Follicular tonsillitis in children: treatment, symptoms, possible complications
The content of the article:
- Classification of sore throats
- Etiology and pathogenesis of follicular tonsillitis
- Symptoms of follicular sore throat in children
- Diagnostics of the follicular sore throat
- How to treat follicular sore throat in a child
- Complications of follicular sore throat
- Video
Follicular angina in children is associated with a high risk of complications that can occur with bacterial inflammation. Therefore, in modern medicine, in particular in pediatrics and otorhinolaryngology, timely diagnosis and selection of rational treatment are important.
With follicular angina, it is important to consult a doctor in a timely manner for the appointment of adequate treatment
Follicular tonsillitis is a common acute infectious disease in which the lymphoid tissue of various tonsils is affected. In most cases, tonsillitis of the tonsils occurs.
Classification of sore throats
Angina, or tonsillitis, is not a homogeneous disease and differs in etiology, pathogenesis, clinical and pharyngoscopic signs.
In clinical practice, there is a division of sore throats into vulgar (common, banal) and atypical.
According to BS Preobrazhensky's classification, in addition to follicular tonsillitis, catarrhal, lacunar, fibrinous, herpetic, phlegmonous, ulcerative-necrotic and mixed forms of tonsillitis vulgaris are distinguished. This classification is based on pharyngoscopic signs, supplemented by data obtained in laboratory research.
The name of the microbe (staphylococcal, streptococcal) or other known causative factor (traumatic, toxic), for example, monocytic follicular tonsillitis, can be added to the main diagnosis.
Etiology and pathogenesis of follicular tonsillitis
Among the various possible causative agents of follicular tonsillitis (cocci, rods, viruses, fungi, spirochetes, etc.), the main etiological role belongs to group A beta-hemolytic streptococcus. It is found in up to 80% of cases. Less commonly, acute tonsillitis is caused by group C streptococci, staphylococci, hemolytic bacillus, gonococci, corynebacteria, anaerobes, mycoplasma and chlamydia. The cause of acute viral tonsillitis can be adenovirus, rhinovirus, coronavirus, influenza and parainfluenza viruses, Epstein-Barr virus, Coxsackie A virus and others.
The most common causative agent of the disease is group A beta-hemolytic streptococcus
The exogenous pathogen enters the mucous membrane of the tonsils by airborne droplets, alimentary or contact. The endogenous pathogen migrates from a chronic focus of infection of the oral cavity or upper respiratory tract (for example, chronic inflammation in the nasal cavity and paranasal sinuses). In chronic tonsillitis or the carriage of beta-hemolytic streptococcus, the pathogen can be in the crypts of the tonsils for a long time and cause an exacerbation of the inflammatory process with a decrease in general or local immunity.
The causative agent of the disease can be transmitted by contact
Also, in the pathogenesis of angina, a certain role can be played by:
- decrease in the general reactivity of the body to cold;
- sharp seasonal fluctuations in environmental conditions (temperature, humidity, nutrition, vitamin deficiency);
- injury to the tonsils;
- constitutional predisposition to tonsillitis in children with lymphatic-hyperplastic constitution;
- the state of the central and autonomic nervous system.
Morphologically, follicular angina is characterized by hyperemia, an increase in lymphatic follicles, massive small-cell infiltration, desquamation of the integumentary epithelium of the tonsils and follicular suppuration in the future.
Symptoms of follicular sore throat in children
Vulgar sore throats differ in the following general features:
- severe symptoms of general intoxication of the body;
- pathological changes are present in both palatine tonsils;
- the duration of angina does not exceed one week;
- the primary etiological factor is a bacterial or viral infection.
Follicular tonsillitis begins with a sudden chill with an increase in body temperature to 40 ° C, severe sore throat. The child has symptoms of intoxication: severe general weakness, headache, pain in the heart, joints and muscles. Dyspeptic symptoms are often noted: nausea, vomiting, loose stools. The amount of urine excreted decreases.
The disease begins with severe sore throat and a sharp rise in body temperature
With the spread of inflammation to the nasopharynx region and the appearance of edema of the mucous membrane of the auditory tubes, congestion and discomfort in the ears may occur, while there is difficulty in nasal breathing and nasal sound.
Diagnostics of the follicular sore throat
Diagnostics is carried out taking into account the complaints of the child and parents, examination data and the results of laboratory and instrumental research methods, which include:
- pharyngoscopy;
- clinical blood test;
- general urine analysis;
- bacteriological examination.
A number of tests are carried out to make a diagnosis, including pharyngoscopy
In the photo of the throat during pharyngoscopy, the palatine tonsils are hyperemic, sharply swollen. Follicles appear through the mucous membrane in the form of whitish-yellowish formations the size of a pinhead.
Other accumulations of lymphoid tissue can also be involved in acute inflammation and lead to retronasal or lingual angina.
Children often develop inflammation of the pharyngeal tonsil or adenoiditis. In this case, a sore throat radiates to the deep parts of the nose, due to tissue swelling, nasal breathing becomes difficult.
Sometimes the process becomes diffuse, spreading throughout the lymphadenoid pharyngeal ring.
On examination, a pronounced lymphadenitis is determined: regional lymph nodes are enlarged, painful.
One of the most effective diagnostic methods is an express test for the detection of pyogenic streptococcus
To determine the bacterial agent, a bacteriological examination of the discharge from the surface of the tonsils is performed. For express diagnostics of the presence of group A beta-hemolytic streptococcus, there is Streptatest, which allows to determine the presence of pyogenic streptococcus antigen within 5-10 minutes. But this test does not exclude the need for a culture study.
