Erkan Demirkaya
- 0000 0004 1936 8884grid.39381.30Division of Paediatric Rheumatology, Western University and Children’s Hospital LHSC, London, ON Canada
| | - Veronique Hentgen
- Hôpital A Mignot - Centre Hospitalier de Versailles, CEREMAIA, French reference center for autoinflammatory diseases and inflammatory amyloidosis, Le Chesnay (Paris), France
| | - Tilmann Kallinich
- 0000 0001 2218 4662grid.6363.0Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ronald Laxer
- 0000 0004 0473 9646grid.42327.30Departments of Pediatrics and Medicine, University of Toronto and The Hospital for Sick Children, Toronto, ON Canada
| | - Ricardo Russo
- 0000 0001 0695 6255grid.414531.6Servicio de Inmunología y Reumatología, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
| | - Natasa Toplak
- Department of Allergology, Rheumatology and Clinical Immunology, University Children’s Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Yosef Uziel
- 0000 0004 1937 0546grid.12136.37Meir Medical Centre, Pediatric Rheumatology Unit, Department of Pediatrics, Kfar Saba and Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Alberto Martini
- 0000 0004 1760 0109grid.419504.dIstituto Giannina Gaslini, Direzione Scientifica, Genoa, Italy
| | - Nicolino Ruperto
- 0000 0004 1760 0109grid.419504.dIstituto Giannina Gaslini, Direzione Scientifica, Genoa, Italy
| | - Marco Gattorno
- 0000 0004 1760 0109grid.419504.dIstituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Genoa, Italy
| | - Michael Hofer
- 0000 0001 0721 9812grid.150338.cUnité Romande d’Immuno-rhumatologie Pédiatrique, CHUV, University of Lausanne, Lausanne, and HUG, Geneva, Switzerland
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19
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Harel L, Hashkes PJ, Lapidus S, Edwards KM, Padeh S, Gattorno M, Marshall GS. The First International Conference on Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis Syndrome. J Pediatr 2018; 193:265-274.e3. [PMID: 29246466 DOI: 10.1016/j.jpeds.2017.10.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 10/11/2017] [Accepted: 10/13/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Liora Harel
- Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tiva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Philip J Hashkes
- Pediatric Rheumatology Unit, Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel; Hadassah Hebrew University School of Medicine, Jerusalem, Israel
| | - Sivia Lapidus
- Pediatric Rheumatology Division, Department of Pediatrics, Goryeb Children's Hospital, Morristown, NJ; Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Kathryn M Edwards
- Department of Pediatrics and Vaccine Research Program, Vanderbilt University School of Medicine, Nashville, TN; Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| | - Shai Padeh
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Pediatrics B, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Italy
| | - Marco Gattorno
- Rheumatology Unit, Department of Pediatrics G, Gaslini Scientific Institute for Children, Genoa, Italy; University of Genoa, Genoa, Italy
| | - Gary S Marshall
- Divison of Pediatric Infectious Diseases, University of Louisville School of Medicine, Louisville, KY
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Arkachaisri T, Tang SP, Daengsuwan T, Phongsamart G, Vilaiyuk S, Charuvanij S, Hoh SF, Tan JHT, Das L, Ang E, Lim W, Chan YH, Bernal CB. Paediatric rheumatology clinic population in Southeast Asia: are we different? Rheumatology (Oxford) 2017; 56:390-398. [PMID: 27994096 DOI: 10.1093/rheumatology/kew446] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Indexed: 12/12/2022] Open
Abstract
Objectives To examine the descriptive epidemiology of the patient population referred to paediatric rheumatology centres (PRCs) in Southeast Asia (SEA) and to compare the frequency of conditions encountered with other PRC populations. Methods A web-based Registry for Childhood Onset Paediatric Rheumatic Diseases was established in 2009 and seven PRCs in four SEA countries, where paediatric rheumatologists are available, participated in a prospective 24 month data collection (43 months for Singapore). Results The number of patients analysed was 4038 (788 from Malaysia, 711 from the Philippines, 1943 from Singapore and 596 from Thailand). Over 70% of patients evaluated in PRCs in Malaysia, the Philippines and Thailand had rheumatic diseases (RDs), as compared with one-half of the proportion seen in Singaporean PRCs, which was similar to the Western PRC experience. Among RDs diagnosed (n = 2602), JIA was the most common disease encountered in Malaysia (41%) and Thailand (61%) as compared with systemic vasculitides in the Philippines (37%) and Singapore (35%) among which Henoch-Schönlein purpura was the most prevalent. SLE and related diseases were more common, but idiopathic pain syndrome and abnormal immunological laboratory tests were rarer than those seen in the West. JIA subtype distributions were different among countries. Among non-RDs (n = 1436), orthopaedic and related conditions predominated (21.7-59.4%). Conclusion The frequencies of RDs seen by SEA PRCs were different from those in the West. Systemic vasculitides and SLE were common in addition to JIA. Paediatric rheumatologist availability and healthcare accessibility partially explain these observed discrepancies.
