Evidence map›Paper›PMID 41972166›Full record

ArticleFrontiers in immunology2026

The etiological spectrum of pediatric FUO and clinical management of PFAPA/SURF: a ten-year retrospective study.

Chenchen Guan, Qinhua Zhou, Jinqiao Sun, Wenjing Ying, Xiaoying Hui, Jia Hou, Lipin Liu, Chenghao Wang, Luyao Liu, Bijun Sun and 2 more

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Article in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Chenchen GuanDepartment of Clinical Immunology and Allergy, Children's Hospital of Fudan University, Shanghai, China.
Qinhua ZhouDepartment of Clinical Immunology and Allergy, Children's Hospital of Fudan University, Shanghai, China.
Jinqiao SunDepartment of Clinical Immunology and Allergy, Children's Hospital of Fudan University, Shanghai, China.
Wenjing YingDepartment of Clinical Immunology and Allergy, Children's Hospital of Fudan University, Shanghai, China.
Xiaoying HuiDepartment of Clinical Immunology and Allergy, Children's Hospital of Fudan University, Shanghai, China.
Jia HouDepartment of Clinical Immunology and Allergy, Children's Hospital of Fudan University, Shanghai, China.
Lipin LiuDepartment of Clinical Immunology and Allergy, Children's Hospital of Fudan University, Shanghai, China.
Chenghao WangDepartment of Clinical Immunology and Allergy, Children's Hospital of Fudan University, Shanghai, China.
Luyao LiuDepartment of Clinical Immunology and Allergy, Children's Hospital of Fudan University, Shanghai, China.
Bijun SunDepartment of Clinical Immunology and Allergy, Children's Hospital of Fudan University, Shanghai, China.
Wenjie WangDepartment of Clinical Immunology and Allergy, Children's Hospital of Fudan University, Shanghai, China.
Xiaochuan WangDepartment of Clinical Immunology and Allergy, Children's Hospital of Fudan University, Shanghai, China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: This study aimed to define the etiologies and clinical features of pediatric Fever of unknown origin (FUO), focusing on periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) and the syndrome of undifferentiated recurrent fever (SURF), to guide clinical management. Methods: We retrospectively analyzed pediatric FUO cases at Fudan University Children's Hospital (2014-2024.6), assessing clinical characteristics, immune phenotypes, laboratory parameters, and treatment responses with at least one-year follow-up. Results: Among 442 children (64.7% male), the mean age at onset was 3.42years. Infectious diseases accounted for 20.6%, mainly EBV infection. Autoinflammatory diseases were predominant (n=291), including PFAPA (n=135), and SURF (n=72). PFAPA presented earlier (mean age, 2.25 years) with regular episodes (median interval, every 25 days). SURF showed variable intervals (range, 7-120 days) and was classified as periodic (n = 38) or non-periodic (n = 34) subtypes. Isolated fever occurred in 21% of SURF periodic, whereas SURF non-periodic more often involved systemic symptoms (fatigue, headache, urticaria, and gastrointestinal complaints). During attacks, both PFAPA and SURF showed elevated CRP/ESR with neutrophilia/monocytosis and lymphopenia. Corticosteroids aborted PFAPA episodes in 90.9% but shortened afebrile intervals in 31.8%; tonsillectomy resulted in a 90.5% complete remission rate. Among non-surgical treatments, immunomodulation proved beneficial, with OM-85 yielding 45.0% complete remission and 65.0% overall clinical benefit. SURF treatment responses were heterogeneous: SURF periodic responded better to OM-85, whereas SURF non-periodic showed partial responses to colchicine or biologics. Conclusion: Autoinflammatory diseases, particularly PFAPA and SURF, were the leading causes of pediatric FUO, offering insights for management and treatment.

Indexed as

Fever of Unknown OriginHereditary Autoinflammatory DiseasesLymphadenitisPharyngitisStomatitis, AphthousChildChild, PreschoolDisease ManagementFemaleHumansLongitudinal StudiesMaleRetrospective StudiesSyndromeautoinflammatory diseasesfever of unknown origin (FUO)periodic fever aphthous stomatitis pharyngitis and cervical adenitis (PFAPA)recurrent feverssyndrome of undifferentiated recurrent fever (SURF)

Identifiers

PMID41972166
PMCPMC13062182

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.