Angina in children: symptoms and treatment, throat photos, signs, causes
The content of the article:
-
Causes of sore throat
- Age features of the development of tonsils in children
- Predisposing factors
- Psychosomatics of angina
- Classification of sore throats
- Symptoms of sore throat in children
- Diagnostics of the sore throat
- How to treat angina in a child?
- Complications
- Video
Angina in children, or acute tonsillitis, is a common infectious disease with local manifestations in the form of acute inflammation of one or more components of the lymphadenoid pharyngeal ring, mainly the palatine tonsils.
Angina in children is one of the most common ENT pathologies
Treatment of angina in children is a difficult task that is better to be entrusted to a specialist, since very often the disease becomes chronic, and also causes many complications from various organs and systems.
Causes of sore throat
Angina can be caused by bacterial flora, viruses and fungi.
The most common pathogens are streptococci, staphylococci, diplococci, pneumococci, enteroviruses, mycoplasmas, chlamydia.
Most often, sore throat is caused by pyogenic streptococcus
Every year in Russia, more than 10 million children and adolescents carry infections associated with streptococcus serological group A.
- streptolysins O and S - toxins that cause hemolysis of the cell membrane by introducing into the walls of erythrocytes, leukocytes and the formation of pores in them;
- cysteine protease - an enzyme aimed at counteracting the immune system, penetrating and spreading in human tissues;
- streptokinase - a protein that helps break down fibrin clots, which allows the pathogen to leave the areas of clotted blood;
- hyaluronidase, protease, lipoproteinase and other enzymes that contribute to the destruction of body tissues, the spread of bacteria in them and penetration into the bloodstream.
Transmission of infection occurs mainly by airborne droplets, but there can be alimentary and contact routes of infection. The source is a person with angina, scarlet fever and other clinical forms of respiratory and cutaneous streptococcal infection, as well as bacterial carriers of pyogenic streptococcus.
Bacteria and viruses are usually transmitted by airborne droplets from a carrier of the infection
Drops after coughing or sneezing, scattering from an infected person, fall on the mucous membranes of the upper respiratory tract. Further, the mechanisms of the fight of the etiological agent with the protective factors of local immunity are launched. The incubation period is several days.
Acute inflammation of the tonsils is accompanied by severe tissue edema, congestion in the lymphatic vessels and plethora. Vascular thrombosis leads to the formation of microabscesses.
Streptococcal infection is characterized by the frequent development of autoimmune and toxic-septic complications.
Age features of the development of tonsils in children
Knowledge of anatomical and functional features in children of different ages plays an important role in the diagnosis and choice of treatment tactics.
In infants, the glands are underdeveloped and functionally inactive, but the body is protected by the mother's antibodies. The lymphoid ring of the pharynx consists of several thin folds of the mucous membrane, which are accumulations of lymphocytes. In children of the first months of life, nasopharyngitis prevails, and not sore throats.
The final development of the follicles is completed by the end of 1 year. In this case, bacteria and toxic substances have a stimulating effect, the action of which the body begins to be exposed to immediately after birth.
The tonsils reach full development at 2 years old or at 3 years old. At 4 years old, the multilayered columnar ciliated epithelium covering the tonsils begins to be replaced by squamous epithelium.
In children over 5 years of age, hyperplasia of the tonsil follicles is observed. Up to 6 years from the vault of the nasopharynx to the entrance to the esophagus, retropharyngeal lymph nodes are located in a chain, which, when suppurating, lead to the formation of a pharyngeal abscess. These lymph nodes subsequently atrophy, therefore, retropharyngeal lymphadenitis does not occur in older children and adults.
At 5-7 years old, the tonsils reach their maximum size. This age is characterized by the highest infectious morbidity. The increase in lymphoid tissue is due to the intensive formation of active immunity with local production of antibodies.
After 9 years, as antibodies accumulate in the body and the immune system improves, age-related involution of lymphoid tissue begins.
