Symptoms of angina and acute pharyngitis in children

Symptoms of acute tonsillitis (tonsillopharyngitis) and acute pharyngitis in children are characterized by a sharp onset, accompanied, as a rule, by a rise in body temperature and deterioration of the condition, the appearance of pain in the throat, the refusal of young children from eating, malaise, lethargy, other signs of intoxication. On examination, the redness and swelling of the tonsils and mucous membrane of the posterior pharyngeal wall, its "granularity" and infiltration, the appearance of purulent exudation and raids mainly on the tonsils, the increase and soreness of the regional anterolateral lymph nodes are revealed.

• For streptococcal etiology of the disease, along with a sudden acute onset are characterized by:
  • body temperature above 38 ° C;
  • absence of cough;
  • hyperemia and swelling of the pharyngeal mucosa;
  • increased tonsils;
  • the appearance of yellowish plaque or individual purulent follicles;
  • anteroposterior lymph nodes;
  • Petechia can be found on the soft palate.
• With viral etiology, plaque lesions are less characteristic or nonexistent. Possible the appearance of erosions (sores) on the mucosa of the posterior pharyngeal wall and on the surface of the tonsils. The defeat of the pharynx is accompanied by the phenomena of rhinitis, laryngitis, bronchitis, conjunctivitis.
• With mycoplasmal and chlamydial etiology, the hyperemia of the pharynx is insignificant, there are no raids and ulcers on the mucous membrane, but cough is common, often acute bronchitis or even pneumonia develops.
• If the cause of tonsillitis (tonsillopharyngitis) in children was the diphtheria wand, which due to the vaccination of the population from diphtheria is now marked much less often, there are marked dirty white coatings on the tonsils and the posterior pharyngeal wall that extend to the surrounding tissues, myocarditis .
• When HIV infection is characterized by mild hyperemia of the throat, sores on the mucous membranes: an increase in regional lymph nodes, splenomegaly. Generalized lymphadenopathy. Rashes on the skin, weight loss.

[1], [2], [3], [4]

Differential diagnosis of tonsillopharyngitis

Causative agent	Clinical manifestations
	Hyperemia of the pharynx	The raids	Sores	Increased cervical lymph nodes	Other clinical features
Group A streptococcus	++++	++++ Yellowish	No	++++ L / nodes are dense	Sharp beginning Petechia on the soft palate
Streptococcus groups C and G	+++	++	No	+++ L / nodes are dense	Less severe current
Adenovirus	+++	++ Folliculitis	No	++	Conjun-quit
Herpes simplex virus	+++	++ Gray-white	++++ On the soft palate	++	Stomatitis
Entero viruses	+++	+ Folliculitis	On the back of the pharynx	+	Rashes on the skin
Influenza virus	+++	No	No	No	Cough, fever, intoxication
The Epstein-on-Barr virus	+++	++++ Gray-white	No	+++	Splenomegaly Generalized lymphadenopathy
Mycoplasma	+	No	No	+	Cough, bronchitis, possible pneumonia
Chlamydia	-	No	No	No	Cough, bronchitis, possible pneumonia
Diphtheria wand	+++	Dirty white	No	++++ L / nodes are dense	The raids extend to the areas surrounding the amygdala Myocarditis Neuropathy
HIV infection	++	No	++	+++	Splenomegaly Generalized lymphadenopathy Rash Weight loss

[5], [6], [7], [8]

Complications of angina and acute pharyngitis in children

Complications are more often observed with streptococcal etiology of acute tonsillitis and pharyngitis and include local, developing on the 4th-6th day of the disease, and general, which usually develop 2 weeks after the onset of the disease:

• Local complications are sinusitis, otitis media, paratonzillar and gullet abscesses and cervical lymphadenitis, parapharyngitis.
• Common complications are rheumatic fever, acute glomerulonephritis, tonsillitis sepsis.

In recent years, due to the widespread use of antibiotic therapy, the common complications of acute tonsillitis and pharyngitis develop less and less. However, local complications occur with the same. If not with a greater frequency. Among them, a special place is occupied by paratonzillite. Hyphalic abscess for currently unknown reasons is observed much more rarely.

Paratonzillit - purulent inflammation of paratonsillar tissue. Hygopharyngeal abscess - purulent inflammation of the pharyngeal filament and deep peri-ocular lymph nodes. Paratonzillitis and zaglone abscesses occur in approximately 3 cases per 1000 cases of acute tonsillitis (tonsillopharyngitis). The etiology of paratonsillitis and an abscess is often different from the etiology of tonsillitis (tonsillopharyngitis). Sometimes these are anaerobes (bacteroides, fusobacteria, peptococci and peptostreptococci). From aerobic pathogens are possible staphylococci and enterococci penetrating into the cellulose from the depths of the lacunae of the tonsils.

Clinically, the paratonsillitis and the retropharyngeal abscess are characterized by a sharp deterioration in the condition of the patient, already seemingly recovered from acute tonsillitis (tonsillopharyngitis) or pharyngitis, an increase in temperature to febrile digits. The child becomes sluggish or moody, complains of a sore throat that radiates into the ear on the side of the lesion. The child can take a forced posture with the head tilted forward and in the side of defeat with paratonzillitis. With a pharyngeal abscess - posteriorly. There may be difficulty in opening the mouth, unilateral swelling of the pharynx, nasal voice. Breathing becomes wheezy when inhaled and exhaling. In general, the difficulties of swallowing and breathing are the most typical manifestations of the disease.

Examination with paratonzillitis usually reveals pronounced edema of the soft palate on the side of the lesion, asymmetry of the pharynx, bulging of the anterior arch on the side of the lesion, and fluctuation there. With the retropharyngeal abscess the bulging of the posterior pharyngeal wall is characteristic. Usually note the reactive changes from the regional lymph nodes in the form of their increase and sharp soreness.

[9], [10], [11], [12]