Recurrent whistle infections in children are a common respiratory disease in children. Upper whistle tract infections are more likely to occur than lower whistle tract infections and are most common in preschool children, with the incidence decreasing each year as they get older. The proportion of daily visits of children with recurrent upper whistle infections to daily outpatient visits of diseases of the whistle system is as high as 10% to 20% in China.
Recurrent upper whistle infections in children are frequent upper whistle infections that occur more frequently than the normal number of times in a year. The main sites of infection include the nasal-sinus, middle ear, and tonsils or pharynx.
The main risk factors for recurrent upper whistle infections in children include the following two:
(1) Physiological and genetic factors: family history of atopic reactions, allergies, atopic reactions, low birth weight, prematurity, structural abnormalities of the airway, gastroesophageal reflux disease, male and craniofacial malformations.
(2) Environmental factors: lack of breastfeeding, participation in day care centers and early socialization, large family size, school age, densely populated environment, parental smoking, smoking during pregnancy, malnutrition, non-vaccination, physical stress reactions, severe physical exertion, climatic and environmental factors (exposure to pollution), dwelling in a humid environment, pacifier use and bottle feeding in the recumbent position.
Ninety to 98% of patients with recurrent upper whistle infections are caused by viral infections, while bacterial infections account for only 2% to 10%. Recurrent upper whistle infections have different sites and show different signs and symptoms. The main areas include the following.
1, nasal – sinus infections
Nasal – sinusitis clinical symptoms are nasal congestion, mucous or purulent nasal discharge, facial pain and headache, the more severe cases are accompanied by fever, the younger the more obvious systemic symptoms. Severe symptoms, including pus, high fever (temperature ≥39°C) and headache, are often seen in the early stages of the disease. In viral infections, symptoms usually resolve within 10
In viral infections, symptoms usually resolve within 10 d. Bacterial infections usually last more than 10 d.
2. Middle ear infections
Acute non-suppurative otitis media mainly manifests as local symptoms with persistent otalgia and fluid accumulation in the tympanic chamber manifested by loss of luster of the tympanic membrane, which is yellowish or amber in color and sometimes visible as curved fluid flat lines. Acute suppurative otitis media is often accompanied by systemic symptoms such as high fever, crying, and gastrointestinal reactions (nausea and vomiting), in addition to persistent and severe localized ear pain and ear pain in infants and children. Earache in infants and children is often accompanied by symptoms such as emotional irritability, covering the ears or tugging on the ears, and some affected children may experience early hearing loss.
3. Tonsil infection
The clinical manifestations of tonsillitis are fever and sore throat. The symptoms of acute catarrhal tonsillitis are similar to those of general pharyngitis, with sore throat, low fever and other mild systemic symptoms. Acute suppurative tonsillitis has a rapid onset, with severe local and systemic symptoms, and can induce severe pain in the pharynx, which often radiates to the ear and is prone to swallowing difficulties. Acute diffuse congestion of the pharyngeal mucosa can be seen, with the tonsils and both palatal arches being the most severe, and the palatine tonsils are enlarged. The lymph nodes in the lower jaw and/or neck are often enlarged and painful.
4. Throat infection
Pharyngitis starts with dryness, burning and foreign body sensation in the throat, followed by pain, which is aggravated when swallowing.
The systemic symptoms are usually mild, but may include fever, headache and general malaise. Laryngitis starts with varying degrees of fever, runny nose, cough and other symptoms of upper whistle catarrh, followed by hoarseness, voice change and typical “barking” cough.
In a few cases, there may be choking cough. On examination, acute congestion of the mucous membrane of the pharynx, redness and swelling of the lymphatic follicles in the posterior pharyngeal wall, edema and congestion of the palatal lobe, and enlarged and painful submandibular lymph nodes are seen.
In case of recurrent bacterial infections, attention should be paid to exclude antibody-deficient diseases; recurrent whistling virus infections are less characteristic, and innate immune abnormalities are less likely.
Immunological examination: Routine immunological examination indicators include serum immunoglobulins (IgG, IgA, IgM, IgE), lymphocyte subpopulations, and complement. Immunoglobulin levels vary among children of different ages, and the age of the child must be taken into account when interpreting the index levels.
Other ancillary examinations: including otoscopy, nasal realm, laryngoscopy, and relevant imaging examinations. The appropriate part of the imaging examination will be taken according to the situation.
Treatment
It is very important to treat children with reasonable medication during the acute phase of recurrent upper whistle infections in order to reduce symptoms and shorten the course of the disease.
Prevention principles
Repeated upper whistle infections emphasize comprehensive treatment, in the acute phase must actively take anti-infective treatment, after the condition is stabilized need to pay attention to the strengthening and improvement of their own immune function, to reduce the chance of re-infection. Families should try to avoid putting the child in a high-risk environment and adopt a scientific and healthy lifestyle to remove the factors that trigger infection. Common preventive measures are as follows
1.Lifestyle and environmental intervention
Exercise regularly to enhance physical fitness and maintain a reasonable diet with balanced nutrition.
Keep the living environment neat and ventilated, and avoid children’s exposure to second-hand smoke.
Try to avoid going to places where crowds gather to reduce contact with pathogens.
2.Vaccination
Vaccination is an effective active immunization provided against specific pathogens. Foreign guidelines recommend that children over 6 months of age and without contraindications should be routinely vaccinated against influenza. Currently, the common influenza virus vaccine is widely used to prevent upper whistle infections. Since there are hundreds of serotypes of the virus, it is not possible to prepare a vaccine for each serotype. Therefore, it is recommended that routine influenza vaccination be combined with other preventive measures to reduce the occurrence of upper whistle infections.
3.Immunomodulators
Common immunomodulators include bacterial lysis products, pidomod, and thymidine. Bacterial lysis products are currently the immunomodulators with the highest level of evidence. Bacterial lysis products mainly enhance the activity of macrophages and NK cells by stimulating Toll-like receptors and up-regulating the expression of adhesion factors. Promotes T-cell transformation, enhances T-cell antiviral effects, and regulates Th1/Th2 to Th1 drift. Enhances the secretion of secretory IgA, IgG and IgM. The dosing regimen for bacterial lysis products in the prophylactic period is 10 d of dosing per month with a 20-d stoppage, for a 3-month course.
The diagnosis and prevention of recurrent upper whistle infections requires comprehensive management, a clear diagnosis of bacterial or viral infections in the acute phase, and avoiding the overuse of antibiotics.