Sore throat is an acute infectious disease and is characterized by an inflammatory process, localized predominantly on the tonsils, therefore it is also called acute tonsillitis in a different way. The causative agents can be bacteria, viruses and fungi, but in the vast majority of cases, they are β-hemolytic streptococcus. Infection of children is carried out by airborne droplets and, less commonly, by household contact with sick children or adults. The most susceptible to the occurrence of the disease are children aged 3 to 6 years who attend children’s groups.
Types of sore throats
Depending on the nature of the inflammation on the tonsils in children, there are several forms of angina:
- Catarrhal It is characterized by a relatively light course, superficial lesion of the tonsils, their redness and swelling, from above they are covered with transparent mucus.
- Lacunar Manifested in the form of education in the gaps of the tonsils and on their surface a yellowish-white purulent deposit.
- Follicular Accompanied by an increase in the tonsils in size, the formation on their surface of yellow or white purulent plugs up to 3 mm in diameter.
- Fibrinous. It is characterized by the appearance of whitish-yellow color in the form of a film over the entire surface of the tonsils and sometimes outside of the fibrinous plaque, most often it is the result of lacunar or follicular angina.
- Ulcerative membranous. Accompanied by loosening of the tonsils and the formation of a grayish-yellow plaque on them, leaving superficial ulcers with a gray bottom, develops with a strong depletion of the body, immunodeficiency, lack of vitamins B and C.
The most common are the first three forms, and lacunar and follicular tonsillitis are often a continuation of the catarrhal.
Sore throat in children may occur as an independent disease (primary) or may be a consequence or complication of other diseases: diphtheria, scarlet fever, mononucleosis, leukemia, agranulocytosis (secondary). Depending on the pathogen, the sore throat is divided into bacterial, viral, fungal.
The most common bacterial pathogens of tonsillitis in children are streptococcus and staphylococcus. At the same time, the share of diseases caused by streptococcus accounts for about 80% of all clinical cases.
The causative agents of viral angina can be Coxsackie and ECHO viruses, as well as viruses of the herpes family (cytomegalovirus, herpes simplex virus, Epshtenya-Barr virus), adenoviruses and others. The disease is accompanied by the appearance of eruptions on the tonsils, which look like vesicles in herpes simplex, and therefore this sore throat is called herpetic.
In fungal tonsillitis, a combination of tonsil lesions by Candida or Leptotryx fungi with streptococci or staphylococci occurs.
Infection with angina in children occurs after contact with a sick child or an adult by airborne droplets, through food, beverages and household items (dishes, towels, toys). A sick person is contagious to others from the first days of the illness until full recovery. The following factors contribute to the development and reproduction of pathogenic microflora on the tonsils when it enters the child’s body:
- drinking cold drinks and foods;
- reduced immunity in the presence of existing or recently transferred diseases;
- chronic fatigue;
- nasopharyngeal disease, accompanied by a violation of nasal breathing;
- poor nutrition.
In infants up to 6 months this disease does not occur, in children from 6 to 12 months the appearance of angina is possible, but this happens very rarely. This is due to the fact that the development of the tonsils and the differentiation of their follicles begins only at the age of six months. Accordingly, if the tonsils are not present, then there can be no inflammation.
In some children, the tonsils are hypertrophied, often inflamed and represent a source of chronic infection. This disease is called chronic tonsillitis. At the same time, any additional infection, cold, hypothermia, stress cause its exacerbation, the symptoms of which are similar to the symptoms of sore throat, but this disease is not a sore throat, since no infection occurs. Just under the influence of favorable factors for the development of pathogenic microflora constantly present on the tonsils in small quantities, it begins to actively multiply and causes inflammation.
In children with sore throat, the following symptoms suddenly appear:
- temperature increase up to 38-40 ° С, which is very hard to get off with traditional children’s antipyretic drugs;
- increase in size and tenderness to palpation of nearby lymph nodes;
- severe sharp sore throat, painful difficulty swallowing;
- feeling of dryness, tickling and tightness in the throat;
- hoarse voice;
- general weakness, nausea, loss of appetite, refusal to eat;
- pain in the joints, muscles and in the region of the heart;
- capriciousness, anxiety, tearfulness (in very young children).
Their intensity depends on the specific form and severity of the disease.
