27.10.2020

Treatment of angina in children

In most cases, sore throat in children is caused by a bacterial or viral infection. In 80-85% of cases, the causative agent is β-hemolytic streptococcus group A; 10% – Staphylococcus aureus; less commonly, pneumococcus, hemophilus bacilli, viruses ( enteroviruses , adenoviruses, herpes virus , Epstein-Barr virus, etc.), mycoplasmas, chlamydia, fungi, mixed infection.

Typically, sore throat in children under 3 years of age is associated with viral pathogens; in children older than 5 years, bacterial infection prevails. The highest incidence of streptococcal angina in children occurs at the age of 5-10 years. Intracellular pathogens cause tonsillitis and pharyngitisin preschool children in 10% of cases. In some cases, angina in children can be caused by conditionally pathogenic bacteria living in the mouth, in a situation of their massive growth and high density of microbial cells.

The predominant way of infection in the tonsils is exogenous (airborne, contact-household, enteral). Traumatic tonsillitis often develops after operations on the nasopharynx and posterior parts of the nasal cavity (for example, after adenotomy in children). Endogenous autoinfection is possible with exacerbation of chronic tonsillitis , dental caries , sinusitis , gastroenteritis .

Predisposing factors for the development of angina in children are abnormalities of the constitution ( lymphatic-hyperplastic constitution ), changes in regional and general immunity during hypothermia , abrupt climate change, vitamin deficiency, etc.

The basis of the development of angina in children is the reaction of the allergic-hyperergic type. The tonsils lacunae contain rich non-pathogenic flora, pathogenic microorganisms and protein decay products are retained, which can act as sensitization factors for the organism. Against the background of prior sensitization, various endogenous or exogenous infectious pathogens can initiate the development of angina in children. Numerous exotoxins secreted by pathogens cause an immune response with the formation of CIC, affecting the tissues of the heart muscle, kidneys and other internal organs.

The local reaction of the tonsils to the introduction and reproduction of pathogens is characterized by swelling of the lymphoid tissue, purulent fusion of the follicles, accumulation of purulent masses in the lacunae, necrosis of the epithelium, and in some cases the tissue of the tonsils.

Classification of angina in children

Taking into account the causes of inflammation of the tonsils, primary, secondary and specific angina is distinguished in children. When primary angina infection initially develops in the tonsils. Secondary or symptomatic tonsillitis in children is often found in other infectious diseases: scarlet fever , measles , diphtheria , mononucleosis , etc. Specific tonsillitis in children include tonsil lesions caused by specific flora – the causative agents of gonorrhea , mycoplasmosis , chlamydia , candidiasis , etc. children can be acute, often recurrent and chronic.

Depending on the nature of changes in the tonsils, among the clinical forms of tonsillitis in children, the following are found: catarrhal, follicular, lacunar, fibrinous, phlegmonous and gangrenous.

In catarrhal angina in children, examination of the pharynx reveals an increase and hyperemia of the tonsils, as well as palatine arches. There is no purulent plaque; against a background of loose and squamous epithelium, a thin layer of serous whitish plaque is defined. Microscopically revealed thick infiltration of the epithelium of the tonsils by lymphocytes and neutrophils.

A sign of follicular tonsillitis in children is translucent punctate point follicles up to 3 mm translucent through the epithelial lining of the tonsils (“picture of the starry sky”). Morphological changes in the parenchyma of the tonsils (plethora, hyperemia) are more pronounced; purulent follicles are leukocyte infiltrates with signs of necrosis.

Lacunar tonsillitis in children occurs with the presence of a linear purulent yellowish plaque, located in the gaps between the lobes of the tonsils. The surface of the tonsils is brightly hyperemic and edematous; islets of plaque in the mouths of the lacunae are prone to unification and the formation of wide confluent purulent foci. Microscopic examination revealed multiple ulceration of the epithelium, leukocyte infiltration of the mucous membrane, purulent fusion of the follicles, and thrombosis of small vessels.

In cases of fibrinous sore throat in children, the tonsils are covered with a filmy whitish translucent bloom. Phlegmonous sore throat in children is rare; accompanied by purulent fusion of the tonsil area and the formation of an intra-tonsillar abscess (usually one-sided).

In case of gangrenous sore throat, necrotic ulceration of the epithelium and the parenchyma of the tonsils takes place. When inspecting the pharynx on the tonsils, a whitish-gray plaque is detected, containing a large number of bacteria, leukocytes, necrotic tissue, and fibrin. After softening and rejection of plaque, ulcers with jagged edges are exposed. A common necrotic process can be complicated by the destruction and, later on, by scarring of the soft palate and pharyngeal line. Necrotic tonsillitis is observed in children with acute leukemia , diphtheria, scarlet fever.

Symptoms of tonsillitis in children

A sore throat in a child is more severe than in an adult: with a higher temperature, severe intoxication, and frequent complications. In children, a consistent transition from one form of angina to another (catarral to follicular, then to lacunar) or non-progressive course is possible.

An acute onset of catarrhal angina in children is characterized by a feeling of irritation, burning, dryness and sore throat, which is worse when swallowing. Body temperature rises to 38-39 ° C, children are lethargic, complaining of indisposition and headache. Tongue dry, covered with whitish bloom; regional lymph nodes may be slightly enlarged and slightly painful. Catarrhal sore throat in children usually lasts 5-7 days.

