Lacunar angina in children: treatment, diagnosis, causes, symptoms
The content of the article:
- Reasons for the development of acute lacunar tonsillitis
- Symptoms of lacunar sore throat in children
- Diagnosis of the disease
- Treatment of lacunar sore throat in children
- Possible complications
- Prevention
- Video
Lacunar angina in children, like the follicular form of the disease, is diagnosed more often than in adults. Both types of pathology are included in the group of vulgar (ordinary) tonsillitis and have similar symptoms, but the course of the first is more severe. In children, it proceeds with the formation of a linear yellowish purulent plaque between the lobes of the tonsils in the lacunae. In this case, the surface of the glands becomes edematous and brightly hyperemic, and the plaque islands in the mouths of the lacunae often combine, forming wide drainage purulent foci.
In children, the disease is accompanied by signs of general intoxication of the body.
The International Classification of Diseases of the 10th revision (ICD-10) classifies the pathology as class X (respiratory diseases), heading J00-J06 - acute respiratory infections of the upper respiratory tract. Lacunar sore throat is referred to as acute tonsillitis, therefore its ICD-10 code is J03.
On average, the duration of the disease in adults varies from 5 to 7 days, while in children it lasts longer - 10-14 days. Usually, bacteria cause an acute inflammatory process, therefore, bacteriological analysis of a throat smear is necessary to determine the pathogen.
In the acute period, otolaryngologists recommend taking antibacterial and anti-inflammatory drugs, gargling with antiseptic solutions, and adherence to bed rest by the patient.
Reasons for the development of acute lacunar tonsillitis
Depending on the age of the patient, the most common causative agents of pathology are:
- young children: measles virus, Coxsackie, adenoviruses;
- adolescents, adults: Haemophilus influenzae, staphylococci, streptococci and other bacterial agents.
Measles virus is one of the possible causative agents of sore throat in young children.
Infection occurs against the background of a decrease in the immune system - pathogenic microorganisms, getting into the oropharynx, are activated, and their accumulation in the lacunae leads to the development of an inflammatory process in the lymphoid formations of the pharyngeal ring. Often, bacteria enter the upper respiratory tract through the inhaled air, less often when using household items on which they are located.
It should be borne in mind that streptococci and other bacteria can spread to the joints, kidneys and heart with the movement of blood. Therefore, the absence of antibiotic therapy against the background of a decrease in immunity is fraught with the development of complications in the form of glomerulonephritis, polyarthritis, endocarditis and myocarditis.
Symptoms of lacunar sore throat in children
In most patients, the clinical symptoms of the disease are characterized by a combination of deterioration of the general condition with local changes in the lymphoid tissues and pharynx. During the physical examination, purulent exudate in the lacunae, yellowish-white contents in the form of separate islands on the surface of the throat, as well as hyperemia, swelling, and an increase in the size of the tonsils are revealed. On palpation of the maxillary and cervical nodes, their swelling is noted, as well as soreness, especially when turning the head and opening the mouth.
Pathology develops rapidly and sharply, the child shows signs of general intoxication of the body, namely:
- Strong headache;
- body aches;
- hyperemia;
- chills;
- fever;
- repeated vomiting;
- decreased or lack of appetite;
- syncope (fainting) conditions;
- irritability;
- weakness;
- sleep disturbance.
On days 2-3, a sore throat may appear, the intensity of which increases when food and water are swallowed. Puffiness and infiltration of the glands and soft palate make it difficult for the child to open his mouth, while his voice becomes nasal, and speech ceases to be intelligible. Frequent signs of pathology are disorders of the gastrointestinal tract (diarrhea, nausea, abdominal pain) and an unpleasant taste in the mouth.
Another characteristic symptom of angina vulgaris is an increase in body temperature to 39-40 ° C. It is recommended to consult a doctor about how much the temperature is kept at this level and what drugs are most effective to bring it down.
Diagnosis of the disease
To make an accurate diagnosis, correctly interpret the clinical manifestations characteristic of acute lacunar tonsillitis, and also to distinguish primary from secondary inflammation, a thorough examination of the child by doctors of various specialties is required - an otolaryngologist, therapist, pediatrician, rheumatologist, nephrologist and infectious disease specialist.
To prescribe adequate treatment, you must consult a doctor
Diagnosis begins with an examination of the patient's throat. This allows us to identify signs characteristic of the lacunar form of angina - the accumulation of yellow islets of purulent exudate in the lacunae, films on the surface of the tonsils, swelling and infiltration of the palatine tonsils. When removing films with a spatula, there is no damage to nearby tissues and no bleeding. In most cases, pharyngoscopy is prescribed, which reveals diffuse hyperemia, swelling and an increase in the size of the glands and edges of the arches, soreness and hypertrophy of regional lymph nodes. During this procedure, the doctor can take a photo of the throat.
