Angina in a child - Causes, symptoms and treatment. MF.

One of the most common infectious diseases in childhood is sore throat. Angina is an acute common infectious and allergic disease, in which the lymphatic tissue of the pharynx is involved in the inflammatory process with the predominant involvement of the palatine tonsils, accompanied by intoxication syndrome( weakness, headache, fever) and sore throat. The lymphatic tissue of the pharynx includes the palatine tonsil( 2), the lingual amygdala( 1), the pharyngeal tonsil( 3), the tubal tonsil( 4), and the lymph follicles of the posterior pharyngeal wall.

Lymphatic tissue of the pharynx

According to which tonsils are affected, respectively, tonsillitis tonsillitis( acute tonsillitis), angina of lingual tonsil, pharyngeal tonsillitis( acute adenoiditis), tubal tonsils. The causes of these anginas are approximately the same.

Causes of angina in children

Angina in a child can be provoked by the same microorganisms as in adults: bacteria( streptococci, spindle-shaped bacillus( spleen, diphtheria bacillus), viruses( adenovirus, Epstein-Barr virus,influenza viruses, Coxsackie viruses, herpes simplex virus type 1 and type 2), viral-bacterial associations, fungi( yeast-like fungi of the genus Candida), chlamydia, mycoplasma.

There are also risk factors such as mechanical trauma and throat burn, general and local hypothermia, which indirectly cause sore throat due to the activation of opportunistic microflora( more often streptococci or viruses) present in the pharynx.

Necessary volume of examination of the child.

If the child has a sore throat, the following tests should be taken:

- a general blood test( it reflects the overall inflammatory process in the body, which will be characterized by a rise in the level of white blood cells above 9.0 -10 * 9 / L, ESR above 12 mm / h);
- blood test for rheumatic tests - antistreptolysin-O, C-reactive protein, rheumatoid factor( this analysis also expresses the degree and nature of the inflammatory process);
- the general analysis of urine( allows to reveal inflammatory process from kidneys and urinary ways which can be one of complications of an angina);
- bacteriological examination( smear from the pharynx) on Lefler's wand to exclude or reveal diphtheria of the pharynx, which is accompanied by a sore throat;
- bacteriological study of the pharynx on the flora and sensitivity to antibiotics( this examination allows us to identify the causative agent of angina and determine the most effective antibiotic for the treatment of the disease).

Symptoms of angina and its flow in children.

The most commonly diagnosed in children is tonsillitis - acute tonsillitis. This disease affects children of all age groups. However, the highest incidence occurs in children older than 3 years, especially those who suffer from chronic tonsillitis. Children under 1 year of age with sore throat rarely, due to the presence of their antimicrobial immunity received from the mother and insufficiently developed lymphoid tissue of the pharynx at this age.

For the sore throat, the incidence rates in the autumn-winter period of the year are typical, when there are such factors as overcooling and crowding of children in the collective( kindergarten, school).The onset of acute tonsillitis is characterized by an increase in body temperature, often up to 39 C and above, general weakness, headache, chills, sore throat. Children become flaccid, pale, they have reduced appetite. In severe cases, vomiting and seizures may occur. Local changes in the pharynx are characterized by an increase in the tonsils, reddening their mucosa. On the surface of the tonsils a white-yellow coating is determined, and it can cover both the whole tonsil and also point in the form of grains. With angina, there is also an increase and soreness of cervical and submandibular lymph nodes.

In children under 3 years of age, angina often occurs against the background of SARS, so the above symptoms can be accompanied by a cough and runny nose.

Symptoms of a sore throat

With what diseases it is possible to confuse angina

Since the origin of angina can be caused by different causative factors, the tactics of treatment will be different. Therefore, it is important to conduct differential diagnosis, based on data on contact with infectious patients, clinical symptoms and laboratory data.

Angina of palatine tonsils( acute tonsillitis), which most often has a streptococcal cause, should be distinguished from angina, in which another lymphatic tissue of the pharynx is affected - lingual tonsil, pharyngeal tonsil, tubal tonsil. Diagnosis of tonsillitis is also carried out with acute vaginal pharyngitis, with diphtheria, the causative agent of which is Lefler's bacillus, with sore throat with infectious diseases( scarlet fever, measles, whooping cough), blood diseases, with sore throat and tuberculosis. It should also exclude neoplasms of the tonsils.