The main differences between sore throats and ordinary acute respiratory viral infections, in which sore throat and other symptoms of sore throats in children can also occur, are the absence of cough, runny nose, high fever with chills, sudden onset of the disease, the presence of pathological changes in the tonsils, and an increase in lymph nodes.
If you suspect a child’s sore throat, you must show the doctor. Self-diagnosis and self-treatment in this situation can result in serious complications. The doctor should collect anamnesis, listen to the complaints of the parents, examine the pharynx and pharynx, assess the condition of the tonsils, order additional examinations.
To identify the cause of the disease to the child, a general analysis of the blood, urine and bacteriological seeding of the pharynx (from the tonsils and the posterior pharyngeal wall) is done to determine the sensitivity of the detected bacteria to antibiotics. With bacterial sore throat in the general analysis of blood is noted:
- increased white blood cell count;
- increase in the number of stab neutrophils;
- increasing the content of immature forms of neutrophils (metamyelocytes and myelocytes);
- decrease in the percentage of lymphocytes;
- high rates of ESR (up to 40-50 mm / hour).
In the urine detect traces of protein and single red blood cells.
If the disease is caused by a viral infection, then in the general blood test the following deviations from the norm are observed:
- high content of lymphocytes;
- a slight increase in the concentration of monocytes;
- reduced neutrophil count;
- increased ESR.
In angina, it is important to conduct a differential diagnosis, since the symptoms typical for it are also observed in diphtheria and infectious mononucleosis. Unlike angina, diphtheria additionally affects the heart, kidneys, nervous system, and in case of infectious mononucleosis, there is an increase in all lymph nodes, damage to the liver and spleen.
Video: Angina in children and adults. How to treat
Treatment of angina in children
If a child’s sore throat is suspected, parents should first call the doctor’s house or go to the children’s clinic. Treatment of this disease can take place both in the hospital and at home, depending on the severity of the patient’s condition. Children under one year are usually hospitalized immediately.
A disease of viral etiology is usually faster and easier than that caused by streptococcus or other bacteria. The basis of therapy for bacterial sore throat is antibiotics in oral or injectable form. In case of herpetic sore throat, symptomatic treatment, but additionally sometimes antiviral and immunomodulating drugs are prescribed.
Treatment of angina is carried out comprehensively and includes taking the following medications:
- drugs directly aimed at combating the pathogen (antibiotics, antiviral or antifungal agents);
- antipyretic drugs;
- local antiseptics.
In addition to medicines prescribed by the doctor, it is necessary to give the child plenty of warm drinks (weak tea, compote, plain or mineral water without gas) to reduce toxicity, replenish fluid loss at elevated temperatures and prevent dehydration. In the room where the patient is, you need to carry out daily wet cleaning and often ventilate it.
In severe conditions in the first days of the disease, children should be kept in bed. A sick child should be allocated separate dishes, hygiene items and isolate it from other children in order to avoid the spread of infection. It is better to feed the child with warm chopped food of a liquid or semi-liquid consistency (mashed potatoes, soups, cereals, broths), in order not to injure the inflamed tonsil mucosa. From this point of view, one should not offer the child spicy, sour, salty foods, carbonated drinks, hot tea.
Usually, 3-4 days after the start of treatment of a sore throat, the child’s condition improves significantly, sore throat becomes less intense, the temperature does not rise to high values. Full recovery in the absence of complications occurs within 7-10 days.
Antibiotics are the main element in the treatment of bacterial angina. Moreover, it has been established that it is more effective to start taking them on the second or third day after the onset of characteristic symptoms of angina in a child, as this will allow the body to form a certain immunity against the pathogen for the future. However, if the child’s condition is severe, treatment should begin immediately.
In case of sore throat, caused by streptococcus, antibiotics are used, which are produced in the form of tablets, suspension or powder for the preparation of injection solutions. The choice of a particular drug and method of its use is solely the task of the doctor. The following antibiotics may be given to children with sore throat:
- penicillin amoxicillin (flemoxin, ampicillin) or amoxicillin in combination with clavulanic acid (amoxiclav, augmentin, ecoclav);
- azithromycin (sumamed, azithromycin, azitrox, hemomycin) and midecamycin (macropen) from the group of macrolides;
- cefuroxime (cefurus, zinnat, aksetin), cefixime (suprax, pancef) and other cephallosporin antibiotics.