In children with angina in children, signs of intoxication are pronounced: weakness, apathy, lack of appetite, arthralgia, headache. There is a high fever with chills, vomiting, stupefaction, convulsions. Typical severe pain in the throat, often with irradiation in the ear, forcing the child to refuse to eat and drink. Symptoms of follicular tonsillitis in children increase over 2 days; on day 3-4, there is an improvement associated with cleansing the surface of the tonsils; however, pain when swallowing persists for another 2-3 days. Clinical recovery of the child occurs in 7-10 days.

Lacunar tonsillitis in children also occurs with severe intoxication syndrome. Due to swelling and infiltration of the tonsils and soft palate, the child barely opens his mouth, while his speech becomes muffled and his voice has a nasal hue. Children complain of severe sore throat and unpleasant taste in the mouth. Regional lymph nodes are enlarged and cause pain when turning the head. The course of lacunar tonsillitis in children is 10-14 days.

Viral sore throats in children are combined with respiratory symptoms ( rhinitis , cough), stomatitis , conjunctivitis , diarrhea.

The most frequent complications of streptococcal angina in children are rheumatic endocarditis , nonspecific polyarthritis , glomerulonephritis, and pharyngeal abscess . Herpangina in children may be complicated by serous meningitis .

Diagnosis of angina in children

If the child has fever and sore throat, contact a pediatrician or pediatric otolaryngologist . Objective signs characteristic of a sore throat are detected by the pediatrician already when examining the pharyngeal mucosa, palpation of the submandibular and cervical lymph nodes.

In general, a blood test is present neutrophilic leukocytosis, stab left shift, increased ESR. Studies of pharyngeal swab on the microflora can identify the causative agent of angina in children. If necessary, serological diagnosis (ELISA) is carried out: detection of antibodies to mycoplasma, candida, chlamydia, herpes virus, and others; the presence of β-hemolytic streptococcus is confirmed by the definition of ASL-O.

Pharyngoscopy in children determines the diffuse hyperemia of the tonsils and arches, infiltration, the presence of plaque, the nature of which allows us to judge the clinical form of angina. Purulent plaque with sore throat is easily removed with a spatula, rubbed on the glass and does not leave a bleeding surface (unlike hard to remove plaque during diphtheria).

Treatment of angina in children

Mild and moderate forms of tonsillitis in children are treated on an outpatient basis; in case of severe angina, hospitalization in the infectious disease ward may be required.

In the treatment of angina in children, it is important to maintain bed rest and rest, isolate a sick child, use individual care items (dishes, towels), organize sparing food and drink plenty of water.

  • In case of bacterial sore throat in children, systemic antimicrobial therapy is prescribed with drugs to which the causative agent is sensitive (if β-hemolytic streptococcus is secreted – penicillins, macrolides, cephalosporins, carbapenems). Along with antibacterial therapy, antihistamine medications, group B vitamins and ascorbic acid, and immunomodulators are indicated.

An important place for sore throat in children is local treatment: gargling with antiseptic solutions (nitrofural, Miramistin) and decoction of herbs (calendula, chamomile, sage), spraying aerosols into the throat.

In case of viral sore throat in children, prescribing antiviral drugs, pharynx irrigation with interferon is indicated.

To surgical treatment – opening paratonzillarnogo / zakruzhnogo abscess resort with abscess complications. In the case of recurrent tonsillitis in children, indications for tonsillectomy are determined .

Prognosis and prevention of angina in children

The streptococcal angina transferred by the child requires an ECG , a study in the dynamics of the general analysis of urine and blood, and if necessary, consultation of a pediatric rheumatologist , pediatric nephrologist , and immunologist . With timely and full treatment of angina in children ends with convalescence. Otherwise, a transition to chronic tonsillitis, development of regional or general complications is likely.

Prevention of angina in children requires limiting contact with infectious patients, increasing the overall resistance, rehabilitation of purulent foci, ensuring full-fledged fortified nutrition.

Sore throat in children is an acute inflammation of the lymphoid tissue of the pharyngeal (usually palatine) tonsils in a child, which is infectious and allergic in nature. Angina in children occurs with high fever, severe signs of intoxication, pain when swallowing, enlarged submandibular and cervical lymph nodes, purulent bloom on the tonsils. Diagnosis of angina in children is carried out by a pediatric otolaryngologist with the help of a physical examination, pharyngoscopy, studies of a pharyngeal smear for microflora, and blood ELISA. Treatment of angina in children includes pathogenetic therapy (antibiotics, antivirals), symptomatic therapy (antipyretic, desensitizing drugs) and local therapy (aerosols, gargling with antiseptics and herbs).

Sore throat in children (acute tonsillitis) is an infectious-allergic disease in which the tonsils are inflamed. The incidence of angina in the pediatric population ranges from 4.2 to 6.7%, second only to ARVI . Due to the high prevalence and infectiousness of angina in children, the disease is the subject of close attention to pediatrics and pediatric otolaryngology . Angina in a child is dangerous for its early ( otitis , paratonsillar, lateral-pharyngeal and pharyngeal abscesses) and long-term complications, including rheumatism , rheumatoid arthritis , glomerulonephritis , etc.

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