Treatment of angina in children.

Children with mild forms of sore throat caused by ARVI or streptococcus can be treated on an outpatient basis under the daily supervision of the district pediatrician. The moderate and severe course of the disease, as well as the presence of complications, requires hospitalization in the infectious department.

A sick child is assigned to bed rest during the feverish period, food rich in vitamins, not acute, not hot and not cold, plentiful warm drink( tea, juices, compotes, milk, mineral water without gas).

Medication includes antipyretic drugs( paracetamol, ibuprofen, nimesulide), antibacterial drugs( amoxicillin, amoxiclav in streptococcal angina).For mild to moderate tonsillitis, antibiotics are administered internally in the form of suspensions and tablets according to the age-related dosage, in severe cases, as intramuscular and intravenous injections. The course of treatment with an antibiotic should be at least 10 days. When a specific pathogen is identified, the antibiotic is administered according to its sensitivity.

To prevent the development of dysbiosis against the background of antibacterial therapy, the use of probiotics( preparations containing lacto- and bifidobacteria) - linex, acipol is recommended. The complex treatment also includes antihistamines( loratadine, cetirizine) and vitamins, especially C and group B.

Local treatment of sore throat includes irrigation of the mucosa with antiseptic sprays and aerosols( Miramistin, Tantum Verde, Hexaspree, Bioparox), resorption of tablets, pastillesand lollipops with antiseptic action( Septotelet, Lizobakt, Trachisan, Strepsils), as well as gargling with a disinfectant. As a disinfectant, 2.5% sodium bicarbonate( soda) is used - 1 teaspoon of soda dissolved in 1 glass of water, a solution of hydrogen peroxide( H2O2) -1 tablespoon of 3% solution per glass of water, Givalex solution, Stomatidine.

For inflammation of the cervical and submandibular lymph nodes, a warming compress on the neck is recommended( alcohol: 1/3 alcohol and 2/3 of water).When the inflammatory process stops, physiotherapeutic procedures are prescribed: UHF on the lymph nodes of the neck, the tube quartz on the area of ​​the palatine tonsils.

Folk remedies for the treatment of angina in children.

Traditional medicine offers a wide range of herbs( chamomile, sage, calendula flowers), decoctions of which have a pronounced anti-inflammatory effect. The broth is prepared from the calculation of 1 tablespoon of herbs per 1 cup of boiling water. Rinse the throat 4-5 times a day. It is indicated for any severity of the disease, provided the child's ability to perform this procedure and the absence of allergies to the listed plants. In the treatment of sore throats, inhalations with the decoctions of the above mentioned herbs, essential oils( 1-2 drops of eucalyptus essential oil are added to a container with hot water, covered with a towel and inhaled deeply for 5-6 minutes).Inhalations are not administered to children under 3 years of age and during the febrile period of the disease.

Prevention of angina in children.

Prevention of angina is aimed at preventing the onset of the disease, as well as preventing the development of complications and the chronization of the process. It includes the elimination of various hazards( dustiness, smoke, dry air, excessive crowding), reducing the protective properties of the body.

It is important to temper the body, exercise, correct mode of work and rest, rational nutrition with sufficient vitamin content. To prevent sore throat, it is necessary to sanitize foci of infection in the oropharynx( carious teeth) and the nasopharynx( adenoids).

Due to the fact that angina is an infectious disease, a sick child needs to organize proper care and ensure the safety of others. The child should be placed in a separate room, which should often be ventilated. The room must be wet cleaned daily using disinfectants. For the child, a separate towel is given, as well as utensils, which after each use are scalded with boiling water. After the transferred sore throat, the child should be under the regular supervision of the district pediatrician within a month.

Forecast.

In case of timely initiated and fully implemented treatment, the prognosis of the disease is favorable - the sick child completely recovers. Otherwise, complications may develop or the process will become chronic. Complications of angina are caused by the spread of the inflammatory process from the amygdala to the surrounding tissue( parafaringitis, paratonzillitis) or nearby organs( purulent lymphadenitis, sinusitis, otitis).Less common are infectious and allergic complications( acute rheumatic fever, glomerulonephritis, myocarditis, arthritis).

Doctor otorhinolaryngologist Rybinets E.A.