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C-reactive protein and procalcitonin during febril attacks in PFAPA syndrome
Hamza Yazgan1, Esengül Keleş, Zerrin Yazgan
1Dept of Pediatrics, Sema Hospital, Turkey. hyazgan@semahastanesi.com.tr
Insights
In children with periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA), C-reactive protein (CRP) levels are high during fevers, but procalcitonin (PCT) levels remain normal. This finding helps differentiate PFAPA flares from infections.
Area of Science:
- Pediatrics
- Immunology
- Infectious Diseases
Background:
- Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) is a common autoinflammatory disorder in children.
- Distinguishing PFAPA febrile attacks from bacterial infections is crucial for appropriate management.
Purpose of the Study:
- To evaluate serum procalcitonin (PCT) and C-reactive protein (CRP) levels in pediatric patients during PFAPA febrile episodes.
- To compare PCT and CRP levels in PFAPA patients with those in children diagnosed with pneumonia.
Main Methods:
- Prospective study of 23 children with PFAPA over three years, recording CRP and PCT during 78 febrile episodes.
- A control group of 20 children with pneumonia had their CRP and PCT levels measured.
- Normal reference ranges: CRP 0-10 mg/L, PCT 0-0.5 ng/mL.
Main Results:
- PFAPA patients exhibited elevated CRP (mean 94.8±71.6 mg/L) but normal PCT (mean 0.29±0.14 ng/mL) during febrile attacks.
- Pneumonia patients showed significantly higher CRP (mean 153.2±26 mg/L) and PCT (mean 1.59±0.53 ng/mL).
- PCT levels were significantly lower in PFAPA patients compared to the pneumonia control group (p<0.001).
Conclusions:
- Elevated CRP with normal PCT levels during febrile episodes suggests PFAPA.
- Combined assessment of CRP and PCT may aid in differentiating PFAPA from infections.
- Larger cohort studies are needed to validate these findings.
Objectives:
To assess the levels of procalcitonin (PCT) and C-reactive protein (CRP) in children diagnosed with PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis) during their febrile attacks.
Methods:
23 patients with diagnosis of PFAPA included into the study prospectively during a three years period. In these patients, CRP and PCT values were recorded during 78 febrile episodes. Furthermore, 20 patients with diagnosis of pneumonia were chosen as a control group and their CRP and PCT values were measured. Normal reference values for CRP and PCT were 0-10 mg/L and 0-0.5 ng/mL, respectively.
Results:
Mean CRP and PCT values of patients with PFAPA were 94.8±71.6 mg/L and 0.29±0.14 ng/mL, respectively. In control group, mean CRP value was 153.2±26 mg/L and PCT was 1.59±0.53 ng/mL. CRP and PCT were high in control group. CRP was detected high and PCT was normal in PFAPA. Compared to control group, in PFAPA group, CRP values were not significantly (p>0.05) and PCT values were significantly lower (p<0.001).
Conclusion:
During febrile episodes in the patients with diagnosis of PFAPA, CRP values were substantially elevated, whereas PCT values were within normal levels. Concomitant assessment of CRP and PCT in addition to clinical diagnostic criteria may be of help in making diagnosis and distinguishing febrile attacks from infections. However, studies in larger groups are required.
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