Herpetic sore throat in children
The content of the article:
- Causes and risk factors
- Forms
- Symptoms of herpetic sore throat in children
- Diagnostics
- Treatment of herpetic sore throat in children
- Possible complications and consequences
- Forecast
- Prevention
Herpetic sore throat (herpangina, ulcerative sore throat, herpetic tonsillitis, aphthous or vesicular pharyngitis) is an acute serous inflammation of the palatine tonsils and the posterior pharyngeal wall, accompanied by the rash of painful opening vesicles - vesicles and the formation of erosions, ulcers and aphthae. The disease occurs mainly in children of preschool and primary school age.
Source: vse-pro-detey.ru
Causes and risk factors
Herpetic sore throat is a highly contagious enterovirus infection transmitted by airborne droplets, fecal-oral and contact. In rare cases, it is possible to infect children from pets, especially from pigs. The causative agents are usually echoviruses and Coxsackie viruses of types A and B. After the transferred disease, a persistent immunity is formed to a certain serotype of the pathogen, which does not spread to representatives of other strains, so the child can get herpangina several times.
Having penetrated the body through the mucous membranes, the causative agents of aphthous pharyngitis actively multiply in the intestinal lymph nodes. Invasive virions enter the bloodstream, causing viremia; further spread depends on the properties of the particular serovariant and the state of the child's immune system. The presence of persistent foci of infection, autoimmune and atopic conditions, constant stress, malnutrition and chronic diseases occurring against the background of immunosuppression increase the likelihood of infection. Also at risk are those who have recently had ARVI; quite often herpetic sore throat in children occurs against the background of influenza or adenovirus infection.
Herpangina is rapidly spreading in children's groups. The peak incidence occurs in the summer-autumn period - from June to September.
Forms
Herpetic sore throat in children can occur both in isolation and in the form of a combined infection. Most often, herpangina is combined with other enteroviral diseases - epidemic myalgia, meningitis, encephalitis and myelitis. Occasionally there are erased and atypical forms of herpetic tonsillitis.
Symptoms of herpetic sore throat in children
The first signs of the disease are preceded by an incubation period of 3 to 14 days. The manifestation of herpetic sore throat in children resembles the flu: a sharp rise in body temperature to 39-40 ° C is accompanied by weakness and weakness, headaches and muscle pains, and loss of appetite. With severe intoxication, symptoms of gastrointestinal tract damage may appear: nausea, vomiting, diarrhea. Some children have diaphragm spasms with abdominal pain.
The clinical picture of inflammation of the palatine tonsils, characteristic of herpangina, develops within a day. At first, the child is worried about the feeling of dryness and sore throat, runny nose and watery eyes; later, swelling and hyperemia of the mucous membranes of the soft palate, tonsils and palatine arches increase, severe pain in the throat, difficulty swallowing and coughing appear. At the same time, there is a bilateral increase in the cervical, submandibular and behind the ear lymph nodes.
A specific symptom of herpetic sore throat in children is the formation of a large number of vesicles on the mucous membranes of the palatine tonsils, uvula, soft palate and back of the throat - small vesicles filled with serous effusion. After a day or two, the vesicles break open, and in their place whitish ulcers and aphthae are formed, surrounded by a red rim of inflammation. When several ulcers merge, extensive erosive areas are formed. Due to the sharp pain of erosions, children can completely refuse to eat and drink. In weakened children, a vesicular rash can also appear on the skin, and the rash is localized mainly in the lower trunk and legs. In atypical and erased forms of herpetic tonsillitis, symptoms may be limited to catarrhal changes in the mucous membranes of the oral cavity and pharynx.
Usually, fever with herpes sore throat in children with a normal state of the immune system weakens on the 3-5th day of illness, and defects in the mucous membranes self-resolve within a week. With pronounced immunosuppression, herpetic tonsillitis proceeds in waves: vesicular rashes and attacks of fever are repeated at intervals of 2-3 days.
Diagnostics
The diagnosis of herpetic sore throat in children is usually made by a pediatrician or pediatric otolaryngologist based on the specific clinical picture of the disease. The detection of vesicles, ulceration and confluent defects in typical localizations (tonsils, soft palate, posterior pharyngeal wall) during examination of the pharynx and pharyngoscopy serves as a sufficient basis for the diagnosis of herpetic tonsillitis.
It is quite easy to differentiate vesicular pharyngitis with aphthous lesions of the oropharynx with chickenpox, herpetic stomatitis, candidiasis and chemical irritation of the mucous membranes: with herpetic sore throat, children do not have rashes on the face, there is no bleeding of the mucous membranes, inflammation of the gums and profuse salivation.