Predisposing factors
The emergence of an acute pathological process in the tonsils is facilitated by various factors:
- hypothermia;
- general and local decrease in immunity;
- dustiness, air pollution;
- avitaminosis;
- unfavorable living conditions;
- congenital immunodeficiency diseases;
- pathological processes in the ENT organs;
- developmental anomalies;
- surgical interventions on the upper respiratory tract;
- chronic somatic diseases.
Psychosomatics of angina
Psychosomatics implies the influence of psychological factors on human health, provoking diseases. Children are more susceptible to psychosomatics than adults. This is due to the poorly formed psyche of the child and the influence of the parents.
The development of frequent angina is associated with psychosomatic causes.
Often children are brought up according to this model, when parents or grandmothers, grandfathers decide everything, not interested in the desire and opinion of the baby and even suppressing his resistance by force. In such cases, the desire to postpone the action that the child does not want to perform is hidden behind the sore throat.
This attitude towards children is unacceptable and leads not only to various pathologies in childhood, but can further affect health in adulthood.
If a child often suffers from angina, it is necessary to recognize what exactly he does not want to do and what worries him.
Thus, the cause of recurrent acute inflammation of the tonsils can be overprotection and weakness, lack of voice and speech in the family. There are other reasons: jealousy of the child, lack of attention, humiliation at school, on the street, notoriousness, constant quarrels between parents.
Classification of sore throats
Sore throats are primary and secondary.
Primary angina, depending on the nature and depth of the lesion, can be:
- catarrhal;
- lacunar;
- follicular;
- ulcerative membranous;
- combined.
Secondary tonsillitis occurs in acute infectious diseases: diphtheria, scarlet fever, measles, tularemia, typhoid fever, infectious mononucleosis. Also, acute inflammation of the tonsils can develop with blood diseases: agranulocytosis, aleukia, leukemia.
Symptoms of sore throat in children
Signs of sore throat in children may differ in different age groups. The disease often occurs with intoxication syndrome.
Angina is usually accompanied by an increase in body temperature
The child becomes irritable, capricious, refuses to eat. As a result of edema of the lymphoid tissue, swallowing becomes difficult, hypersalivation appears, and an unpleasant odor in the mouth. Possible breathing problems.
Body temperature reaches 38–39 ° C, which is often accompanied by convulsions, vomiting, darkening or loss of consciousness. Dyspeptic symptoms are observed, most often - abdominal pain and loose stools.
The severity of clinical manifestations depends on the type of angina.
Catarrhal sore throat begins acutely, body temperature is most often subfebrile. The child has a headache, malaise, chills. Older children complain of a sore throat that gets worse when swallowing. There is an increase in regional lymph nodes.
With lacunar and follicular angina, the condition of patients is moderate and severe, body temperature is 38–39 ° C and above, symptoms of intoxication are expressed. The sore throat is intense.
For ulcerative-filmy sore throat, moderate one-sided sore throat, low-grade fever, and no symptoms of intoxication are characteristic. Regional lymphadenitis is detected on the affected side.
Diagnostics of the sore throat
If a child has complaints or a change in his general condition, it is necessary to consult a doctor: pediatrician, infectious disease specialist or otorhinolaryngologist. The specialist will conduct an examination and prescribe the necessary diagnostic measures:
- clinical blood test;
- general urine analysis;
- pharyngoscopy;
- throat swab for Leffler's bacillus;
- bacteriological culture from tonsils for pathological flora and antibiotic sensitivity.
To identify the pathogen, a throat smear is prescribed
According to the indications, C-reactive protein, rheumatoid factor are additionally determined, ECG (electrocardiography), chest X-ray examination, consultation of a cardiologist, nephrologist, neuropathologist, dentist are performed.
If it is necessary to hospitalize a child, in addition to the listed tests, a hemostasiogram, a biochemical blood test, a study of feces for worm eggs and protozoa are taken.
