Proper treatment of angina in children? What causes and symptoms does it have?

Tonsillitis acuta is an inflammation of the tonsils, specifically the Waldeyer's lymphatic ring. The primary role of the tonsils is to fight infection. The causative agent of the inflammation is a bacterium called Streptococcus pyogens, which is present in almost 70% of cases.

It occurs most often in children, but does not affect adults either.

Despite the fact that it is a relatively common infection, if it is not treated properly, serious consequences can occur later in life, affecting the heart, valves, joints or kidneys. Therefore, proper treatment of tonsillitis in children is extremely important.

You are interested in:
What causes angina and what are the symptoms?
Can it be viral?
Is it purulent or feverless?
Is it infectious/transmitted?
Can home treatment help or is specialist care necessary?

Why does strep throat occur?

Tonsillitis acuta is a bacterial infection of the tonsils. It is predominantly caused by streptococcal infection. Up to 70% are triggered by Streptococcus pyogenes.

Other bacteria involved are Streptococcus pneumoniae, but also some staphylococcal infections or Escherichia Coli. Bacterial, purulent angina is called bacterial angina because of the predominance of bacteria as the causative agent. However, it can also be caused by viruses or fungi (e.g. Candida albicans).

The tonsils (tonsilla palatina) are a paired organ located in the oral cavity between the root of the tongue and the soft palate. They belong to the Waderey's lymphatic system. They are made up of lymphatic tissue, like the nasal tonsils. They have a protective function in fighting infection. The surface of the tonsils is uneven, made up of depressions, which often trap pathogens.

Clinical course of the disease

Symptoms caused by streptococcal infection can be broadly divided into local and systemic symptoms. Local symptoms occur at the site of the causative agent, where it continues to multiply without treatment. Systemic symptoms are manifested by non-specific symptoms similar to those of other bacterial infections.

Local symptoms

When the bacterium attaches to the tonsils, it causes inflammation. The inflammatory process is catarrhal. The mucous membranes are inflamed, red, oozing and painful.

Subsequently, a purulent process begins, during which purulent plugs, plaques and even purulent follicles (vesicles filled with an inflammatory infiltrate) form on the tonsils. The plaques are coloured white to yellow-white, later merging into larger areas. Petechial haemorrhages (punctate - hair-like) are found on the palate.

These changes are externally manifested by pain in the throat spontaneously and on touch from the front of the neck. The pain may radiate to the jaws, from there to the ear and ends in the nape of the neck. Swallowing, coughing, sneezing or even talking and head movements - mainly rotational - are considered to provoke a higher intensity of pain.

To some extent, the pain causes difficulty in swallowing in combination with swelling of the mucous membranes, which narrows the throat space. The narrowed throat space, together with the thickened pharyngeal tonsils, also causes difficulty in breathing, which is forced through the mouth.

For the same reason, snoring may be observed during sleep. Due to the narrowing of the auditory tube, ear drooping is common. Voice changes that are more like humming are also observed.

Systemic symptoms

Angina is characterised by high fevers with shivering (chills), reaching 39 °C or more. The fevers cause excessive sweating. The child is therefore often dehydrated, weak and lethargic. Fatigue and lethargy are typical. Febrile convulsions (temperature cramps) are not uncommon. Less frequently, delirium and disorientation may occur.

Especially in children, the disease begins with fever and vomiting. Persistent vomiting contributes to worsening dehydration and general alteration of consciousness.

Gradually, other symptoms such as scratching or the sensation of a foreign body or dry throat are associated. The dry throat irritates the cough, which is usually dry and irritating. With each cough, the sore throat increases, making the child more sullen, weepy and dissatisfied.

Typically, regional (adjacent) nodes are enlarged. They can be palpated and are locally painful when palpated and pressed. This is a clear sign that the body is fighting an infection. Most often, the submandibular nodes (submandibular) can be palpated.

What complications can affect the course of the disease?

Most cases of strep throat can be managed with proper treatment and isolation of the sick child within 10 days without any complications arising. Complications are more likely to arise with poor diagnosis and subsequent improper therapy. Still, we may encounter them and it is good to know about them.

Chronic angina

It occurs as a consequence of previous and often recurrent acute tonsillitis. These leave a microbial flora in the tonsils that can cause recurrences of chronic inflammation. They manifest themselves in the same way as acute tonsillitis.

