What is Angina in Children?
Angina is one of the forms of streptococcal infection, causing inflammation in the oropharynx, mainly in the tonsils. Angina is manifested by fever, intoxication, reaction of regional lymph nodes, sore throat.
Angina often affects children. Sore throat is different as a disease of its own and a sore throat that originated on the background of another disease of infectious nature.
Streptococcal sore throat is allocated in an independent nosological form, but in children it usually develops as a complication of ARVI or as a result of exacerbation of chronic tonsillitis.
Epidemiology. The pathogen is isolated patients with streptococcal infection and healthy carriers of beta-hemolytic streptococcus. The main ways of transmission are airborne, contact-household, through food.
The infection enters the body through the lymphadenoid tissue of the pharynx, where it multiplies.
Streptococcal angina is more susceptible to children from 3 years of age, especially those who suffer from chronic tonsillitis. In children up to 12 months, angina caused by streptococci is extremely rare, since they have antitoxic and antimicrobial immunity obtained from the mother. Also among the causes of their rare incidence is insufficient differentiated lymphoid tissue of the oropharynx.
Angina patients are most often ill in autumn and winter, which is explained not only by weather conditions, but by longer contact of children.
Causes of Angina in Children
In 90-95 cases out of 100, the causative agent of bacterial angina in a child is β-hemolytic streptococcus group A. Angina is often caused by viruses in the child: rhinoviruses, adenoviruses, respiratory syncytial virus, crown virus, cytomegalovirus, Epstein-Barr and herpes viruses. In a third of cases, the cause of angina are bacteria. Viral forms of acute tonsillitis (tonsillitis) are found mainly in children under 3 years of age. After 5 years, the most common bacterial forms of tonsillitis in children.
Pathogenesis during Angina in Children
The ability of β-hemolytic group A streptococcus to predominantly affect the epithelial lining of the lymphoid tissue of the pharynx is associated with the direct local effect of one of the antigenic structures of the microorganism, lipoteic acid associated with M protein, which fixes the pathogen on the tonsils. M-protein reduces the phagocytic activity of leukocytes at the site of the entrance gate and thereby contributes to the increased susceptibility of the child to streptococcus.
Pathomorphology. There is a purulent fusion of lymphoid follicles, accumulation in the lacunae of purulent masses, necrosis of the surface epithelium and, in some cases, the tissue of the tonsils. Angina by morphological changes is divided into lacunar, follicular and necrotic.
Follicular sore throat is characterized by purulent fusion of the tonsil tissue in the zone of single follicles located on the free surface of the tonsils.
When lacunar tonsillitis lymphoid follicles located along the palatine tonsils undergo purulent fusion.
In case of necrotic angina, due to the necrosogenic activity of β-hemolytic streptococcus, not only lymphoid follicles are exposed to necrotic changes, but also stromal segments of the tonsils.
Symptoms of Angina in Children
Streptococcal sore throat has an acute onset. The body temperature rises to the level of 38-39 ° C, the baby is shivering, the headache begins, it also hurts to swallow. Symptoms are most pronounced on the first day of illness. Older children may receive complaints of general weakness, poor appetite, and sore throat, which can “give” to the ear and lateral parts of the neck. Severe cases are characterized by delirium, repeated vomiting, seizures, agitation.
Appearance of the patient with angina is typical. There is dry skin, flushing of the face, blush on the cheeks, brightness and redness of the lips, as well as their dryness, sometimes stuck in the corners of the mouth. The oropharynx is usually red (hyperemic), also the redness extends to the tonsils, the soft and hard palate, the back wall of the pharynx. But there are cases when the hyperemia concerns only tonsils and palatine arches. Tonsils are enlarged mainly due to infiltration and swelling. When lacunar quinsy in the gaps of the tonsils visible plaque (overlay). Often these overlays are yellowish-whitish, they are easy to remove with a spatula and rub between slides. This means that they consist of pus and detritus.
When the follicular sore throat on the tonsil is visible whitish follicles, the diameter of which is from 2 to 3 mm, they are slightly above the tonsil. They can not be removed with a tampon or spatula, since the follicles are purulent masses located under the epithelium. They are formed as a result of the destruction of the lymphoid follicles of the tonsils. Usually microabscesses ripen and open, which causes a new rise in body temperature and the appearance of superficial purulent overlays in the form of islands on the tonsils.
