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American Family Physician Apr 2024
Topics: Humans; Pharyngitis; Anti-Bacterial Agents
PubMed: 38648823
DOI: No ID Found -
Pediatrics International : Official... Jan 2022Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is an autoinflammatory disease occurring in children. Although PFAPA is the most...
BACKGROUND
Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is an autoinflammatory disease occurring in children. Although PFAPA is the most common periodic fever syndrome found in children, there are only a few studies defining the clinical characteristics and the efficacy of treatment strategies among Japanese children. This study aimed to clarify the demographic characteristics and clinical features of patients with PFAPA syndrome and to evaluate treatment efficacy.
METHODS
We retrospectively reviewed the clinical features of children with PFAPA who visited Saitama Children's Medical Center between January and December 2019. We also evaluated treatment strategies and their efficacy; abortive treatment with corticosteroids, prophylaxis with cimetidine or colchicine, and surgical management with tonsillectomy.
RESULTS
A total of 100 Japanese children (61% male) with PFAPA were included. Median age of onset was 3 years, median duration of fever episodes was 5 days, and median interval between episodes was 4 weeks. The symptoms (frequencies) were pharyngitis (89%), exudate on tonsils (71%), cervical adenitis (50%), and aphthous stomatitis (49%). Approximately 37% of patients took prednisolone for aborting fever attacks, showing a 100% response; 93% were treated with cimetidine, showing an 79.6% response, and 18% were treated with colchicine, showing a 66.7% response. Only one patient underwent tonsillectomy.
CONCLUSIONS
Among Japanese children with PFAPA, 28% of them were ≥5 years with a male predominance. Pharyngitis is the most frequent symptom associated with fever. Cimetidine is suitable for initial therapy because of its safety and efficacy.
Topics: Child; Cimetidine; Colchicine; Female; Fever; Humans; Infant, Newborn; Japan; Lymphadenitis; Lymphadenopathy; Male; Pharyngitis; Prednisolone; Retrospective Studies; Stomatitis, Aphthous; Syndrome; Tonsillectomy; Treatment Outcome
PubMed: 36134651
DOI: 10.1111/ped.15294 -
Clinical Pediatrics Oct 2020Pharyngitis is commonly diagnosed in the emergency department (ED) and accounts for substantial antibiotic burden in pediatrics. This study describes ED patterns of...
Pharyngitis is commonly diagnosed in the emergency department (ED) and accounts for substantial antibiotic burden in pediatrics. This study describes ED patterns of group A streptococcal (GAS) pharyngitis diagnosis and antibiotic prescribing patterns. This was a secondary data analysis of the National Hospital Ambulatory Medical Care Survey. Diagnosis and antibiotic treatment for GAS and non-GAS (viral) pharyngitis were reported in all ages and specifically examined in children <3 years of age from 2010 to 2015. GAS pharyngitis was diagnosed in 29% of visits for children with pharyngitis; however, 60% of patients with any pharyngitis received antibiotics. Twenty percent of children <3 years were diagnosed with GAS pharyngitis, yet over half were given antibiotics. Broad-spectrum antibiotics were commonly prescribed. Antibiotic treatment of pharyngitis, including broad-spectrum antibiotics, remains high when compared with the known prevalence of GAS pharyngitis. Diagnosis and treatment of GAS pharyngitis in patients <3 years persists despite recommendations against testing.
Topics: Anti-Bacterial Agents; Antimicrobial Stewardship; Child; Child, Preschool; Emergency Service, Hospital; Female; Humans; Male; Pharyngitis; Practice Patterns, Physicians'; Streptococcal Infections
PubMed: 32501119
DOI: 10.1177/0009922820927042 -
Acta Paediatrica (Oslo, Norway : 1992) Aug 2019Periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome is the most common cause of a periodic fever in childhood. The exact pathogenesis... (Review)
Review
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.
Topics: Child, Preschool; Diagnosis, Differential; Fever; Humans; Lymphadenitis; Pharyngitis; Stomatitis, Aphthous; Syndrome
PubMed: 30901126
DOI: 10.1111/apa.14792 -
Annals of Emergency Medicine May 2022
Topics: Humans; Intubation, Intratracheal; Male; Pharyngitis
PubMed: 35461578
DOI: 10.1016/j.annemergmed.2021.11.002 -
European Archives of... Aug 2020To evaluate the long-term treatment results of patients with PFAPA syndrome and to determine their need for tonsillectomy.
OBJECTIVE
To evaluate the long-term treatment results of patients with PFAPA syndrome and to determine their need for tonsillectomy.
MATERIALS AND METHODS
The clinical characteristics, treatments and long-term results of 16 patients admitted to the Pediatric and Otorhinolaryngology Clinic between 2015 and 2019 were retrospectively analyzed.
RESULTS
Twelve male and four female patients were examined between 1.5 and 8 years (mean age 4.8 ± 1.1) (75% male, 25% female). The mean duration of attacks was 4.4 ± 1.4 weeks. Twelve patients recovered completely with single-dose steroid therapy. In the 4-year follow-up of 12 patients who were given a single dose of steroid therapy, there were no relapses. Surgical decisions were made for four patients whose attacks did not pass with steroid treatment. Two patients (75%) underwent adenotonsillectomy, and one patient underwent tonsillectomy While three of these patients did not have an attack again, one patient continued to have an attack every 8 weeks. At the age of 9, his attacks were completely resolved spontaneously. All patients had fever. The most common concomitant symptoms were pharyngitis (94%), cervical adenitis (82%) and aphthous stomatitis (77%). Exudative tonsillitis was present in 25% of the patients.
