Quinsy at children – an acute inflammation of lymphoid fabric pharyngeal (is more often palatal) almonds at the child, having infectious and allergic character. Quinsy at children proceeds with high fever, the expressed symptoms of intoxication, pain when swallowing, increase in submaxillary and cervical lymph nodes, a purulent raid on almonds. Diagnosis of quinsy at children is carried out by the children's otolaryngologist by means of fizikalny survey, a faringoskopiya, dab research from a throat on microflora, blood IFA. Treatment of quinsy at children includes pathogenetic therapy (antibiotics, antiviral means), symptomatic therapy (the febrifugal, desensibilizing medicines) and local therapy (aerosols, rinsings of a throat antiseptics and herbs).
Quinsy at children
Quinsy at children (sharp tonsillitis) – an infectious and allergic disease at which palatal almonds inflame. Incidence of quinsy in children's population fluctuates from 4,2 to 6,7%, conceding on frequency only to a SARS. In view of high prevalence and transmissibility of quinsy at children, the disease is a subject of close attention of pediatrics and children's otolaryngology. Quinsy at the child is dangerous early (otitis, paratonzillyarny, side and pharyngeal and zaglotochny abscesses) and the remote complications among which - rheumatism, rheumatoid arthritis, glomerulonefrit, etc.
The reasons and pathogenesis of quinsy at children
In most cases quinsy at children is caused by a bacterial or viral infection. In 80-85% of cases the β-hemolytic streptococcus of group A acts as the activator; in 10% - golden staphylococcus; more rare - a pneumococcus, a hemophilic stick, viruses (enteroviruses, adenoviruses, herpes virus, Epstein-Burra's virus, etc.), mycoplasmas, hlamidiya, mushrooms, a mikst-infection. As a rule, quinsy at children up to 3 years is connected with virus activators; at children 5 years are more senior the bacterial infection prevails. The greatest incidence of streptococcal quinsy at children is the share of age of 5-10 years. Intracellular activators are the reason of tonsillitis and pharyngitises at preschool children in 10% of cases. In some cases quinsy at children can be caused by the opportunistic bacteria living in an oral cavity in a situation of their massive growth and high density of microbic cages.
Primary way of penetration of an infection to almonds is exogenous (airborne, contact and household, enteralny). Traumatic quinsies quite often develop after nasopharynx operations and back departments of a cavity of a nose (for example, after an adenotomiya at children). The endogenous autoinfektion is possible at an exacerbation of chronic tonsillitis, caries of teeth, sinusitis, a gastroenteritis.
As the contributing factors of development of quinsy in children serve anomalies of the constitution (the limfatiko-hyper plastic constitution), changes of regionarny and general immunity when overcooling, sharp change of climate, avitaminosis, etc.
Reaction of allergic-giperergichesky type is the cornerstone of development of quinsy in children. Lacunas of almonds contain rich not pathogenic flora, pathogenic microorganisms and products of proteinaceous disintegration which can act as organism sensitization factors are late. Against the background of a preliminary sensitization various endogenous or exogenous infectious activators can initiate development of quinsy in children. The numerous ekzotoksina allocated by activators cause an immune response with formation of the CEC striking tissues of a cardiac muscle, kidneys, etc. internals.
Local reaction of almonds to introduction and reproduction of activators is characterized by swelling of lymphoid fabric, purulent fusion of follicles, a congestion of purulent masses in lacunas, an epithelium necrosis, and in certain cases and fabrics of almonds.
Classification of quinsy at children
Taking into account the reasons of an inflammation of almonds allocate primary, secondary and specific quinsy at children. At primary quinsy the infection initially develops in almonds. Secondary or symptomatic quinsy often occurs at children at other infectious diseases: to scarlet fever, measles, diphtheria, mononukleoza and so forth. At children refer the defeats of almonds caused by specific flora to specific quinsies – causative agents of gonorrhea, mycoplasmosis, clamidiosis, candidiasis, etc. Children can have a sharp course of quinsy, often recidivous and chronic.
Depending on the nature of change of almonds, the following occurs among clinical forms of quinsy at children: catarrhal, follicular, lacunary, fibrinozny, flegmonozny and gangrenous.
At catarrhal quinsy at children survey of a pharynx reveals increase and hyperaemia of almonds, and also palatal handles. The purulent raid is absent; against the background of a friable and deskvamirovanny epithelium the thin layer of a serous whitish raid is defined. Microscopically dense infiltration of an epithelium of almonds lymphocytes and neutrophils comes to light.
The purulent dot follicles up to 3 mm ("picture of the star sky") translucent through an epitelialny cover of almonds are a sign of follicular quinsy at children. Morphological changes in a parenchyma of almonds (polnokrovy, hyperaemia) are more expressed; purulent follicles represent leykotsitarny infiltrates with the necrosis phenomena.
Lacunary quinsy at children proceeds with existence of a linear purulent raid of the yellowish color located in lacunas between shares of almonds. The surface of almonds is brightly hyperemic and edematous; raid islands in mouths of lacunas are inclined to association and formation of the wide drain purulent centers. At a microscopic research multiple ulcerations of an epithelium, leykotsitarny infiltration mucous, purulent fusion of follicles, thromboses of small vessels are found.
