CLINICAL PRESENTATION AND PECULIARITIES OF ACUTE TONSILLITIS IN CHILDREN
Keywords:
acute tonsillitis, children, McIsaac score, Centor scale, bacterial infection, viral infection, outpatient pediatricsAbstract
Introduction. Acute tonsillitis is one of the most common infectious diseases in pediatric practice and remains an important problem in outpatient pediatrics. In clinical practice, the Centor score modified by McIsaac is widely used for diagnosing infections caused by Group A beta-hemolytic streptococcus (GABHS) and for determining antibacterial therapy. However, this scale is less commonly used for assessing acute tonsillitis caused by other etiopathogenetic factors. We proposed additional criteria to improve the diagnostic and clinical assessment value of the McIsaac-modified Centor scale in children with viral, bacterial, and mixed infections.
Aim. To evaluate the effectiveness of the Centor scale modified by McIsaac with additional clinical criteria in assessing the severity and clinical presentation of acute tonsillitis in children.
Materials and Methods. The study was conducted in outpatient settings among 128 children aged 3–14 years diagnosed with acute tonsillitis. All children underwent clinical examination, pharyngoscopy, and bacteriological analysis of tonsillar swabs. The Centor scale modified by McIsaac (1998) was supplemented with additional criteria including odynophagia, tonsillar edema, and hyperemia. The quality of diagnostic assessment was evaluated using the QUADAS-2 tool.
Results. Catarrhal tonsillitis was diagnosed in 65.63% (n=84) of children, follicular tonsillitis in 22.66% (n=29), and lacunar tonsillitis in 11.72% (n=15). Viral infection was identified in 75.8% of cases and contributed to enhanced colonization of the tonsils by pathogenic bacteria, particularly Staphylococcus aureus (42.2%) and Streptococcus pneumoniae (32.0%). Mixed bacterial colonization was observed in 66% of cases. According to the modified scale, 21.1% of patients had mild disease, 71.9% had moderate disease, and 7% had severe disease.
Conclusion. The modified McIsaac-Centor scale with additional criteria allows clinicians to assess the severity of acute tonsillitis more accurately and optimize treatment strategies in outpatient pediatric practice.
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