Nasopharyngitis in children

Nasopharyngitis in children - respiratory disease, which ranks first among the pathologies of the upper respiratory tract in children of preschool and early school age.

This prevalence of the disease is associated with the availability of transmission routes in organized children's groups.

[1], [2], [3], [4], [5]

Causes of the nasopharyngitis in children

Nasopharyngitis is a disease that affects children several times a year. This is due to the variety of etiological factors.

The causes of nasopharyngitis in children are viruses. Among the possible pathogens - influenza virus, parainfluenza, adenovirus, respiratory syncytial virus, rhinovirus.

All these viruses have a tropism for a particular respiratory tract, for example respiratory syncytial virus affects bronchioles more often, and rhinovirus is a mucous membrane of the nasal cavity, however these same viruses can cause nasopharyngitis.

Infection occurs by airborne droplets. The source of the infection is a patient with nasopharyngitis, rhinitis, bronchitis or a virus carrier. The disease develops in children against the background of weakened immunity, that is, when the child is not fully recovered from the previous infection. Often, nasopharyngitis develops against the background of an already existing acute viral infection - acute rhinitis. Then breathing through your nose becomes difficult and the baby breathes with his mouth. In this case, the air is not cleaned, warmed and there is no protective function of the cilia of the epithelium of the nasal cavity. Therefore, a secondary viral agent is attached.

The incubation period depends on the type of pathogen. With the flu - from a few hours to two days, and with a respiratory syncytial virus - from two to five days.

Viruses have tropism to the epithelium of the upper respiratory tract, so they easily fall and are fixed on the epithelium. In the envelope of the virus there are protein structures that resemble the proteins of the cell membrane of a normal cell, so the virus particle is not perceived as alien. This contributes to infection with the virus.

Thus, the main cause of the disease is infection with the virus, especially against the background of weakened immunity.

Pathogenesis

A virus with droplets of saliva or with an aerosol of air gets on the mucous membrane of the nasopharynx. For the development of the disease, it is necessary that the number of virus particles is sufficient, that is, a certain viral number is needed.

The pathogenesis of nasopharyngitis in children has its own characteristics, which is associated with anatomical and functional features of the structure of the upper respiratory tract. The lymphatic system of the posterior pharyngeal wall in children, unlike adults, is more friable, the epithelium is well-blooded and not mature enough. The cell of the epithelium has proteins in the membrane that are similar to the structures of the viral particle, which contributes to the very easy entry of the virus into the middle of the cell. Being in a cage, the virus particle easily penetrates the nucleus of the cell and affects DNA. The next stage - the virus builds its own DNA into the nucleus of the cell and synthesizes new particles. In this case, normal epithelial cells die and are rejected. The local immune system reacts to this process: the lymphocytes of the swallowing lymphatic system by phagocytosis neutralize the foreign elements. So the immune response develops. In this case, proinflammatory substances are distinguished - histamine, bradykinin, interleukins of different classes. They promote vasodilation and develop edema and hyperemia. There is hyperplasia of the lymphatic system of the posterior pharyngeal wall.

Thus, the clinical manifestations of the disease develop.

[6], [7], [8], [9], [10], [11], [12]

Symptoms of the nasopharyngitis in children

Since this virus disease affects the general condition of the child, the signs of intoxication appear to the fore, which are moderately expressed, given the viral etiology. The child becomes sluggish, appetite and sleep worsen. He complains of headache, muscle pain, sore throat when swallowing.

Symptoms of nasopharyngitis in children can be divided into general and local.

The first signs of the disease are a deterioration in the child's well-being, a rise in temperature to a low-grade figure. Such a moderate increase in temperature confirms the viral nature of the disease.

Local symptoms develop later, when the degree of damage to epithelial cells is significant and intensive swelling develops. Then there are complaints of sore throat when swallowing, but unlike bacterial damage, with pharyngitis, warm tea improves the baby's condition. Because of the swelling of the nasopharynx, air permeability deteriorates and a feeling of nasal congestion develops. Sometimes there may be rhinitis. As a local reaction, regional lymph nodes increase, but this is not common in viral lesions.

Patients complain of a cough that is unproductive, difficult to clear up and worries mostly in the morning. This cough is not a sign of damage to the bronchi or lungs, it is a reactive process. At night in the horizontal position, mucus from the nasopharynx accumulates and in the morning, when the child rises, this secret clears throat. Its a little, so cough is insignificant. That's why you should not worry about coughing with nasopharyngitis, if only it is so insignificant.

