Клініко-параклінічні маркери активності запального процесу при гострих тонзилофарингітах у дітей

Abstract

Purpose — to study clinical and paraclinical markers of inflammatory activity in acute non-streptococcal and streptococcal tonsillopharyngitis in children to address rational treatment tactics. Materials and methods. To achieve this goal, a comprehensive examination of 102 children with acute tonsillopharyngitis, which was divided into two clinical groups depending on the isolation of beta-hemolytic streptococcus group A during a culture of smears from the mucosa of the tonsils/pharynx. The first (I) clinical group included 68 patients in whom bacteriological examination did not reveal BGSA — GTP of non-streptococcal etiology (nGTP). And 34 children in whom the streptococcal etiology of the disease was determined formed the second (II) clinical group — streptococcal acute tonsillopharyngitis (cGTP). Results. The presence of a subfebrile body temperature in the child increased its post-test probability by 27.4%, and higher fever figures reduced the probability of non-streptococcal GTP by only 4.3%. The absence of symptoms of intoxication syndrome in children with a high degree of specificity — 91.4% confirms the non-streptococcal nature of the disease. Expressive layers on the tonsils are more characteristic of streptococcal GTP, and the assessment of their severity <3 points was much more common in patients with non-streptococcal disease. When using the determination of the content of C-reactive protein <50.0 mg/l in the venous blood of children as a test, allows you to verify the non-streptococcal nature of acute tonsillopharyngitis with a fairly high sensitivity — 73.5% (95% CI 63.7–81.8), however, low specificity — 35.3% (95% CI 26.0–45.5). Conclusions. Indicators of local inflammation and clinical manifestations of the general inflammatory reaction were less pronounced in patients with non-streptococcal GTP. Indicators of C-reactive protein <50.0 mg/l in venous blood with high sensitivity (73.5%; 95% CI 63.7–81.8) and relative risk 1.2 (95% CI 1.0–1.5) probably testified in favor of the nonstreptococcal nature of acute tonsillopharyngitis. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: acute tonsillopharyngitis, children, clinic, C-reactive protein.