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. What is Marshall's syndrome 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 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 attacks of fever, in which patients had stomatitis and swelling of the cervical lymph nodes. In the English version, this syndrome is called formed by the 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 ailment affects children aged three to five years.
The main known manifestations of the disease now are regular, but rare, usually with a frequency of one to two times a month, temperature jumps. In this case, the child has colds such as swelling of the lymph nodes in the neck and under the lower jaw, as well as inflammatory processes in the oral cavity and throat. It was found that the appearance of this disease in children has nothing to do with either their national, gender or any other affiliation. Manifestations of the syndrome also do not have a distinct geographical areola.
Forecast of specialists
Most often, symptoms can last for four to eight years, during which Marshall syndrome is periodically repeated in its typical manifestations. Signs of an illness after the end of the acute course of the disease usually pass 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.
Relief of symptoms
One of the most important symptoms of the syndrome is bouts of very high fever. It usually ranges from thirty-nine degrees and above. Sometimes the values of the thermometer can reach thirty-nine and five, and even less - values over forty.
Usually the use of any means to lower the heat does not have a significant effect in the treatment of Marshall's disease. The syndrome can be stopped only with complex treatment. As a rule, this is therapy with hormone-containing drugs.
Side symptoms
In addition to the previously mentioned fever, a general depressed state typical of any serious illness can also indicate a disease like 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 high temperature, trembling, pain in muscles, bones and joints is observed. Many patients also complain of severe headache with Marshall's disease. The syndrome can also cause abdominal pain, and even less often, vomiting is observed.
Despite the fact that the symptoms of Marshall's syndrome are very similar to the manifestations of colds, usually no more signs of infection are detected. Sometimes, in some children, irritation and redness of the mucous membrane of the eye, as well as tearing, coughing, nasal congestion and discharge from it, may be present. Nervous disorders and allergic reactions, as well as other symptoms were not noticed.
Course of exacerbation
Fever usually bothers the baby 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. In this case, the nodes swell up to four to five centimeters, they become dense and even a little painful. In most cases, swelling of the nodes becomes noticeable to the naked eye, which becomes the most common reason for going to the doctor. Typically, lymph nodes located in other parts of the body are not affected by this disease.
Associated symptoms
As a rule, in addition to reactions from the lymphatic system, the child develops irritation in the throat, usually in the form of pharyngitis or tonsillitis. It can take place in a lighter form, but there are cases when the disease manifests itself in a copious plaque on one or both tonsils. In medical practice, cases of removal of tonsils in connection with this disease are even known. Data from Greek scholars speak of thirty percent of children with symptoms of Marshall syndrome among those who underwent this procedure. At the same time, their American counterparts report twenty-two out of a hundred and seventeen children undergoing surgery, with persistent tonsillitis and the presence of other Marshall syndromes. Five of them had all the symptoms of the disease known to science. In addition to the inflamed tonsils, all children 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 more severe forms of the course of this disease. As a rule, after undergoing an exacerbation, the tonsils decrease in size and no longer bother the child. Inflammation also disappears by itself.
Less often, in addition to inflammation of the lymph nodes and tonsils, in children there are irritations of the oral mucosa. It is observed from three to seven out of ten cases.
Difficulties in diagnosing
The problem in establishing a diagnosis is associated with such a factor that in young children it is very difficult to detect all the necessary signs for diagnosis of such a complicated disease as Marshall's syndrome. Diagnosis is often complicated by the fact that 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 sedimentation of red blood cells in the patient’s blood, as well as a possible reflection of inflammatory processes in the form of an increase in white blood cell count. Other changes in the percentage of proteins in the plasma are also possible. As a rule, such jumps in individual blood elements quickly return to normal. In addition to the above changes in the composition of the plasma, no sign phenomena typical of this syndrome were detected.
Treatment
Science still does not have a unanimous opinion about the therapy of children with Marshall syndrome. The treatment of individual symptoms, such as fever, runny nose, has no effect. Usually, taking antipyretic drugs to relieve symptoms of the usual disease like fever, headache and chills is not enough. In turn, statistics say that removing tonsils is enough to recover . Analysis of the postoperative period suggests that in seven out of ten cases, ectomy completely stops the course of the disease. However, not all researchers agree that such therapy has such a strong effect on cure
Another way to treat the syndrome is to use a drug such as cimetidine. As practice shows, it is able to restore the balance between T-helpers, as well as block receptors on T-suppressors. Such treatment contributes to recovery in three quarters of patients, but such therapy is not widespread.
Another treatment option is the use of steroids. Such treatment has an effect at any age, whenever Marshall's syndrome is detected. In children, treatment consists in the use of a loading dose or course for several days. Typically, such procedures help get rid of the heat, but do not exclude repeated attacks. Despite the existing opposite opinion that it is steroids that can shorten the period of remissions, such therapy is most common among specialists. As a treating agent, the choice most often falls on the preparation of prednisoline, which is administered to the child at the rate of 2 milligrams 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!