The clinical picture of nasopharyngitis in children develops gradually and with mild course can not affect the general condition of the child, except for infants. Such children due to nasal congestion can have weight loss, breast rejection and diarrhea manifestations, so these children require special attention in the treatment of any viral diseases.

Forms

Disease of the upper respiratory tract in children often has an acute course. This is due to the high reactivity of the child's body and the good functional activity of the immune system.

Acute nasopharyngitis in children lasts from 10 to 14 days: the first 2-3 days - the incubation period, when there are no signs of the disease, the next 3-5 days - a detailed clinical picture. In the absence of complications, by the end of the second week the child recovers. The disease can last longer in the event of complications. In general, the criterion of acute course is the development of the disease for no more than three weeks.

Chronic nasopharyngitis occurs in children with weakened immunity, in children at risk for respiratory system pathology. The course of the disease for more than three weeks allows you to suspect a bacterial infection or a chronic process. This form, as a rule, is not catarrhal, but hypertrophic or atrophic. In children, this pathology is not frequent, because for chronicity and profound changes in the epithelium of the nasopharynx, a very prolonged course is necessary. Therefore, if nasopharyngitis in a child lasts more than 21 days, a comprehensive examination is needed.

[13], [14],

Complications and consequences

Timely diagnosis and treatment of nasopharyngitis in children prevents complications. The main complications arise from infection with the bacterial flora on the background of viral damage. Then on the 3-5th day of the disease, the condition of the sick child worsens, the temperature rises above 38 degrees, a puffiness appears and the symptoms of intoxication become worse. This indicates a possible pneumonia. Sometimes the etiological factor in the development of pneumonia may be viral-bacterial associations. The course of such pneumonia is very difficult, even a hemorrhagic component is possible in the development of changes in the lungs, which has an unfavorable prognosis.

In young children, the effects of viral nasopharyngitis may include symptoms such as poor appetite, rejection of the breast, weight loss, diarrhea syndrome. This is due to the deterioration of breathing through the nose, which disrupts the process of breastfeeding. Also in small children, due to anatomical and functional features of the ear, otitis often develops. If the causative agent is an adenovirus, then a concomitant viral conjunctivitis develops, which, if improperly handled for the eye mucosa, can be affected by bacteria and keratitis, uveitis develop.

If the causative agent of nasopharyngitis is a respiratory syncytial virus, then the development of bronchiolitis may become a consequence of this in children of the first two years of life.

Parainfluenza virus, as one of the complications, can cause laryngeal edema with the development of false croup syndrome.

Another complication of viral nasopharyngitis may be hyperthermia syndrome, which is characterized by the presence of febrile seizures, especially in children at risk.

The most serious complication is the development in the child of toxic encephalopathy, which is caused by the toxic effect of the products of the virus metabolism on the central nervous system.

Mainly, complications of nasopharyngitis occur with improper treatment or in the absence of adequate treatment.

[15], [16], [17], [18]

Diagnostics of the nasopharyngitis in children

Symptoms of nasopharyngitis are not specific to a particular pathogen, so it is often impossible to establish an exact etiological diagnosis. Diagnosis of nasopharyngitis in children is complex: complaints, collection of anamnesis, data of objective examination, instrumental and laboratory diagnostics.

When collecting anamnesis, the symptoms and the time of onset of the disease are elucidated. Upon examination, the doctor reveals a bright hyperemia of the posterior pharyngeal wall. A characteristic diagnostic sign - hyperplasia of follicles of the posterior pharyngeal wall - is a "paving stone symptom". Regional lymph nodes can be enlarged.

Laboratory diagnostic methods are prescribed for the purpose of differential diagnosis. Changes in the general analysis of blood are characteristic for a viral infection - this is a relative lymphocytosis with an unchanged leukocyte formula.

Instrumental diagnosis, as a rule, in uncomplicated cases is not applied. Only with the suspicion of the development of pneumonia for confirmation of the diagnosis is chest X-ray.

To identify a specific pathogen, a smear of the posterior pharyngeal wall should be directed to a virological examination. You can identify the virus by polymerase chain reaction (PCR) in a blood test. But these methods of diagnosis are rarely used, since the treatment of the disease is pathogenetic and does not depend on the type of pathogen.

Clinical examination of the child is the main method of diagnosing this disease.

[19], [20], [21]

Differential diagnosis

Many viral diseases in children proceed according to the type of nasopharyngitis or angina. Different etiological factors can cause similar clinical symptoms, but in some cases it is necessary to identify the pathogen for clinical manifestations for proper treatment.