It is very important not to stop taking antibiotics after the child’s condition improves, and to undergo a full course of treatment, which for most drugs is 7-10 days. Otherwise, the likelihood of the child developing further serious complications after a sore throat increases, since the pathogen is not completely destroyed and becomes resistant to the therapy.
The lack of a therapeutic effect after 3 days after taking the prescribed antibiotic is an indication for its replacement.
For the prevention of dysbiosis in parallel with antibiotics and some time after the end of their admission to the child give probiotics. Such drugs include Linex, Bifidumbacterin, Bifiform, Lactobacterin.
Topical treatment of children with angina has an antiseptic effect, helps to ease swallowing, reduce inflammation and sore throat, but does not affect the recovery time. The doctor should select the drugs for him, taking into account the age of the child and contraindications. Treatment may include gargling, loosing tablets or lozenges, and spraying the throat. It should be carried out after meals 3-5 times a day. Do not eat or drink for at least 30 minutes after local throat treatment.
For rinsing you can use:
- furatsilina solution (2 tablets per glass of water);
Sprays are used for children older than 3 years, as at an earlier age children are not yet able to hold their breath during the injection of the drug, which is fraught with reflex contraction of the muscles of the larynx. When treating the throat with a spray for the prevention of laryngospasm, it is better to direct the drug stream not directly into the throat, but on the cheek. Of the drugs in this group for angina, children are most often prescribed ingalipt, hexoral spray, lugol spray, tantum verde, orasept.
Faringosept, hexoral tabs, lysobact, grammidine, strepsils, stopangin are used for resorption in case of angina.
For very young children who are not able to gargle and dissolve the pills, local treatment may consist in removing purulent plaque from the tonsils with tampons soaked in the above rinse solutions. To perform this procedure, the mother must wind the cotton wool on the index finger, moisten it with medication and wipe the throat. On how to properly perform this procedure and whether to even do it, it is better to consult a doctor.
To reduce the temperature, antipyretic agents prescribed for children are prescribed in the form of paracetomol-based syrups (efferalgan, panadol, calpol) or ibuprofen (nurofen, ibufen). Given that the characteristic temperature for angina can be accompanied by vomiting, it is preferable to use them in the form of rectal suppositories (cefecone, efferalgan, nurofen).
To prevent allergic reactions in the presence of antibiotics, many doctors prescribe antihistamines to children as part of a combination therapy. Most often they are used in the form of syrups (tsetrin, Erius, zodak, peritol) or drops (fenistil, zyrtek).
Treatment of folk remedies
Of folk remedies in the treatment of angina apply gargles with infusions of medicinal herbs with antiseptic and anti-inflammatory effects. These include chamomile, calendula, sage, eucalyptus, St. John’s wort. Also for rinsing you can use a solution made from ½ tsp. salt and soda, 200 ml of water and a few drops of iodine.
An effective folk remedy for many diseases of the upper respiratory tract is warm milk with the addition of honey and butter. This drink softens the mucous throat and relieves pain.
The use of traditional methods of treatment of angina for a child must be coordinated with the doctor, since some procedures for this disease are strictly contraindicated. First of all it concerns steam inhalations and warming compresses.
Video: Pediatrician Komarovsky E. O. about the symptoms and treatment of angina
In the absence of timely correct therapy, a sore throat can end up with sad consequences for a child. This is due to the fact that streptococcus, which in the overwhelming majority of cases is the causative agent of the disease, affects the heart, kidneys and joints. As a result, after several months or years, a child may develop the following serious chronic diseases:
- rheumatoid arthritis;
- rheumatic endocarditis and myocarditis;
- necrotizing fasciitis;
- rheumatic chorea.
Currently, thanks to the use of antibiotics effective against streptococcus, such complications are extremely rare. For their timely detection after suffering a sore throat, it is necessary to monitor the doctor for a month and conduct examinations (ECG, complete blood count and urine analysis).
With angina there is a risk of local complications that occur immediately during the disease. These include:
- purulent lymphadenitis;
- paratonsillar abscess.
Video: Complications of angina
The most reliable method for the prevention of angina is to avoid contact of the child with children or adults infected by it, and carefully following the rules of personal hygiene. In addition, parents should take measures in advance to strengthen the child’s immune system, which include a balanced diet, hardening, adherence to the day regimen, good sleep, exercise, and frequent walks in the fresh air.