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Affiliation(s)
- Thaschawee Arkachaisri
- Rheumatology and Immunology Service, Department of Pediatric Subspecialties, KK Women's and Children's Hospital.,Department of Paediatrics, Duke-NUS Graduate Medical School
| | - Swee-Ping Tang
- Pediatric Rheumatology Unit, Selayang Hospital, Kuala Lumpur, Malaysia
| | | | - Gun Phongsamart
- Department of Pediatrics, Queen Sirikit National Institute of Child Health
| | - Soamarat Vilaiyuk
- Division of Pediatric Rheumatology, Department of Pediatrics, Ramathibodi Hospital
| | - Sirirat Charuvanij
- Division of Pediatric Rheumatology, Department of Pediatrics, Siriraj Hospital, Bangkok, Thailand
| | - Sook Fun Hoh
- Division of Nursing, KK Women's and Children's Hospital
| | - Justin Hung Tiong Tan
- Rheumatology and Immunology Service, Department of Pediatric Subspecialties, KK Women's and Children's Hospital
| | - Lena Das
- Rheumatology and Immunology Service, Department of Pediatric Subspecialties, KK Women's and Children's Hospital
| | - Elizabeth Ang
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics
| | - Wendy Lim
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Christine B Bernal
- Pediatric Rheumatology Section, Department of Pediatrics, University of Santo Tomas Hospital, Manila, Philippines
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21
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Lantto U, Koivunen P, Tapiainen T, Renko M. Long-Term Outcome of Classic and Incomplete PFAPA (Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis) Syndrome after Tonsillectomy. J Pediatr 2016; 179:172-177.e1. [PMID: 27692464 DOI: 10.1016/j.jpeds.2016.08.097] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 08/19/2016] [Accepted: 08/30/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare the effectiveness of tonsillectomy and the long-term outcome of periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome in patients fulfilling the classic diagnostic criteria and in those with regularly recurring fever as the only symptom or with onset of symptoms after age 5 years or both. STUDY DESIGN We reviewed the medical records of 3852 children who underwent tonsillectomy between 1990 and 2007 and identified 108 children who did so because of regularly recurring fevers. The patients were invited to an outpatient visit and were classified into 2 groups: those who met (N = 58) and those who did not meet (N = 50) Thomas diagnostic criteria. We then compared the clinical profile and outcome of PFAPA symptoms after tonsillectomy between the 2 groups. RESULTS In the group that met Thomas criteria, 97% (56/58) had complete resolution of fever episodes after tonsillectomy; in the group that did not meet Thomas criteria (50/50) had complete resolution of fever episodes after tonsillectomy (P = .25). The clinical profile of the periodic fevers and the occurrence of other illnesses during follow-up were similar in both groups. Thomas criteria identified 56 of 106 patients responding to tonsillectomy. CONCLUSIONS Tonsillectomy was an effective treatment for patients with regularly recurring fever episodes who failed to meet the classic Thomas criteria. We suggest that PFAPA syndrome should be suspected and tonsillectomy considered in children with a late onset of symptoms (>5 years of age) or when fever is the only symptom during the episodes.
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Affiliation(s)
- Ulla Lantto
- PEDEGO Research Unit, Department of Pediatrics, Medical Research Center, University of Oulu, Oulu, Finland; Department of Otorhinolaryngology, Oulu University Hospital, Oulu, Finland.
| | - Petri Koivunen
- PEDEGO Research Unit, Department of Pediatrics, Medical Research Center, University of Oulu, Oulu, Finland; Department of Otorhinolaryngology, Oulu University Hospital, Oulu, Finland
| | - Terhi Tapiainen
- PEDEGO Research Unit, Department of Pediatrics, Medical Research Center, University of Oulu, Oulu, Finland; Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Marjo Renko
- PEDEGO Research Unit, Department of Pediatrics, Medical Research Center, University of Oulu, Oulu, Finland; Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
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22
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Wekell P, Karlsson A, Berg S, Fasth A. Review of autoinflammatory diseases, with a special focus on periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis syndrome. Acta Paediatr 2016; 105:1140-51. [PMID: 27426283 PMCID: PMC5095866 DOI: 10.1111/apa.13531] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 06/09/2016] [Accepted: 07/14/2016] [Indexed: 12/11/2022]
Abstract
There have been remarkable developments in the field of autoinflammatory diseases over the last 20 years. Research has led to definitions of new conditions, increased understanding of disease mechanisms and specific treatment. The polygenic autoinflammatory condition of periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) is the most common autoinflammatory disorder among children in many parts of the world. The clinical features often include clockwork regularity of episodes, prompt responses to corticosteroids and therapeutic effects of tonsillectomy, but the disease mechanisms are largely unknown. Conclusion This review discusses the emerging understanding of autoinflammatory diseases, with special emphasis on PFAPA.
