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Marshal's syndrome: description, causes, diagnosis, symptoms and treatment

The syndrome of fever, aphthous stomatitis, pharyngitis and cervical lymphadenitis, also called Marshal's syndrome, refers to one of the most rare and poorly studied childhood diseases. About what the Marshal's syndrome is in children and how it is treated, this article will be discussed.

The origins of the disease

For the first time, cases of outbreaks of the 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, they were periodic fever attacks, in which patients experienced stomatitis and swelling of the cervical lymph nodes. In the English-speaking version, this syndrome is called, formed by capital letters of the main symptoms. In France, he was named after the Marshal. The syndrome has received a similar designation in domestic medicine.


During the study of this disease, French researchers found that this disease most often affects children aged three to five years.
The main known manifestations of the disease are regular, but rare, usually periodic in one or two times a month, temperature jumps. In this case, the child has such catarrhal symptoms as swelling of lymph nodes on 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 national, nor with gender, nor with any other affiliation. Manifestations of the syndrome also do not have a clearly defined geographical areola.

Forecast of specialists

The most common symptoms can last for four to eight years, during which the Marshal Syndrome recurs periodically in its typical manifestations. Signs of ailment after the termination of an acute course of illness 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 say 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 signs of the syndrome are seizures of very high temperature. Usually it ranges from thirty-nine degrees or more. Sometimes the thermometer can reach the mark of thirty-nine and five, even less often - values above forty.
Usually the use of any means to reduce heat does not have a significant effect in the treatment of Marshal's disease. The syndrome can be stopped only with complex treatment. As a rule, this therapy is hormone-containing drugs.

Adverse symptoms

In addition to the previously mentioned fever, the general depressed state, typical for any serious illness, may also indicate a disease such as Marshal's syndrome in children. Diagnosis in children is hampered by the abundance of science-known symptoms similar to other colds. Patients may experience weakness, increased aggression. Moreover, very often the child, in addition to high temperature, there is a tremor, pain in the muscles, bones and joints. Many patients also complain of a severe headache with Marshal's disease. The syndrome can also cause abdominal pain, even less often there is vomiting.

Despite the fact that the symptoms of Marshal's syndrome are very similar to the manifestations of colds, usually no more signs of infections are detected. Sometimes some children may have irritations and reddening of the mucous membrane of the eye, as well as tearing, coughing, stuffy nose and discharge from it. Nervous disorders and allergic reactions, as well as other symptoms, were not noticed.

Exacerbation of exacerbation

Elevated temperature usually worries the child 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 Marshal disease. The syndrome most often affects the lymphatic system in the neck region. In this case, the nodes swell up to four to five centimeters, they become dense and even slightly painful. In most cases, swelling of the knots becomes noticeable to the naked eye, which becomes the most common reason for contacting a doctor. Usually, lymph nodes located in other parts of the body do not undergo changes in this disease.

Concomitant 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 light form, but there are cases when the disease manifests a plentiful bloom on one or both tonsils. In medical practice, even cases of tonsillectomy in connection with this disease are known. Data from Greek scientists speak of thirty percent of children with symptoms of Marshall syndrome among those who underwent this procedure. At the same time, their American colleagues report twenty-two of the one hundred and seventeen children who underwent surgery, with permanent tonsillitis and the presence of other Marshall syndromes. Five of them possessed all the known scientific symptoms of this disease. All the children besides the inflamed tonsils suffered from reddening of the throat, but the degree of development of tonsillitis was different for all. There were children without a special plaque, but there were also more severe forms of the course of this disease. As a rule, after passing through an exacerbation, the tonsils decrease in size and do not disturb the child anymore. Inflammation also disappears by itself.

Less often, in addition to inflammation of lymph nodes and tonsils in children, there are irritations of the mucous membrane of the mouth. It is observed from three to seven out of ten cases.

Difficulties in diagnosing

The problem in establishing the diagnosis is associated with such a factor that in young children it is very difficult to detect all the signs necessary for diagnosis of such a complex disease as Marshal'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 manifest all at once or after a certain period of time.

Laboratory studies usually show an elevated 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 the level of leukocytes. Other changes in the percentage of proteins in the 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 more typical for this syndrome of sign phenomena have been detected.


Science still does not have a common opinion about the therapy of children who have Marshal syndrome. Treatment of individual symptoms, such as fever, runny nose, has no effect. Usually, taking antipyretics to stop such familiar symptoms for the disease as fever, headache and chills is not enough. In turn, statistics argue that recovery is sufficient to remove tonsils. Analysis of the postoperative period suggests that in seven cases out of ten, the 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 such as cimetidine. As practice shows, it is able to restore balance between T-helpers, and also block receptors on T-suppressors. Such treatment contributes to recovery in three-quarters of patients, but this therapy has not received widespread use.
Another method of treatment is the use of steroids. Such treatment has an effect at any age, whenever the Marshall syndrome is detected. In children, treatment consists of applying a shock dose or course for several days. Usually such procedures help to get rid of the heat, but do not rule out repeated attacks. Despite the existing contrary opinion that it is the steriods that can shorten the period of remission, this therapy is most common among specialists. As a cure, the choice falls more often on the drug Prednisoline, which is given to the child in the calculation of 2 mg per kilogram body. It is worth bearing in mind that the selection of a steroid and the appointment of its dosage should be handled only by a doctor!

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