Symptoms of sore throat and acute pharyngitis in children

Symptoms of acute tonsillitis (tonsillopharyngitis) and acute pharyngitis in children are characterized by an acute onset, usually accompanied by a rise in body temperature and deterioration of the condition, the appearance of a sore throat, refusal of small children to eat, malaise, lethargy, and other signs of intoxication. During examination, redness and swelling of the tonsils and mucous membrane of the back wall of the pharynx, its "granularity" and infiltration, the appearance of purulent exudation and plaque mainly on the tonsils, enlargement and soreness of the regional anterior cervical lymph nodes are detected.

• For streptococcal etiology of the disease, along with a sudden acute onset, the following are characteristic:
  • body temperature above 38 °C;
  • no cough;
  • hyperemia and swelling of the mucous membrane of the pharynx;
  • enlarged tonsils;
  • the appearance of yellowish plaque or individual purulent follicles;
  • enlargement of the anterior cervical lymph nodes;
  • petechiae may be found on the soft palate.
• In viral etiology of the disease, plaque is less characteristic or absent altogether. Erosions (ulcers) may appear on the mucous membrane of the back wall of the pharynx and on the surface of the tonsils. Pharyngeal lesions are accompanied by rhinitis, laryngitis, bronchitis, and conjunctivitis.
• In mycoplasma and chlamydial etiology, hyperemia of the pharynx is insignificant, there are no plaques or ulcers on the mucous membrane, but a cough is characteristic, and acute bronchitis or even pneumonia often develops.
• If the cause of tonsillitis (tonsillopharyngitis) in children is the diphtheria bacillus, which is now much less common due to the vaccination of the population against diphtheria, then pronounced dirty-white plaques on the tonsils and the back wall of the pharynx are characteristic, spreading to the surrounding tissues, and myocarditis quickly joins in.
• HIV infection is characterized by moderate hyperemia of the pharynx, ulcers on the mucous membranes: enlargement of regional lymph nodes, splenomegaly, generalized lymphadenopathy, skin rashes, weight loss.

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Differential diagnostics of tonsillopharyngitis

Exciter	Clinical manifestations
	Hyperemia of the pharynx	Raids	Ulcers	Enlarged cervical lymph nodes	Other clinical features
Group A Streptococcus	++++	++++ Yellowish	No	++++ L/nodes are dense	Sharp start Petechiae on the soft palate
Streptococci groups C and G	+++	++	No	+++ L/nodes are dense	Less severe course
Adenovirus	+++	++ Folliculitis	No	++	Conjunctivitis
Herpes simplex virus	+++	++ Grey and white	++++ On the soft palate	++	Stomatitis
Enteroviruses	+++	+ Folliculitis	On the back wall of the pharynx	+	Skin rash
Influenza virus	+++	No	No	No	Cough, fever, intoxication
Epstein-Barr virus	+++	++++ Grey and white	No	+++	Splenomegaly Generalized lymphadenopathy
Mycoplasma	+	No	No	+	Cough, bronchitis, possible pneumonia
Chlamydia	-	No	No	No	Cough, bronchitis, possible pneumonia
Diphtheria bacillus	+++	Dirty white	No	++++ L/nodes are dense	The plaque spreads to areas surrounding the tonsils Myocarditis Neuropathy
HIV infection	++	No	++	+++	Splenomegaly Generalized lymphadenopathy Rash Weight loss

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Complications of tonsillitis and acute pharyngitis in children

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

• Local complications include sinusitis, otitis, peritonsillar and retropharyngeal abscesses and cervical lymphadenitis, parapharyngitis.
• Common complications include rheumatic fever, acute glomerulonephritis, tonsillogenic sepsis.

In recent years, due to the widespread use of antibiotic therapy, general complications of acute tonsillitis and pharyngitis develop less and less frequently. However, local complications occur with the same, if not greater, frequency. Among them, paratonsillitis occupies a special place. For unclear reasons, retropharyngeal abscess is now observed much less frequently.

Paratonsillitis is a purulent inflammation of the paratonsillar tissue. Retropharyngeal abscess is a purulent inflammation of the retropharyngeal tissue and deep retropharyngeal lymph nodes. Paratonsillitis and retropharyngeal abscess occur in approximately 3 cases per 1000 cases of acute tonsillitis (tonsillopharyngitis). The etiology of paratonsillitis and retropharyngeal abscess often differs from the etiology of tonsillitis (tonsillopharyngitis). Sometimes these are anaerobes (bacteroides, fusobacteria, peptococci and peptostreptococci). Of the aerobic pathogens, staphylococci and enterococci are possible, penetrating into the tissue from the depths of the lacunae of the tonsils.

Clinically, paratonsillitis and retropharyngeal abscess are characterized by a sharp deterioration in the patient's condition, who had seemingly recovered from acute tonsillitis (tonsillopharyngitis) or pharyngitis, with an increase in temperature to febrile numbers. The child becomes lethargic or capricious, complains of a sore throat that radiates to the ear on the affected side. The child may take a forced position with the head tilted forward and to the affected side with paratonsillitis. With a retropharyngeal abscess - backward. There may be difficulty opening the mouth, one-sided swelling of the pharynx, and a nasal voice. Breathing becomes wheezy on inhalation and exhalation. In general, difficulty swallowing and breathing are the most typical manifestations of the disease.

Examination of paratonsillitis usually reveals pronounced swelling of the soft palate on the affected side, asymmetry of the pharynx, bulging of the anterior arch on the affected side, and fluctuation there. Retropharyngeal abscess is characterized by bulging of the posterior pharyngeal wall. Reactive changes in the regional lymph nodes are usually noted in the form of their enlargement and severe pain.

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