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Affiliation(s)
- Per Wekell
- Department of Pediatrics NU‐Hospital Group Uddevalla Sweden
- Department of Pediatrics Institute of Clinical Sciences, University of Gothenburg Gothenburg Sweden
| | - Anna Karlsson
- Department of Rheumatology and Inflammation Research Institute of Medicine, University of Gothenburg Gothenburg Sweden
| | - Stefan Berg
- Department of Pediatrics Institute of Clinical Sciences, University of Gothenburg Gothenburg Sweden
- The Queen Silvia Children's Hospital Gothenburg Sweden
| | - Anders Fasth
- Department of Pediatrics Institute of Clinical Sciences, University of Gothenburg Gothenburg Sweden
- The Queen Silvia Children's Hospital Gothenburg Sweden
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23
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Statler VA, Marshall GS. Characteristics of Patients Referred to a Pediatric Infectious Diseases Clinic With Unexplained Fever. J Pediatric Infect Dis Soc 2016; 5:249-56. [PMID: 26407248 DOI: 10.1093/jpids/piv008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 02/03/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Older case series established diagnostic considerations for children meeting a priori definitions of fever of unknown origin (FUO). No recent study has examined the final diagnoses of children referred for unexplained fever. METHODS This study was conducted with a retrospective chart review of patients referred to a pediatric infectious diseases clinic from 2008 to 2012 for unexplained fever. RESULTS Sixty-nine of 221 patients were referred for "prolonged" unexplained fever. Ten of these were not actually having fever, and 11 had diagnoses that were readily apparent at the initial visit. The remaining 48 were classified as having FUO. The median duration of reported fever for these patients was 30 days; 15 had a diagnosis made, 5 of which were serious. None of the serious FUO diagnoses were infections. Of 152 patients with "recurrent" unexplained fever, 92 had an "intermittent" fever pattern, and most of these had sequential, self-limited viral illnesses or no definitive diagnosis made. Twenty of the 60 patients with a "periodic" fever pattern were diagnosed with periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome. Overall, 166 patients either were not having fever, had self-limited illnesses, or ultimately had no cause of fever discovered. Only 12 had a serious illness, 2 of which were infections (malaria and typhoid fever). CONCLUSIONS Most children referred with unexplained fever had either self-limited illnesses or no specific diagnosis established. Serious diagnoses were unusual, suggesting that these diagnoses rarely present with unexplained fever alone, or that, when they do, the diagnoses are made by primary care providers or other subspecialists.
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Affiliation(s)
- Victoria A Statler
- Division of Pediatric Infectious Diseases, University of Louisville School of Medicine, Louisville, Kentucky
| | - Gary S Marshall
- Division of Pediatric Infectious Diseases, University of Louisville School of Medicine, Louisville, Kentucky
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Abstract
BACKGROUND Linezolid serves as an important component for the treatment of drug-resistant tuberculosis although there is little published data about linezolid use in children, especially in childhood tuberculous meningitis (TBM). METHODS In this study, we retrospectively reviewed records of childhood TBM patients who started treatment between January 2012 and August 2014. A total of 86 childhood TBM patients younger than 15 years old were enrolled. Out of 86 children, 36 (41.9%) received the regimen containing linezolid. RESULTS Thirty-two (88.9%) of 36 linezolid-treated cases had favorable outcomes, and 35 (70.0%) cases were successfully treated in the control group. The frequency of favorable outcome of linezolid group was significantly higher than that of control group (P = 0.037). In addition, compared with cases with fever clearance time of <1 week, the control group had more cases with fever clearance time of 1-4 weeks (P = 0.010) and >4 weeks (P = 0.000) than linezolid group. Furthermore, there was no significant difference in the frequency of adverse events between the two regimens (P = 0.896). In addition, the patients with adverse events were more likely to have treatment failure, the P value of which was 0.008. CONCLUSIONS Our data demonstrate that linezolid improves early outcome of childhood TBM. The low frequency of linezolid-associated adverse effects highlights the promising prospects of its use for treatment of childhood TBM.