Tonsillar abscess

If the bacteria have entered the deeper structures of the tonsil and its surroundings, an abscess may form. An abscess is a purulent, oval-shaped, circumscribed inflammation or a sinus filled with pus. It usually forms in chronic tonsillitis and affects one side. The tonsil on the side of the abscess is enlarged and painful.

Sepsis

If the bacteria moves from the lesion (tonsil) through the bloodstream into the bloodstream, it is able to multiply there and cause further problems. The infection in the bloodstream is called septicemia. From there, it can get trapped in any organ of the body and invade it. The symptoms vary depending on which organ is involved. It also causes metastatic abscesses in these organs.

Basic diagnosis and examination

The most important thing of all is correct diagnosis. It is not difficult. Based on the patient's history, clinical picture, blood tests and tonsil swab, tonsillitis can be confirmed or ruled out.

In tonsillitis, there is an increased number of leukocytes (white blood cells) and an increased ASLO titer, which proves that there are antibodies to streptococcal infection in the blood. The sedimentation of erythrocytes (red blood cells) increases, the rate of which is changed (increased) by proteins typical of inflammation.

How to properly treat strep throat in children?

For bacterial infections, antibiotics are the first choice of treatment. Tonsillitis is mainly caused by streptococcal infections, which we can prove by blood results.

Ever since Fleming, the most effective antibiotic against streptococci is phenoxymethylpenicillin, a common and frequently used penicillin.

The medicine should be taken at regular intervals for a period of time determined by the doctor. The time intervals between doses of the medicine must be precise, because if the medicine were given, for example, two hours later, it might no longer work.

You may not have known: The antibiotic effect diminishes after 8 to 12 hours (depending on the type of antibiotic) and the infection becomes resistant to it. If the bacteria becomes resistant to a particular antibiotic, this no longer works and makes further treatment more difficult.

For pain, swelling, scratching and inflammation in the throat, there are nowadays a large number of over-the-counter preparations in the form of syrups or chewable lozenges. In addition to relieving pain, they also act as antiseptics and disinfect the oral cavity and pharynx.

Some gargles or herbal teas also have anti-inflammatory and soothing effects. They significantly reduce swelling and make it easier for the baby to swallow. This is extremely important when taking in food and fluids, which should be rich in vitamins.

Increased intake of vitamins and minerals increases natural immunity. Fluids are lost from the body too quickly through sweating and vomiting. Especially in children, this is very dangerous. Therefore, they need to be replenished.

It is not good to give hot teas and drinks during tonsillitis and bacterial infections in general. A warm environment is also suitable for bacterial growth, so lukewarm or only slightly warm liquids should be chosen.

Caution: in tonsillitis caused by other infectious agents, such as viruses, antibiotic treatment is ineffective!!!

Treatment of viral inflammation is purely symptomatic. Only symptoms such as fever, vomiting, pain are suppressed. Care should be taken to supplement vitamins, minerals and fluids.

If the temperature exceeds 38 °C, chest and abdomen wraps with a damp towel soaked in lukewarm water are recommended. As the temperatures in angina are very high, it is sometimes necessary to combine wraps with antipyretics (antipyretic drugs).

Bed rest is equally important. The patient should avoid any physical exertion that would worsen the course of the disease.

In the past, tonsillectomy (removal of the tonsils) was very often performed. Nowadays, it is recommended only in some cases, mainly in recurrent chronic tonsillitis or abscesses that cannot be removed by antibiotic treatment. To prevent a relapse of the infection and subsequent septicaemia, the tonsils are removed as a source of bacterial infection (bearing).

What can cause untreated tonsillitis from childhood later in life?

Tonsillitis is an easily treatable, predominantly bacterial infection. If neglected in childhood, it can cause serious or even fatal consequences that may not appear immediately. It often appears subtly or is discovered incidentally during a preventive check-up several years to decades apart.

Rheumatic fever is considered to be the most serious. It is caused by poorly treated infections caused by group A streptococcus. It is an inflammatory disease. It causes inflammation of the joints and musculoskeletal system and subsequently affects the heart muscle.

It causes inflammation of the heart muscle (myocarditis), which can lead to heart failure. The bacteria also often settle in the heart valves via the bloodstream.