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Treatment of infections of the upper respiratory tract, accompanied by the development of acute tonsillopharyngitis in children

Upper respiratory tract infections (UTI), or catarrhal diseases, are the most common diseases and are one of the main reasons children miss classes in kindergartens and schools. Most IVDPs are viral in nature, and more than 200 types of viruses can participate in the onset of the disease, in some cases other infectious agents, such as bacteria, become the cause. In children with an allergic and lymphatic-hypoplastic type of constitution, the course of IVPD is often complicated by acute inflammation of the lymphoid tissue of the pharyngeal ring. The cause of this lesion is often different viruses, but in some cases, bacteria such as group A streptococci, Streptococcus pneumoniae, Haemophilus influenzae and various types of Mycoplasma or Chlamydia, which are mainly transmitted by airborne droplets, can also participate in the pathological process. Depending on their virulence, immune status and constitution of the child, local inflammation may develop, covering the tonsils, adenoids, pharynx, and larynx. In children aged 5 to 15 years, acute tonsillopharyngitis (OTP) is more common with seasonal dependence (winter, spring), which may also be associated with a common disease: scarlet fever, infectious mononucleosis, herpes infection or aphthous stomatitis. OTF – acute infectious inflammation of the mucous membrane and lymphatic structures of the oropharynx (palatine tonsils, lymphoid follicles of the posterior pharyngeal wall). OTF is a polyetiological disease, therefore this term (OTF) without specifying the etiology (viral / bacterial, primarily streptococcal / fungal) cannot act as a clinical diagnosis. The term “OTF” itself combines acute inflammation of the tonsils (acute tonsillitis) and acute inflammation of the posterior pharyngeal wall (acute pharyngitis), since in the vast majority of cases there is inflammation of both localizations (with the exception of pharyngitis in a patient who has undergone tonsillectomy).

According to the International Classification of Diseases of the 10th revision, the following nosologies are distinguished.

J 02.0 Acute streptococcal pharyngitis.

J 02.8 Acute pharyngitis caused by other specified pathogens.

J 02.9 Acute pharyngitis, unspecified.

J 03.0 Acute streptococcal tonsillitis.

J 03.8 Acute tonsillitis caused by other specified pathogens.

J 03.9 Acute tonsillitis, unspecified

The diagnosis is made taking into account the predominance of the severity of inflammation of a particular part of the oropharynx. However, there are exceptions when tonsillopharyngitis is only a clinical manifestation of other diseases, these include:

herpetic gingivostomatitis and pharyngotonsonitis (caused by the herpes simplex virus, B 00.2);

influenza (influenza virus identified (J 10.1), influenza virus not identified (J 11.1));

infectious mononucleosis (B 27);

enteroviral vesicular pharyngitis, or “herpangina” (B 08.5).

Currently, they propose to abandon the term “tonsillitis”, since its classification based on the pharyngoscopic picture does not correlate with the etiology and therapeutic tactics [7].

Clinical manifestations of IVDP with OTF
The first symptoms of tonsillopharyngitis are redness and swelling of the tonsils (catarrhal tonsillopharyngitis) or folliculitis (follicular tonsillopharyngitis) with tingling, burning, and sore throat, especially when swallowing. Subsequently, there may be an increase in temperature to high numbers, pain and swelling of the submandibular and cervical lymph nodes, sometimes a shooting pain in the ear appears. Due to pain symptoms, intoxication and impaired general well-being in patients, the appetite decreases, daily activity is impaired, the child cannot attend the institution.

Frequent recurrent infections of the tonsils often lead to chronic inflammation with structural changes and scarring in the peritonsillar and tonsillar tissues. The remains of cells, inflammation elements in poorly drained crypts create an ideal breeding ground for bacteria, which supports ongoing inflammation.
Typically, chronic tonsillopharyngitis is accompanied by subtle symptoms, such as swelling, poor swallowing, unpleasant taste in the mouth, bad breath (in the case of a large number of cell fragments), and mild redness of the anterior palatine arch. Patients often complain of local pain in the tonsils due to pressure from the enlarged lymph nodes in the mandibular joint. Sometimes decay products – liquid pus – stand out from the tonsils. Chronic inflammation can lead to severe tonsil hyperplasia, while swallowing and breathing are difficult, which is an indication for tonsillectomy. With streptococcal infection, the production of antibodies can start, as a result of which a systemic disease, such as jade, carditis, can occur. This is due to the formation of antigen-antibody complexes that can affect various organs.

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