The symptom of pharyngitis can be when infected not only with respiratory viruses, but also with herpes viruses. One example is infectious mononucleosis, which causes the Epstein-Barr virus from the herpesvirus family. The disease also manifests a bright hyperemia of the posterior pharyngeal wall, but in contrast to pharyngitis, is also accompanied by an increase in all groups of lymph nodes, hepato- and splenomegaly. The main diagnostic feature of the disease is an increase in the total blood mononuclear cells.

Differential diagnosis of nasopharyngitis in children is also carried out with bacterial infections. In the bacterial lesion of the nasopharynx, in addition to hyperemia, white films appear on the tonsils, which is not present in viral processes. A distinctive feature is the so-called "empty pharynx" symptom - in viral nasopharyngitis, warm tea reduces the intensity of pain in the throat, while in the angina any irritations only increase the pain.

It is necessary to distinguish between nasopharyngeal hyperemia in viral nasopharyngitis and measles. The measles virus is characterized by a bright hyperemia of the entire oral cavity with the appearance in the future of a specific rash in the form of small grains and spots of Filatov.

When scarlet fever also appears red, "glowing" yawn, but these changes are accompanied by the appearance of a characteristic rash on the skin.

Treatment of the nasopharyngitis in children

Start treatment for any disease you need as quickly as possible, and this is no exception. Early and correct treatment helps prevent complications.

The regime for nasopharyngitis in children should be bed rest for the period of the height of the disease, when the temperature is raised.

The diet should correspond to the age of the child and be full of the main food ingredients. In this case, you need to increase the amount of protein and reduce the percentage of animal fats and simple carbohydrates. Food should be in a warm form, not hot, by the consistency of cereal. This is provided in order not to irritate the affected throat. A very important element of treatment is the drinking regime. The child should drink a lot of fluids, since this removes viral toxins from the body through sweat glands and with urine. Drink preferably a warm, weak tea with lemon without excess sugar. You can also have fruit drinks, fruit compotes, but not multicomponent. Proper drinking regimen is one of the items of pathogenetic treatment.

Vitamins should be in the form of fruits and vegetables, which is more important than medicines.

Drug treatment involves the use of medications. These drugs are used as a topical or systemic treatment.

1. To act on the virus itself, antiviral drugs are prescribed. One of them is "Amizon" for children.

"Amizon" acts on the envelope of the virus, so it can not infect epithelial cells and the virus is inhibited. The drug also has an immunomodulatory effect by enhancing the synthesis of endogenous interferon. The drug also has an antipyretic effect due to the influence on the center of thermoregulation. "Amizon" is produced in tablets of 0,125 g. The dose for treatment of children from 6 years - 1 tablet 2-3 times a day. The course of treatment is 5-7 days.

Precautions during the use of the drug: should not be administered to children under 6 years of age, not prescribed in case of allergy to iodine preparations or other components of the drug.

The side effects of the drug are mucosal edema, a bitter taste in the mouth, allergic and dyspeptic reactions.

For local treatment, lozenges are used for resorption. They reduce the swelling of the pharynx and have an analgesic effect.

2. "Pharyngosept" - antiseptic for the throat, suppressing the growth of bacterial flora. This prevents the development of complications of bacterial etiology. The drug stimulates the secretion of saliva and reduces dryness and perspiration in the throat. Produced in the form of tablets of 10 mg with a taste of lemon. Dose for treatment of pharyngitis - for children from three to seven years, 1 tablet 3 times a day, not less than half an hour after eating; for children from 7 years - 1 tablet 5 times a day. Tablets dissolve until completely dissolved and after 2-3 hours do not drink or eat. The course of treatment is 5-7 days.

Precautions: Do not take if hypersensitivity to the substance of the drug.

Side effects - allergic reactions, rash on the skin.

3. Symptomatic treatment with nasopharyngitis is prescribed with a significant increase in temperature.

Paracetamol is an antipyretic drug that is recommended for use in children. It has a central antipyretic effect by inhibiting the enzyme cyclooxygenase. To bring down the temperature is necessary for children, if it reaches above 39 degrees. If the child is less than three months old - to lower the temperature above 38 degrees, and children with heart, lung, nervous system diseases - above 38.5

The drug is produced in syrup - "Panadol baby" for 100ml. A single dose for a child is 10-15 mg per kg of body weight. The interval between doses, even if the drug is ineffective, should not be less than 4 hours.

Precautions: Do not give children younger than 2 months, if there are allergic reactions and severe impairment of kidney function.

Side effects: the effect on the bone marrow - agranulocytosis, thrombocytopenia, anemia.