In the clinical analysis of blood, leukocytosis is determined, a shift of the leukocyte formula to the left. In the general analysis of urine, traces of protein may appear.
How to treat follicular sore throat in a child
Rational treatment of follicular angina in children includes adherence to a sparing regimen, local and systemic therapy. In the early days of illness, bed rest is recommended, limiting physical activity. Prescribe a non-irritating, soft, nutritious diet, mainly vegetable-milk, vitamins, and plenty of drink.
To prevent metatonsillar diseases (rheumatism, myocarditis, glomerulonephritis) with a bacterial infection, regardless of the severity of the condition, antibiotic therapy is prescribed.
Beta-hemolytic group A streptococcus is highly sensitive to penicillins and cephalosporins.
Antibiotic resistance is a big problem. In Russia, resistance to macrolides is 13–17%, to tetracyclines and sulfonamides - over 60%. Therefore, tetracyclines, sulfonamides, co-trimoxazole do not provide eradication of the pathogen and should not be used to treat acute streptococcal tonsillitis, caused even by strains that are sensitive to them.
The first-line drug for the treatment of follicular sore throat caused by hemolytic streptococcus is penicillin (phenoxymethylpenicillin). But the use of amoxicillin clavulanate seems to be more reliable, due to the possible resistance of the pathogen.
If you are allergic to beta-lactam antibiotics, lincosamides (Lincomycin, Clindamycin) are prescribed.
The required dosage depends on the age, body weight, severity of the disease and is selected by the doctor individually. The recommended duration of antibiotic therapy is 10 days.
In a severe course of the disease, treatment is carried out in an infectious hospital by parenteral administration of antibacterial agents.
Chloropyramine, Loratadin, Diphenhydramine and others are prescribed as a hyposensitizing drug.
To combat fever, antipyretic paracetamol-containing agents are used: Nurofen, Ibuprofen, Paracetamol. Drinking plenty of fluids is very important during a fever. Regidron helps to restore water-salt balance, especially in the presence of dyspeptic symptoms.
Local therapy plays an important role in the treatment of sore throat.
Local therapy plays an important role in the treatment of follicular angina. Topical medications for pain and inflammation can include:
- local antibiotics;
- antiseptics (chlorhexidine, hexetidine, benzydamine, thymol, iodine preparations);
- anesthetics;
- non-steroidal anti-inflammatory drugs;
- bacterial lysates;
- factors of nonspecific protection of the mucous membranes with antiviral effects (lysozyme, interferon);
- essential oils (menthol, eucalyptus).
Warm rinsing with a solution of Furacilin, Miramistin, calendula tincture, chamomile decoction is recommended. A warming compress is applied to the submandibular region.
Among topical antiseptic drugs, silver proteinate is widely used in the form of a 2% solution. Silver ions prevent the growth of bacteria, have an anti-inflammatory effect due to the formation of a protective film as a result of the deposition of proteins by silver. As a result, the sensitivity of the mucous membranes decreases, the vessels narrow and the inflammatory reactions are inhibited.
The drug is prescribed for children from 1 year old. Silver proteinate does not affect the body's own non-pathogenic flora and does not disrupt metabolic processes.
For children over 12 years old, it is recommended to use Strepsils Intensive, which contains flurbiprofen. The drug inhibits the synthesis of prostaglandins, which contributes to anti-inflammatory and analgesic action. The therapeutic effect is provided locally without the occurrence of adverse reactions. Swelling is reduced by 4-6 hours, which greatly facilitates difficulty swallowing.
Pediatrician Komarovsky recommends that when treating a child at home, follow the doctor's prescriptions, and if a high body temperature, headache and other symptoms of the disease persist within 3-4 days, re-consult a specialist to correct therapy.
It is also very important to observe preventive measures that warn children against chronic inflammation. You need to follow the doctor's prescriptions. Do not skip taking an antibiotic, the course of treatment should be at least 7 days. Do not stop taking medications immediately after improvement in general condition and relief of symptoms of the disease.
Complications of follicular sore throat
In cases where therapy was started at a relatively late date, local complications arise: peritonsillitis, paratonsillar abscess, otitis media, and others. With the spread of the inflammatory process and the formation of purulent foci, the general condition worsens and the following symptoms develop:
- high fever;
- the predominance of one-sided pain in the throat, sharply increasing when swallowing;
- increased salivation;
- lockjaw;
- soreness when opening the mouth;
- unilateral edema.
Pharyngoscopy reveals hyperemia of the soft palate, edema of the palatine arch on the affected side, asymmetry of the uvula, displacement to the center of the affected tonsil.
One of the dangers of follicular angina is a high risk of complications, in particular glomerulonephritis
Angina develops as an allergic-hyperergic reaction, which is a prerequisite for complications that are infectious and allergic in nature and are associated with the antigen of hemolytic streptococcus:
- rheumatism;
- acute diffuse arthritis;
- infectious and allergic myocarditis;
- polyarthritis;
- cholecystocholangitis;
- glomerulonephritis.
Pathology from the heart can be diagnosed by persistent signs on an electrocardiogram, for example, with focal myocardial damage. A moderate increase in lactate dehydrogenase is determined in the blood.
Glomerulonephritis is characterized by moderate proteinuria, leukocyturia, erythrocyturia, and cylindruria.
Video
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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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