The syndrome of periodic fever, aphthous stomatitis, pharyngitis and cervical lymphadenitis, also called Marshall's syndrome, is one of the rarest and least studied childhood diseases. About what Marshall's syndrome is in children and how it is treated will be discussed in this article.
The origins of the disease
The first cases of outbreaks of Marshall's syndrome were documented in 1987. At that time, medicine had information about twelve such precedents. All cases had a similar course of the disease: as a rule, these were periodic bouts of fever, in which patients had stomatitis and swelling of the cervical lymph nodes. In the English version, this syndrome has a name formed by capital letters of the main symptoms. In France, he was named after Marshal. The syndrome received a similar designation in domestic medicine.
Symptoms
During the study of this disease by French researchers, it was found that most often this disease affects children aged three to five years. The main known manifestations of the disease are nowregular, but rare, usually with a frequency of one or two times a month, temperature jumps. At the same time, the child has such cold symptoms as swelling of the lymph nodes in the neck and under the lower jaw, as well as inflammatory processes in the mouth and throat. It was found that the appearance of this disease in children is in no way connected with their nationality, gender, or any other affiliation. The manifestations of the syndrome also do not have a clearly defined geographical areola.
Expert forecast
Most often, symptoms can last for four to eight years, during which Marshall's syndrome recurs periodically in its typical manifestations. Symptoms of the disease after the end of the acute course of the disease usually disappear without a trace. The development of the child during the course of the disease does not stop and does not slow down. Doctors note that the prognosis for children who have undergone this diagnosis is positive. After complete recovery, there is a complete absence of relapses and further normal physical, mental and neurological development of the child.
Symptom relief
One of the most important signs of the syndrome are bouts of very high temperature. Usually it ranges from thirty-nine degrees and above. Sometimes thermometer readings can reach thirty-nine and five, even more rarely - readings over forty. Usually, the use of any means to reduce fever does not have a significant effect in the treatment of Marshall's disease. The syndrome can be stoppedonly with complex treatment. As a rule, this is therapy with hormone-containing drugs.
Side symptoms
In addition to the fever already mentioned earlier, the general depression typical of any serious illness can also indicate a disease such as Marshall's syndrome in children. Diagnosis in babies is difficult due to the abundance of symptoms known to science, similar to other colds. Patients may experience weakness, increased aggressiveness. Moreover, very often in a child, in addition to a high temperature, there is trembling, pain in muscles, bones and joints. Many patients also complain of a severe headache with Marshall's disease. The syndrome can also cause abdominal pain, and vomiting is even less common.
Despite the fact that the symptoms of Marshall's syndrome are very similar to those of colds, usually no other signs of infection are detected. Sometimes some children may have irritation and redness of the mucous membrane of the eye, as well as tearing, coughing, nasal congestion and discharge from it. Nervous disorders and allergic reactions, as well as other symptoms, were not observed.
The flow of exacerbation
Fever usually bothers a child for about three to five days. However, even during a fever, not every child experiences the whole complex of symptoms that is considered typical for this Marshall's disease. The syndrome most often affects the lymphatic system in the neck area. At the same time, the nodesthey swell up to four to five centimeters, they become dense and even a little painful. In most cases, swelling of the nodes becomes visible to the naked eye, which becomes the most common reason for visiting a doctor. Usually, lymph nodes located in other parts of the body do not undergo changes with this disease.
Associated symptoms
As a rule, in addition to reactions from the lymphatic system, the child has irritation in the throat, usually in the form of pharyngitis or tonsillitis. It can take place in a mild form, however, there are cases when the disease manifests itself as a profuse plaque on one or both tonsils. In medical practice, there are even known cases of removal of the tonsils in connection with this disease. Data from Greek scientists speaks of thirty percent of children with symptoms of Marshall's syndrome among those who have undergone this procedure. At the same time, their American colleagues report twenty-two out of one hundred and seventeen children who underwent surgery with persistent tonsillitis and the presence of other Marshall's syndromes. Five of them had all the symptoms of this disease known to science. All children, in addition to inflamed tonsils, suffered from redness of the pharynx, but the degree of development of tonsillitis was different for everyone. There were children without much plaque, but there were also more severe forms of this disease. As a rule, after the passage of an exacerbation, the tonsils decrease in size and no longer bother the child. The inflammation also disappears by itself.
Rarely, in addition to inflammation of the lymph nodes and tonsils in children, there are irritations of the oral mucosa. It occurs in three to seven out of ten cases.
Difficulties in diagnosing
The problem in establishing a diagnosis is related to such a factor that in young children it is very difficult to detect all the signs necessary for diagnosis of such a difficult disease as Marshall's syndrome. Diagnosis is often difficult because a child aged three to five years is unlikely to complain to parents about headaches or discomfort in the tonsils. Moreover, sometimes the signs of the disease do not appear all at once or after a certain period of time.
Laboratory studies usually show an increased level of red blood cell sedimentation in the patient's blood, as well as a possible reflection of inflammatory processes in the form of an increase in the level of leukocytes. Other changes in the percentage of proteins in plasma are also possible. As a rule, such jumps of individual blood elements quickly return to normal. In addition to the above changes in the composition of the plasma, no other significant phenomena typical of this syndrome were found.
Treatment
Science still has no consensus on the treatment of children diagnosed with Marshall's syndrome. Treatment of individual symptoms, such as fever, runny nose, has no effect. Usually taking antipyretic drugs to stop such symptoms familiar to the disease as fever, headachepain and chills is not enough. In turn, statistics claim that removal of the tonsils is sufficient for recovery. An analysis of the postoperative period suggests that in seven cases out of ten, an ectomy completely stops the course of the disease. However, not all researchers agree that such therapy has such a strong effect on the cure
Another way to treat the syndrome is to use a drug like cimetidine. As practice shows, it is able to restore the balance between T-helpers, as well as block receptors on T-suppressors. Three-quarters of patients recover from this treatment, but it is not widely used. Another treatment is steroids. Such treatment has an effect at any age, whenever Marshall's syndrome is diagnosed. In children, treatment consists of a loading dose or a course over several days. Usually, such procedures help get rid of the fever, but do not exclude repeated attacks. Despite the existing opposing opinion that it is steroids that can reduce the period of remissions, such therapy is most common among specialists. As a treatment, the choice falls most often on the drug prednisolin, which is administered to the child at the rate of 2 mg per kilogram of body. It should be borne in mind that only a doctor should deal with the selection of a steroid and the appointment of its dosage!
