Features of the clinical course of streptococcal and Epstein-Barr virus tonsillopharyngitis in children at the present stage

Abstract

Introduction. Acute tonsillopharyngitis is an inflammatory process of the pharyngeal mucosa, which also involves the tonsil tissue, caused by various microorganisms. This disease is widespread among the population, especially among children, accounting for 1.3% of all outpatient visits. Early etiologic diagnosis is key for optimized treatment in childhood, which will avoid the irrational use of antibacterial therapy. The aim of the study. To study the features of the clinical course of streptococcal and Epstein-Barr virus tonsillopharyngitis in children to optimize treatment. Materials and methods. We examined 103 children of different ages with acute tonsillopharyngitis who were treated in the infectious boxed wards No. 1 and No. 2 of the Chernivtsi Regional Children's Clinical Hospital during 2017–2019 and 2022–2023. The first (I) group consisted of 63 patients with Epstein-Barr virus acute tonsillopharyngitis (EBV ATP), and the second (II) group consisted of 40 children with the presence of BGSA in smear-prints/bacteriological culture – the group of streptococcal acute tonsillopharyngitis (sATP). The severity of acute tonsillopharyngitis was assessed by the constellation principle. Results and discussions. During inpatient treatment, patients with Epstein-Barr virus acute tonsillopharyngitis complained of sore throat, discomfort when swallowing, the presence of dyspeptic manifestations, and persistent lymphadenopathy for a longer period of time. In particular, on the 5th day of hospitalization, these indicators were recorded with the following severity, which was assessed according to the constellation principle: sore throat ≥ 2 points, sore throat discomfort ≥ 2 points, dyspeptic manifestations ≥ 1.5 points, lymphadenopathy ≥ 2 points. In children with streptococcal tonsillitis, clinical symptoms such as intoxication and headache were more pronounced. Conclusions. 1. Preservation of sore throat ≥ 2 points (sensitivity 68.2%), sore throat discomfort ≥ 2 points (sensitivity 68.2%), dyspeptic manifestations ≥ 1.5 points (odds ratio 25.8%), lymphadenopathy ≥ 2 points (odds ratio 5.1%) on the 5th day of inpatient treatment with high sensitivity and probable risk are in favor of Epstein-Barr virus tonsillitis. 2. The predominance of severe symptoms of intoxication ≥ 3.5 points (specificity 66.7%, odds ratio 5.1%) and headache ≥ 1.5 points (specificity 94.9%, odds ratio 12.9%) in patients with acute tonsillopharyngitis was more typical for streptococcal tonsillopharyngitis.