Acıbadem Altunizade Hospital Pediatrics, Pediatric Rheumatology Specialist Assoc. Dr. Ferhat Demir says that PFAPA Syndrome is one of the most common causes of unnecessary antibiotic use in children over the age of one. Pediatric Rheumatology Specialist Assoc. Dr. Ferhat Demir explained 9 important points to know about PFAPA syndrome (recurrent fever), which can be seen in all seasons, and made important warnings and suggestions.
9 IMPORTANT POINTS TO KNOW ABOUT PFAPA SYNDROME!
PFAPA syndrome is an additional common rheumatic periodic fever disease of childhood, which usually lasts between 3-6 days and goes away spontaneously, frequently recurring, with persistent fever, pharyngitis, tonsillitis (tonsillitis), mouth sores and lymph node enlargement findings. Assoc. Dr. Ferhat Demir “PFAPA syndrome is not an infection, and it is not a condition that requires antibiotics at all. It is not contagious. The most common misapplication we see in this disease is that children use antibiotics for unnecessary reasons, sometimes several times a month, considering that they have beta microbes or throat infections.
ATTENTION TO THESE SYMPTOMS
In children, fever, which reaches 39-40 degrees with an interval of 3-4 weeks, develops. The attack range may decrease up to a week or expand to two-three months. The most common finding accompanying fever is the presence of white plaques on the tonsils in the throat. Enlargement of the neck lymph nodes, pharyngitis-tonsillitis, sores in the mouth, joint pain, more rarely rash, abdominal pain and diarrhea may accompany. Between the attacks, the children are completely healthy and there is no effect on growth and development due to the disease.
CAN BE FAMILY TRANSFERRED
In PFAPA Syndrome (recurrent fever), attacks often begin between the ages of 2-5 and disappear by the age of 7-8 years. In some patients, these attacks may continue in adolescence and adulthood. Researches; Although a genetic cause cannot be determined exactly, it suggests that the disease may show familial transmission. In our own clinical experience, we can see that in certain patients, such as parents-uncle-aunt-aunt-uncle, there are similar findings in childhood, and the findings cease after tonsillectomy.
EVERY SEASON CAN BE VIEWED
One of the features of the disease is that it does not observe the seasons, unlike other infections; Although it is more common in winter and spring, PFAPA attacks can develop in any season. The reason why it is more common in some seasons is that possible viral infections can trigger the PFAPA attack by stimulating the immune system. In this respect, families of children with PFAPA should be more protective and careful about upper respiratory tract infections. Children should not be restricted from their school and social life as long as their general condition is good.
MAIN REASON; INTENSIVE WORK OF THE IMMUNE SYSTEM
Pediatric Rheumatology Specialist Assoc. Dr. Ferhat Demir said, “While the immune system is working intensively in PFAPA syndrome, symptoms similar to infectious diseases may develop and cause patients to receive unnecessary treatments as if they have an infection. “With current scientific data, it’s not known for sure what causes it, but we do know that certain genetic conditions can pose a risk for this disease.”
CAN BE MIXED WITH OTHER DISEASES
The diagnosis of the disease is made by a doctor’s examination and the appearance of similar attacks of the patient. In laboratory tests, heights are seen as if there is a microbial condition in the body. Before making a diagnosis of PFAPA, it is necessary to exclude other diseases that may cause similar findings. Because, in addition to other infectious diseases, the findings of FMF, which is common in our country, and a few rheumatic periodic fever syndromes can be confused with PFAPA.
ATTENTION TO THIS POINT IN TREATMENT
Assoc. Dr. Ferhat Demir said, “Although steroid (cortisol) treatment is frequently used and beneficial during relapse periods, an undesirable side effect of steroid application is that it causes shortening of attack intervals. After steroid administration, attacks may become more frequent up to once a week. In this respect, steroid therapy is not a treatment method that we recommend to be used every month or more frequently. For this reason, after the evaluation of the pediatric rheumatologist and exclusion of other rheumatic causes, additional treatments can be given to help reduce the frequency of attacks, if necessary. Adeno-tonsillectomy (nasal and tonsil surgery) is the most effective treatment method that provides complete termination of attacks in 85-90% of patients. There are higher-level treatment options for patients whose symptoms persist and persist despite tonsil surgery.
CONTINUOUS FOLLOW-UP IS REQUIRED
PFAPA does not cause any permanent problems. It does not retard growth and development, but it can cause febrile convulsions due to high fever in children with low seizure threshold. Diagnosed patients should definitely follow up with a pediatric rheumatologist. Since PFAPA disease is basically a rheumatic fever disease, it is strongly recommended that these children be evaluated in terms of other periodic rheumatic fever diseases.
EARLY DIAGNOSIS AND TREATMENT IS VERY IMPORTANT
Assoc. Dr. Ferhat Demir said, “The biggest problem we experience due to the disease is the serious decrease in the quality of life of both the child and the family. This is more prominent especially in children who have attacks once a month or more frequently. For this reason, children’s school life may also be interrupted. In this respect, our main goal should be to make a good differential diagnosis in the early period and to reduce or completely eliminate the frequency and severity of attacks with effective treatment.