In doubtful cases, laboratory studies of nasopharyngeal swabs and pharyngeal swabs may be required. The detection of enteroviral DNA by polymerase chain reaction (PCR) confirms the primary diagnosis. For virological studies with the cultivation of the pathogen, the material must be selected no later than 5 days after the onset of the disease.
In the case of a serological test by enzyme-linked immunosorbent assay (ELISA), the diagnostic sign is an excess of the titer of antibodies to enteroviruses by at least four times. If necessary, typing of the isolated pathogen is carried out by the immunofluorecent method and the determination of the serological variant of the virus by staging indirect hemagglutination reactions (RNGA) and complement binding (RSC). To monitor the effectiveness of treatment, serological tests are repeated after 2-3 weeks.
To exclude complications after the transferred herpangina, it is recommended to pass general blood and urine tests, to conduct an ECG. If serious deviations from the standard indicators are detected, children are referred for consultation to specialists - a pediatric cardiologist and nephrologist. If you suspect serous meningitis with a combined enterovirus infection, the child should be examined by a pediatric neurologist.
Treatment of herpetic sore throat in children
Standard treatment regimens for herpangina involve a combination of specific antiviral therapy and symptomatic measures. One of the most effective methods of etiotropic therapy for vesicular pharyngitis is endopharyngeal and endonasal instillation of liquid leukocyte interferon.
To alleviate the general condition of the child with a violent inflammatory reaction and severe intoxication, antihistamines and hyposensitizing agents, abundant warm drinks, immunomodulators and vitamin preparations - B vitamins and ascorbic acid are prescribed. Antipyretic drugs are used only at body temperature above 38 ° C and poor tolerance to fever.
Local treatment of herpetic sore throat in children is aimed at preventing the addition of a secondary bacterial infection and accelerating the epithelialization of damaged areas of the mucous membranes. In pediatric practice, antiseptic aerosols with anesthetic and enveloping effect, proteolytic and keratoplastic agents have proven themselves well. A good effect is given by hourly rinsing of the throat with disinfectant solutions and treatment of the tonsils and the back of the throat with antiviral and bactericidal ointments.
For the speedy healing of defects in the mucous membranes, a sick child should be given liquid and semi-liquid non-irritating food - broths, mashed porridge, jelly, decoctions, etc.
After the acute phase of the disease, a course of ultraviolet irradiation of the nasopharynx and laser therapy can be carried out in order to accelerate the epithelialization of ulcers and erosions.
Home remedies for sore throats in aphthous pharyngitis should be used with great caution. In particular, with herpangina, inhalations and warming compresses are strictly prohibited, since heat exposure promotes the spread of infection by activating blood circulation. Herbal decoctions for gargling can be used as adjuvants, but do not replace medications prescribed by a doctor.
Possible complications and consequences
The causative agents of herpangina are distinguished by an increased affinity not only for mucous membranes, but also for nervous and muscle tissue. With generalized viremia, vesicular pharyngitis can be complicated by hemorrhagic conjunctivitis, pyelonephritis and myocarditis; the most dangerous complications are enteroviral serous meningitis and encephalitis. The protracted course of the disease creates the prerequisites for the development of the rheumatic process due to the perversion of the immune response.
Layering of a secondary bacterial infection with a large area of ulceration of the mucous membranes of the oropharynx can lead to suppuration up to the formation of abscesses and phlegmon in the periopharyngeal space, causing suffocation. Aphthous pharyngitis is especially severe in weakened children and in babies under three years old.
Forecast
With timely and adequate treatment, herpetic sore throat in children is completely cured. In the case of generalization of the process and the development of multiple organ lesions, the prognosis is more cautious.
Prevention
Due to the high contagiousness of the disease, anti-epidemic measures become the main means of preventing herpetic sore throat in children:
- isolation of patients;
- 14-day quarantine of contact persons;
- the introduction of specific gamma globulins to children in contact with a sick child;
- current and final disinfection of the epidemiological focus.
After the transferred herpangina, the child can return to the team no earlier than 7-8 days after the onset of the disease.
Most of the seasonal outbreaks of herpetic sore throat occur in holiday camps and children's sanatoriums. When sending a child for health improvement, parents should pay attention to the sanitary well-being of children's institutions and ask about the epidemiological history of the institution.
A set of measures aimed at strengthening immunity contributes to a decrease in the incidence of herpetic tonsillitis: good nutrition, hardening, adherence to the optimal daily regimen, minimizing stress, exercising and walking in the fresh air. To prevent infection with aphthous pharyngitis through the fecal-oral and contact routes, it is important to teach the child to observe the rules of personal hygiene.
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
