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Tonsillectomy beneficial for recurring fevers :

December 6, 2016

Children with recurring fevers appear to benefit from tonsillectomy even if they don’t meet the criteria for periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome.

“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,” researchers wrote in a new study.


PFAPA affects about 2.3 in 10,000 children under age 5 years and is “the most common pediatric inflammatory fever syndrome,” according to the study. Symptoms typically continue for four to five years if the child does not undergo a tonsillectomy.

Children with PFAPA experience recurring fevers that begin before age 5 and are accompanied by at least one of the clinical signs of the classic Thomas criteria (aphthous stomatitis, pharyngitis or adenitis) without upper respiratory infection. These children are asymptomatic between episodes, developing normally and do not have cyclic neutropenia.

In this study of 108 children in Finland who underwent a tonsillectomy, just over half met the criteria. The others were older than 5 when symptoms began or did not have one of the namesake signs.

Tonsillectomy proved to be effective in resolving recurring fever episodes for about 97% of children meeting Thomas criteria and all of those who did not meet the criteria.

Authors suggested broadening consideration of tonsillectomy.

“Had the clinical decision to perform tonsillectomy been based strictly on Thomas criteria, 47% of our patients would not have received effective treatment,” they wrote.

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