At fibrinozny quinsy at children of an almond become covered by a filmy whitish translucent raid. Flegmonozny quinsy occurs at children seldom; is followed by purulent fusion of the site of an almond and formation of intratonzillyarny abscess (usually unilateral).
At gangrenous quinsy ulcer and necrotic change of an epithelium and parenchyma of almonds takes place. At survey of a pharynx on almonds the whitish-gray raid comprising a large number of bacteria, leukocytes, nekrotizirovanny fabric, fibrin comes to light. After a softening and rejection of a raid deckle-edged ulcers are bared. Widespread necrotic process can be complicated by destruction, and further – scarring of a soft palate and the line of a throat. Necrotic quinsy is observed at a sharp leukosis at children, diphtheria, scarlet fever.
Quinsy symptoms at children
Quinsy at the child proceeds heavier, than at the adult: with more high temperature expressed by intoxication, frequent complications. At children consecutive transition of one form of quinsy to another (catarrhal in follicular, then in lacunary) or not progressing current is possible.
The sharp beginning from feeling of irritation, burning, the dryness and a sore throat amplifying when swallowing is characteristic of catarrhal quinsy at children. Body temperature increases to 38-39 °C, children sluggish, complain of an indisposition and a headache. Language dry, is covered with a whitish raid; regionarny lymph nodes can be slightly increased and slightly painful. Catarrhal quinsy at children usually proceeds 5-7 days.
At follicular quinsy at children symptoms of intoxication are brightly expressed: weakness, apathy, lack of appetite, artralgiya, headache. High fever with oznoba, vomiting, consciousness obscuring, spasms takes place. Severe pain in a throat is typical, it is frequent with irradiation in an ear, forcing the child to refuse food and drink. Symptoms of follicular quinsy at children accrue within 2 days; for 3-4 day there occurs the improvement connected with clarification of a surface of almonds; however pain when swallowing remains 2-3 more days. Clinical recovery of the child occurs in 7-10 days.
Lacunary quinsy at children also proceeds with a heavy intoksikatsionny syndrome. Owing to puffiness and infiltration of almonds and a soft palate the child hardly opens a mouth, at the same time his speech gets muffled sounding, and a voice – a nasal shade. Children complain of the expressed sore throat and unpleasant smack in a mouth. Regionarny lymph nodes are increased and cause painful feelings at turns of the head. The course of lacunary quinsy at children makes 10-14 days.
As the most frequent complications of streptococcal quinsy at children, the rheumatic endocarditis, nonspecific polyarthritis act, glomerulonefrit, zaglotochny abscess. Herpangina at children can be complicated by serous meningitis.
Diagnosis of quinsy at children
At emergence in the child of temperature and a sore throat it is necessary to address the pediatrician or the children's otolaryngologist. The children's doctor finds objective signs, characteristic of quinsy, already at survey mucous a pharynx, a palpation of submaxillary and cervical lymph nodes.
At the general blood test there is neytrofilny , a stab shift to the left, increase in SOE. Allows to reveal dab researches from a throat on microflora the causative agent of quinsy at children. If necessary serological diagnostics (IFA) is carried out: identification of antibodies to a mycoplasma, Candida, to hlamidiya, a herpes virus, etc.; presence of a β-hemolytic streptococcus is confirmed by definition of ASL-O.
Faringoskopiya at children defines the poured hyperaemia of almonds and handles, infiltration, existence of a raid which character allows to judge a clinical form of quinsy. The purulent raid at quinsy easily is removed the pallet, is pounded on glass and does not leave the bleeding surface (unlike a hard-to-remove raid at diphtheria).
Treatment of quinsy at children
Easy and medium-weight forms of quinsy at children are treated on an outpatient basis; at the heavy course of quinsy hospitalization in infectious office can be required.
In treatment of quinsy at children observance of a bed rest and rest, isolation of the sick child, use of individual objects of leaving (ware, towels), the organization of the sparing food and plentiful drink is important.
At bacterial quinsy at children system antimicrobic therapy by medicines to which the activator (is sensitive at allocation of a β-hemolytic streptococcus – penicillin, macroleads, tsefalosporina, karbapenema) is appointed. Along with antibacterial therapy reception of antihistaminic medicines, vitamins of group B and ascorbic acid, immunomodulators is shown.
The important place at quinsy at children is taken by local treatment: rinsing of a throat solutions of anti-septic tanks (nitrofurat, ) and broths of herbs (a calendula, a camomile, a sage), dispersion in a throat of aerosols.
At viral quinsy at children purpose of antiviral medicines, irrigation of a throat is shown by interferon.
– to opening of paratonzillyarnogo/zaglotochny abscess resort to surgical treatment at abstsediruyushchy complications. In case of the recidivous course of quinsy at children indications to a tonzillektomiya are defined.
The forecast and prevention of quinsy at children
The streptococcal quinsy transferred the child demands implementation of the ECG, a research in dynamics of the general analysis of urine and blood, if necessary – consultations of the children's rheumatologist, the children's nephrologist, the immunologist. At in due time begun and full treatment quinsy at children comes to an end with a convalescence. Otherwise transition to chronic tonsillitis, development of regionarny or general complications is probable.
Prevention of quinsy demands from children restriction of contact with infectious patients, increase in the general resistance, sanitation of the purulent centers, providing the good vitaminized nutrition.