In a severe course of the disease or after an infection, the doctor may send an ultrasound scan of the heart and kidneys to exclude rheumatic complications.
What a sore throat looks like can be seen in the photo of the throat during pharyngoscopy. Typical signs of different forms of pathology:
- catarrhal: there is significant hyperemia of the mucous membrane of the palatine tonsils and adjacent anterior and posterior arches, partly of the soft palate. The tongue is coated, dry;
- lacunar: against the background of edema and hyperemia of the mucous membrane on the tonsils, whitish plaques are detected. Plaque can be located at the mouths of the lacunae;
- follicular: there is a bright hyperemia and edema of the mucous membrane of the palatine arches and tonsils. On the surface of the tonsils, multiple whitish-yellowish suppurative follicles of a rounded shape are visible;
- ulcerative membranous: an ulcer is determined on one of the tonsils. It is covered with a grayish-yellow bloom. Ulcerations can also be located on the soft palate, oral mucosa, back of the pharynx.
The manifestations of sore throat vary depending on its form.
Acute tonsillitis is characterized by an increase in the number of leukocytes, an accelerated ESR, the appearance of C-reactive protein in the blood. In the general analysis of urine, traces of protein and microhematuria may appear.
The results of bacteriological culture allow us to determine the type of pathogen and its sensitivity to antibacterial drugs. They become known 5–6 days after taking the material.
Rapid tests allow you to quickly identify pyogenic streptococcus
For preliminary additional diagnosis of the presence of group A beta-hemolytic streptococcus, rapid tests are performed. Express identification is based on the determination of group-specific antigens of streptococcus. The sensitivity and specificity of the test is above 90%. This allows you to timely prescribe etiotropic treatment, which is the prevention of early and late complications of streptococcal infection.
How to treat angina in a child?
Rational therapy of patients with angina with penicillin antibiotics, to which streptococci are highly sensitive, leads to the release of the body from the pathogen within a few days. Dr. Komarovsky confirms that a systemic antibiotic is needed in the treatment of streptococcal tonsillitis.
The following antibacterial drugs are prescribed:
- Phenoxymethylpenicillin;
- Amoxicillin;
- Amoxiclav.
You can use 1–2 generation cephalosporins (Cefuroxime, Ceftriaxone, Cefepime). If you are allergic to these drugs, macrolides (Azithromycin) are prescribed.
It is very important to take the antibiotic correctly, following your doctor's recommendations. Treatment is carried out on average for 7-10 days.
At elevated body temperature, antipyretics are prescribed
Antipyretic therapy is prescribed at a body temperature above 38.5 ° C (Paracetamol, Ibuprofen).
With moderate and severe detoxification treatment, which includes 5% glucose solution, electrolyte solutions, is required.
According to indications, antihistamines (Suprastin) and mucolytics (Acetylcysteine) are prescribed.
Locally, irrigation and rinsing of the throat with antiseptic solutions (Hexoral, Ingalipt, Miramistin, Lugol's solution) is carried out. The anti-inflammatory effect is provided by frequent gargling with alkaline and saline solutions, decoctions of chamomile, sage, calendula.
Complications
Streptococcal tonsillitis can lead to early and late complications, which include:
- retropharyngeal abscess;
- cervical lymphadenitis;
- acute otitis media;
- acute sinusitis;
- mastoiditis;
- acute rheumatic fever with or without carditis;
- post-streptococcal glomerulonephritis;
- tonsillogenic sepsis.
In children, the pharyngeal abscesses in the upper parts of the pharynx are often unilateral, since in the nasopharynx the pharyngeal space is divided into two halves by a ligament.
Video
We offer for viewing a video on the topic of the article.
Alina Ervasova Obstetrician-gynecologist, consultant About the author
Education: First Moscow State Medical University. THEM. Sechenov.
Work experience: 4 years of work in private practice.
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