Next, it is necessary to establish the nature of the pathogen that caused the inflammation. For this, a study of the contents of a smear from the pharynx and glands, bacteriological or virological analysis is carried out.
To confirm the diagnosis, a general and biochemical blood test can be prescribed.
In addition, the child is prescribed:
- general clinical blood test, thanks to which the activity of the process is determined;
- a general clinical study of urine, it shows whether there are complications from the urinary system;
- a biochemical blood test is performed to exclude complications, including rheumatism.
With lacunar angina, differential diagnosis with other diseases of the upper respiratory tract and secondary processes of infectious origin is necessary, since their symptoms are similar.
Treatment of lacunar sore throat in children
Therapy of pathology, especially in children, should be carried out under supervision and in accordance with the doctor's prescription. Hospitalization of a child is required only in case of a severe course of the disease; in most cases, treatment is carried out at home.
In the absence of complications, treatment is carried out at home
The main method of treating lacunar sore throat of bacterial etiology is the use of antibacterial drugs. According to Dr. Komarovsky, there is no need to take them immediately (within the first few hours after the first signs of the disease appear). To form the body's natural immunity to pathogens and prevent repeated relapses of pathology, it is recommended to start taking them from the third day.
Antibacterial agents should be used in sufficient dosage and taking into account the sensitivity of the pathogen. Usually, penicillin, cephalosporin, or macrolide antibiotics are prescribed.
In addition to antibiotic therapy, it is advisable to use local agents - sprays, rinses, and lozenges. For symptomatic treatment, non-steroidal anti-inflammatory drugs, immunomodulators, vitamin complexes, as well as drugs whose action is to normalize the functions of the nervous and cardiovascular systems, gastrointestinal tract and urinary tract are used. After the acute symptoms subside, patients are given a referral for physiotherapy.
Until the symptoms of the disease subside, it is recommended to eat warm grated food.
In addition to general and local treatment, compliance with a sparing regimen is recommended, namely:
- limiting physical activity throughout the entire period of therapy;
- adherence to bed rest on the first day from the onset of inflammation;
- use of separate dishes and personal hygiene products;
- restriction of communication with persons living with the child;
- reception of warm, but not hot liquid (jelly, compotes, cranberry juice) and puree food (if you have appetite, refusal to eat is a normal protective reaction of the body);
- exclusion of fresh milk from the diet, the bacteria of which linger in the mucous membrane of the oral cavity and contribute to the reproduction of pathogenic microflora.
As an adjunct to conservative treatment, as prescribed by a doctor, traditional medicine methods can be used. It is not recommended to independently select such remedies, especially based on herbs, since their interaction with the active substances of the drugs taken and, as a result, side effects, including allergic reactions, is possible.
Provided adequate timely therapy, complete relief of the manifestations of lacunar tonsillitis in children occurs on average on 10-15 days. In cases of complications, the treatment regimen is changed. So, with the appearance of glomerulonephritis or rheumatic heart disease in a specialized hospital, the patient receives antibiotics, glucocorticosteroids and other drugs under medical supervision, and with the development of local complications (for example, paratonsillar abscess), surgical intervention is indicated with the opening of a purulent focus of infection.
Possible complications
The absence or improperly selected treatment of purulent inflammation can lead to its spread to the middle ear and paranasal sinuses, as well as to the appearance of a pharyngeal or paratonsillar abscess. Against the background of these processes, the patient retains hyperthermia, and the sore throat acquires a pulsating character and can radiate to the ear. Opening the mouth, like swallowing food, remains difficult.
If the treatment of angina is ineffective, the development of a paratonsillar abscess is possible
If sore throats are repeated several times during the year, there is a constant inflammation of the lymphoid and tissues surrounding the pharynx - chronic tonsillitis develops. Distant organs and tissues are also affected - joints, kidneys, heart muscle.
Prevention
As measures to prevent primary or re-infection, it is recommended:
- timely sanitation of the oral cavity;
- regular exercise and sports;
- hardening the body;
- limiting contact with persons suffering from angina or colds, the use of personal protective equipment;
- airing and wet cleaning of rooms where the child spends most of the time;
- adherence to wakefulness and sleep;
- provision of full-value fortified food;
- exclusion of visits to crowded places during epidemics of influenza and acute respiratory viral infections.
It should be borne in mind that with self-medication, the likelihood of a transition of lacunar acute tonsillitis into a chronic form, which is much more difficult to treat, is high. Since the complications of the disease are glomerulonephritis, rheumatism and other pathologies, it is recommended to seek medical help when the first symptoms appear.
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
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