Differential diagnosis of parapharyngeal abscess with multisystem inflammatory syndrome in children associated with COVID-19

The pandemic of the new coronavirus infection (COVID-19) has identified new diagnostic and medical tasks before different doc-tors. As observations show, children have the flow of infection easier than adults. However, in some cases, COVID-19 in children proceeds extremely difficult, with fever and multisystem inflammation, possibly requiring treatment in the resuscitation depart-ment. In domestic practice, the term “Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19” is used to indicate the disease. Among the local symptoms of MIS are inflammations of the skin and mucous membranes, as well as var-ious lymphadenopathy. The article presents the results of our clinic’s observation of 205 patients with MIS for the period from May 2020 to May 2021. In some patients, the clinical manifestations of MIS-C required differential diagnosis with parapharyngeal abscesses (PPA). For this purpose, the children were consulted by an otorhinolaryngologist and a CT scan of the neck with contrast enhancement was performed. Despite the striking clinical manifestations similar to PPA, in no case was a pharyngeal abscess re-vealed. Both of these diseases are potentially fatal if treatment is not started on time, and therefore we believe that the awareness of otorhinolaryngologists about the manifestations of MIS-C will be useful in modern clinical practice. © 2022, Media Sphera Publishing Group. All rights reserved

Modern features of rheumatic chorea in children

Chorea is the nervous system lesions with rheumatic fever (RF) as a result of the phenomenon of antigenic mimicry with antibodies cross-reactivity to BGSA antigens with similar antigen epitopes of brain tissue. Objective of the research - to determine frequency of nervous system lesion by RF, chorea clinical symptoms structure and prognosis of the disease in children. The study included 56 children 4-17 years old, hospitalized in the Morozov Children’s Clinical Hospital in 2001-2015 with RF. Clinical and medical history, laboratory and instrumental methods (ECG, ECHOCG, CT and/or MRI of the brain, EEG, ENMG) were used. The main clinical manifestation of RF was carditis (89,3%) with a high frequency (76,8%) of extracardiac manifestations: arthritis (46,4%), annular erythema (10,7%), in one child (1,8%) - rheumatoid nodules. Noteworthy is high frequency of chorea development (42,9%) mainly in patients with neurological history (p<0,05). 12,5% of children had isolated chorea. Most (30,4%) had combined form of neurorheumatism. The study revealed frequent errors (66%) in RF diagnosis in the prehospital stage. Medical history (45,8%) and streptococcal infection laboratory markers (p=0,02) are rarely detected among patients with chorea compared with patients without chorea symptoms (69%). Hemichorea (78%) with subacute onset (75%) predominated. RF issue requires attention from the medical community. Chorea is the most challenging for the differential diagnosis, especially isolated (29%). Even with isolated chorea chronic rheumatic heart disease (12,5%) may develop. In rheumatic chorea treatment, in addition to antibacterial drugs and drugs that affect dopamine and GABA metabolism, glucocorticosteroids (prednisolone) are needed. © 2016, Pediatria Ltd. All rights reserved

Modern features of rheumatic chorea in children

Chorea is the nervous system lesions with rheumatic fever (RF) as a result of the phenomenon of antigenic mimicry with antibodies cross-reactivity to BGSA antigens with similar antigen epitopes of brain tissue. Objective of the research - to determine frequency of nervous system lesion by RF, chorea clinical symptoms structure and prognosis of the disease in children. The study included 56 children 4-17 years old, hospitalized in the Morozov Children’s Clinical Hospital in 2001-2015 with RF. Clinical and medical history, laboratory and instrumental methods (ECG, ECHOCG, CT and/or MRI of the brain, EEG, ENMG) were used. The main clinical manifestation of RF was carditis (89,3%) with a high frequency (76,8%) of extracardiac manifestations: arthritis (46,4%), annular erythema (10,7%), in one child (1,8%) - rheumatoid nodules. Noteworthy is high frequency of chorea development (42,9%) mainly in patients with neurological history (p<0,05). 12,5% of children had isolated chorea. Most (30,4%) had combined form of neurorheumatism. The study revealed frequent errors (66%) in RF diagnosis in the prehospital stage. Medical history (45,8%) and streptococcal infection laboratory markers (p=0,02) are rarely detected among patients with chorea compared with patients without chorea symptoms (69%). Hemichorea (78%) with subacute onset (75%) predominated. RF issue requires attention from the medical community. Chorea is the most challenging for the differential diagnosis, especially isolated (29%). Even with isolated chorea chronic rheumatic heart disease (12,5%) may develop. In rheumatic chorea treatment, in addition to antibacterial drugs and drugs that affect dopamine and GABA metabolism, glucocorticosteroids (prednisolone) are needed. © 2016, Pediatria Ltd. All rights reserved