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25
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Torreggiani S, Filocamo G, Esposito S. Recurrent Fever in Children. Int J Mol Sci 2016; 17:448. [PMID: 27023528 PMCID: PMC4848904 DOI: 10.3390/ijms17040448] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/13/2016] [Accepted: 03/21/2016] [Indexed: 12/16/2022] Open
Abstract
Children presenting with recurrent fever may represent a diagnostic challenge. After excluding the most common etiologies, which include the consecutive occurrence of independent uncomplicated infections, a wide range of possible causes are considered. This article summarizes infectious and noninfectious causes of recurrent fever in pediatric patients. We highlight that, when investigating recurrent fever, it is important to consider age at onset, family history, duration of febrile episodes, length of interval between episodes, associated symptoms and response to treatment. Additionally, information regarding travel history and exposure to animals is helpful, especially with regard to infections. With the exclusion of repeated independent uncomplicated infections, many infective causes of recurrent fever are relatively rare in Western countries; therefore, clinicians should be attuned to suggestive case history data. It is important to rule out the possibility of an infectious process or a malignancy, in particular, if steroid therapy is being considered. After excluding an infectious or neoplastic etiology, immune-mediated and autoinflammatory diseases should be taken into consideration. Together with case history data, a careful physical exam during and between febrile episodes may give useful clues and guide laboratory investigations. However, despite a thorough evaluation, a recurrent fever may remain unexplained. A watchful follow-up is thus mandatory because new signs and symptoms may appear over time.
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Affiliation(s)
- Sofia Torreggiani
- Pediatric Medium Intensive Care Unit, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Giovanni Filocamo
- Pediatric Medium Intensive Care Unit, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
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Pastore S, Vuch J, Bianco AM, Taddio A, Tommasini A. Fever tree revisited: From malaria to autoinflammatory diseases. World J Clin Pediatr 2015; 4:106-112. [PMID: 26566482 PMCID: PMC4637800 DOI: 10.5409/wjcp.v4.i4.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/20/2015] [Accepted: 09/08/2015] [Indexed: 02/06/2023] Open
Abstract
Over the centuries the idea of recurrent fevers has mainly been associated with malaria, but many other fevers, such as typhoid and diphtheria were cause for concern. It is only in recent times, with the more severe forms of fever from infectious origin becoming less frequent or a cause for worry that we started noticing recurrent fevers without any clear infectious cause, being described as having a pathogenesis of autoinflammatory nature. The use of molecular examinations in many cases can allow a diagnosis where the cause is monogenic. In other cases, however the pathogenesis is likely to be multifactorial and the diagnostic-therapeutic approach is strictly clinical. The old fever tree paradigm developed to describe fevers caused by malaria has been revisited here to describe today’s periodic fevers from the periodic fever adenitis pharyngitis aphthae syndrome to the more rare autoinflammatory diseases. This model may allow us to place cases that are yet to be identified which are likely to be of multifactorial origin.
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27
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Piram M, Koné-Paut I. [Recurrent fevers in childhood]. Presse Med 2015; 44:1266-75. [PMID: 26549686 DOI: 10.1016/j.lpm.2015.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 07/07/2015] [Accepted: 09/03/2015] [Indexed: 10/22/2022] Open
Abstract
Recurrent fevers are defined as multiple stereotypical febrile episodes separated by spontaneous symptom-free intervals and occurring for months and years. Hereditary recurrent fevers are rare prototype Mendelian diseases due to inherited mutations in genes encoding partners of the innate immunity. Recurrent episodes of fever plus acute features of inflammation starting during childhood with family history are the main clues for suspecting HRF. Their common associated complication is AA amyloidosis. The diagnosis is made on clinical grounds but the genetic diagnosis may contribute in most cases of monogenic hereditary recurrent fevers. Recurrent fevers must be distinguished from intermittent fevers, mostly infectious, characterized by variation in associated symptoms from episode-to-episode and without periodicity.
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Affiliation(s)
- Maryam Piram
- AP-HP, université Paris Sud, CHU de Bicêtre, centre de référence des maladies auto-inflammatoires de l'enfant (CeRéMAI)(1), service de rhumatologie pédiatrique, 78, rue du Général-Leclerc, 94270 le Kremlin-Bicêtre, France.
| | - Isabelle Koné-Paut
- AP-HP, université Paris Sud, CHU de Bicêtre, centre de référence des maladies auto-inflammatoires de l'enfant (CeRéMAI)(1), service de rhumatologie pédiatrique, 78, rue du Général-Leclerc, 94270 le Kremlin-Bicêtre, France
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