If the tonsillitis is necrotic, an enlarged, uneven, dull surface of a greenish-yellow or gray shade is visible on the affected areas of the tonsils, extending into the depths of the mucous membrane. In frequent cases, the raids are saturated with fibrin and become dense. Attempts to remove them cause bleeding. After rejection of overlays, a tissue defect is formed, which has a whitish hue, an uneven, bumpy bottom, an irregular shape. With streptococcal infection, necrosis may concern the arches, uvula, the posterior pharyngeal wall, and not just the tonsils.
In addition to typical changes in the oropharynx for a sore throat, regional lymph nodes are enlarged in all patients. On palpation, they are dense, there are painful sensations. The severity of angina is determined by how severe the general and local disorders are, the decisive importance belongs to general toxic disorders: the height of the fever, changes in the cardiovascular system, the central nervous system, the endocrine system.
Flow. As a rule, streptococcal angina has an acute course with a favorable outcome. If adequate treatment is carried out in time, the symptoms of intoxication and local changes in the oropharynx disappear in less than a week, then the body begins to recover. Complications may occur if the pathological process is transferred to nearby organs, which causes sinusitis, suppurative lymphadenitis, otitis. Allergic complications such as myocarditis, glomerulonephritis, etc. may occur, although very rarely.
Features of angina in young children. In children under 3 years of age, streptococcal sore throat, as a rule, will develop on the background of ARVI. Symptoms of acute respiratory viral infections and symptoms of oropharyngeal lesions appear, catarrhal phenomena (runny nose, cough) appear for a long time. Changes in the oropharynx correspond to the form of angina, but there is a slow cleansing of the tonsils from overlays, persistent hyperemia and swelling of the mucous membranes of the oropharynx, as well as an increase in the tonsils and regional lymph nodes. In such patients, complications often develop.
Diagnosis of Angina in Children
Streptococcal sore throat is diagnosed according to typical symptoms: bright hyperemia of the mucous membrane of the oropharynx, severe intoxication, necrotic changes in the tonsils; on the epidemiological history (the doctor should know about the contact with an adult or child who has had streptococcal infection); according to the results of laboratory research.
In patients with angina, they take cultures of mucus from the oropharynx, in which beta-hemolytic streptococcus is found, and an increase in antibody titers to streptococcus antigens is also detected.
Treatment of Angina in Children
Patients with streptococcal angina are usually treated at home. In severe forms and complications of patients are hospitalized. Also, hospitalization is indicated for children in whom it is difficult to rule out oropharyngeal diphtheria. Patients should be placed in the box. It is recommended to adhere to bed rest for 5-6 days, to take mechanically sparing food, multivitamins.
The oropharynx is rinsed with decoctions of eucalyptus, chamomile, St. John’s wort, sage, liniment solutions of 5% cycloferon, potassium permanganate, furatsilina, etc. Obtaining antibiotics is required by the prescribing physician. Mild and moderate forms are usually treated with phenoxymethylpenicillin, moksiklavom, erythromycin, azithromycin in doses, according to age. If a child has intolerance to antibiotics, sulfanilamide preparations, such as lidaprim, bactrim, etc., are used for treatment.
Prevention of Angina in Children
- Compliance with the rules of personal hygiene. Everyone should have their own towel, dishes, toiletries, especially for patients.
- General hygiene activities. The patient must be isolated from other family members and from the team.
- Rational nutrition. Sick and healthy people should eat according to their age needs, food containing enough protein, carbohydrates and fats.
- Timely detection and treatment of worms and chronic infections: pyelonephritis, caries, chronic sore throat, sinusitis, purulent skin lesions.
- Hardening. It is necessary to temper a child from childhood, but it is not late to begin tempering at any age. Such methods as pouring, rubbing, swimming, douche, walking barefoot, etc. are used. During the period of exacerbation of diseases hardening is prohibited.
- Strengthening local and general immunity by various means.Local immunity. Damage to the mucous membranes with dry and warm air should be avoided; avoid frequent use of local throat antiseptics. Refrain from drinking cool and cold drinks is not worth it. They lead to the tone of the mucous.
To increase the body’s defenses, drugs that stimulate cellular and humoral immunity (interferons, thymalin, licopid), immunomodulators of bacterial origin (bronchomunal, ribomunyl), and vitamins are used.
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Prevention of exacerbation of chronic angina caused by beta-hemolytic streptococcus group A (GABHS). For the prevention apply facein 3 or 5, reparpen. With their help, an antibiotic depot is created in the body in a few weeks. This helps to prevent recurrence of angina in children, carriers of GABHS, or prone to infection with them.