CONCLUSION
Medical treatment should be the first treatment option in patients with PFAPA syndrome. Although single-dose steroid treatment is effective in these patients, tonsillectomy is an important treatment option in refractory cases.
Topics: Adenoidectomy; Child; Child, Preschool; Female; Humans; Lymphadenitis; Male; Pharyngitis; Retrospective Studies; Stomatitis, Aphthous; Tonsillectomy
PubMed: 32239314
DOI: 10.1007/s00405-020-05943-7 -
BioMed Research International 2022The study aimed to explore the active composition and mechanism of the Chaiqin Qingning capsule (CQQN) against pharyngitis based on the network pharmacology and through...
OBJECTIVE
The study aimed to explore the active composition and mechanism of the Chaiqin Qingning capsule (CQQN) against pharyngitis based on the network pharmacology and through using a pharyngitis rat model.
METHODS
The active ingredients and targets of CQQN were queried using the TCMSP database. Disease-related target genes were queried in the DrugBank, GeneCards, OMIM, and DisGeNEt databases using "pharyngitis" as the search term. The STRING database was used to establish a protein-protein interaction (PPI) network. GO function enrichment and KEGG pathway enrichment analyses were performed to identify active components and key targets. Cytoscape software (version 3.7.2) was used to construct an active component/target gene/enrichment pathway network. AutoDock software was used to select the best binding target for molecular docking. The effect of CQQN was verified in the pharyngitis rats.
RESULTS
Network pharmacology showed 30 active compounds in CQQN with 240 targets, including 54 for the treatment of pharyngitis. Potential active ingredients included quercetin, kaempferol, stigmasterol, saikosaponin D, and isorhamnetin. The key targets involved were AKT1, TNF, IL-6, and IL-1. Signaling pathways included virus infection, TNF, IL-17, and cancer pathways. The molecular docking results showed that the critical components in CQQN had good potential for binding to key target genes. Animal experiments showed that CQQN could significantly reduce the expression of TNF-, IL-1, IL-6, and IL-17 in the serum of rats with pharyngitis ( < 0.05). Hematoxylin and eosin staining showed that the inflammatory state of pharyngeal tissue in rats was significantly reduced compared to that in the model group.
CONCLUSION
CQQN can improve pharyngitis by regulating the TNF and IL-17 signaling pathways. The study makes a positive exploration and provides a new idea for a more comprehensive and in-depth excavation of CQQN with an intervention effect on pharyngitis and other upper respiratory diseases in the future.
Topics: Animals; Drugs, Chinese Herbal; Interleukin-17; Interleukin-6; Medicine, Chinese Traditional; Molecular Docking Simulation; Pharyngitis; Rats
PubMed: 35528163
DOI: 10.1155/2022/5616942 -
The Journal of Emergency Medicine Jan 2022
Topics: Humans; Intubation, Intratracheal; Pharyngitis
PubMed: 34893383
DOI: 10.1016/j.jemermed.2021.10.024 -
Pediatric Rheumatology Online Journal Sep 2023Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is the most common periodic fever syndrome in children; by definition, episodes...
OBJECTIVE
Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is the most common periodic fever syndrome in children; by definition, episodes occur every 2 to 8 weeks. However, in a subset of our patients, we noticed a higher frequency of attacks, of less than 2 weeks, which we refer to as extreme PFAPA (ePFAPA). This group consisted of patients who were extreme upon presentation of PFAPA, and those who became extreme after initiation of abortive corticosteroid treatment. We aimed to characterize demographic and clinical features of ePFAPA, including the two groups, and to compare them to patients with non-extreme PFAPA (nPFAPA).
STUDY DESIGN
The medical records of 365 patients with PFAPA who attended Schneider Children's Medical Center of Israel from March 2014 to April 2021 were reviewed. Patients with concomitant familial Mediterranean fever were excluded. Characteristics of the ePFAPA (including subgroups) and nPFAPA groups were compared using Wilcoxon rank sum, Pearson's chi-squared, and Fisher's exact tests.
RESULTS
Forty-seven patients (12.9%) were identified as having ePFAPA. Among patients with ePFAPA, compared to patients with nPFAPA, the median (interquartile range) age at disease onset was earlier: 1.5 years (0.7-2.5) vs. 2.5 years (1.5-4.0), P < 0.001; and diagnosis was younger: 2.6 years (2.0-3.6) vs. 4.5 years (3.0-6.2), P < 0.001. A higher proportion of patients with ePFAPA than nPFAPA were treated with colchicine prophylaxis (53% vs. 19%, P < 0.001), but symptoms and signs during flares did not differ significantly between these groups. Demographic and clinical characteristics were similar between patients with ePFAPA from presentation of PFAPA (22, 47% of those with ePFAPA) and ePFAPA from after corticosteroid treatment.
CONCLUSION
About half the patients categorized with ePFAPA syndrome already had extreme features upon presentation. Patients with ePFAPA compared to nPFAPA presented and were diagnosed at an earlier age.
Topics: Child; Humans; Infant; Stomatitis, Aphthous; Lymphadenitis; Lymphadenopathy; Familial Mediterranean Fever; Pharyngitis; Syndrome
PubMed: 37658370
DOI: 10.1186/s12969-023-00880-1 -
Military Medicine Sep 2020
Topics: Adult; Goals; Humans; Pharyngitis; Streptococcal Infections
PubMed: 32207526
DOI: 10.1093/milmed/usaa057