Alternative treatment of nasopharyngitis in children

Alternative treatment of nasopharyngitis in children is very common due to its simplicity and accessibility. Various methods are used, which give a good result, because in one way or another they act on the virus or its toxins. Children do not use aggressive drugs, that is, garlic is not recommended, any tinctures on alcohol.

The main recipes for home remedies are:

• Kidney fir need to collect, rinse thoroughly and boil in a ratio of 1: 1. Then broth the broth, put in a dark place to infuse for 3-4 hours. Before the reception, add honey to taste, so that the child can drink, and take 1 teaspoon 3 times a day.
• warm milk, mixed with honey and butter, helps to drink - not only is it pleasant to the baby, it also reduces the pain in the throat.
• it is useful to soak your feet in the water with chamomile and spruce flowers, then dry with a towel, put on warm socks and sweat - the well-being will improve significantly.
• The fruits of the viburnum mash, add honey and rub, then pour hot water and strain, drink instead of tea.
• more adult child can grate the carrot on a fine grater and mix with the juice of lemon and honey, let the mouth hold for several minutes, and then spit and repeat the procedure several times.
• indisputable benefit of tea with honey, lemon and ginger.

Also for the treatment is very often used infusions of herbs:

• inflorescences and blackberry fruits, you can also use blueberries, pour boiling water and insist, add honey for taste and drink on a teaspoon three times a day.
• leaves of mint, mother-and-stepmother, lime, balm, pour boiling water, insist and take 50 ml throughout the day.
• sage herb insist in hot water and take for the night 1 teaspoon, adding a little honey.

Homeopathic remedies are also used in the treatment of nasopharyngitis, especially in children. Homeopathic remedies include:

• "Lymphomyosot" - a drug that has anti-edematous, anti-inflammatory, lymph drainage action, increases the immune status of the child. It is produced in ampoules and applied in the form of drops. Dosage for children under 6 years of 5 drops under the tongue 2 times a day, and for children over 6 years - 10 drops 2 times a day. Precautions - do not use for hyperthyroidism, thyrotoxicosis. Side effects are not revealed.
• "Tonzilotren" - a drug that detects a decongestant, immunomodulating effect, provides trophic action. It is used for children 1-12 years, 1 tablet every three hours for the first day (no more than 8 tablets per day) and then 1 tablet 3 times a day until recovery, and for children over 12 years - 1 tablet every hour in the first day and further on 1 tab. 3 times a day until the symptoms disappear. Precautions - individual intolerance of the components of the drug. Side effects are not revealed.
• "Traumeel S" - analgesic, anti-edematous, anti-inflammatory agent. It is available in ampoules for parenteral administration and in tablets. Dosage for children under 3 years on half a tablet 3 times a day, and after three years for 1 tablet 3 times a day. Precautions - not recommended for hypersensitivity. Side effects are possible in the form of redness and itching at the injection site.
• "Pharyngomed" - lozenges for absorption, have anti-edematous, anti-inflammatory effect. Produced in the form of tablets. Dose for children older than five years - 1 tablet every 2 hours on the first day (no more than 5 tablets), then 1 tablet 3 times a day. Precautions: Do not use on children under 5 years of age. No side effects were found.

[22], [23], [24], [25], [26], [27], [28]

Prevention

This disease is easily transmitted, especially in children's groups, but it is impossible to restrict the child in communication, so if a child is sick once or twice a year, this is not a pathology. However, there are preventive measures that must be adhered to in order to protect against possible complications.

Prevention of nasopharyngitis is in nonspecific measures, since there is no specific immunization with this disease. It is necessary not to let the child into the kindergarten, if he has not completely recovered, it is better to stay at home. It is necessary to prevent subcooling, sudden changes in the temperature of the child's body. Nutrition should be appropriate to the age and needs of the child. You have to walk in the fresh air, play games in nature. In severe frost, it is necessary to close the child's mouth with a scarf, so that he breathes his nose. In acute rhinitis, it is better not to let a child out into the street for a while, so that pharyngitis does not develop.

[29], [30]

Forecast

The prognosis of nasopharyngitis for recovery is favorable, in case of correct timely treatment complications are rare. If bronchitis, bronchiolitis or pneumonia develops, the treatment will be longer and slightly different, but the prognosis is also favorable.

Nasopharyngitis in children is a frequent pathology, especially if the child goes to a kindergarten or school. This is not a dangerous pathology, as pathogens are viruses, but with improper treatment or lack of it, bacterial complications such as pneumonia or otitis may appear. Therefore, you should monitor the health of your child, but in the best interests of his or her care.

[31], [32], [33]