Acute tonsillitis in child and adult

Acute tonsillitis (from lat. tonsillae - tonsils), in everyday life - angina (from lat. ango - “squeeze, squeeze, soul”) - an infectious disease with local manifestations in the form of acute inflammation of the components of the lymphatic pharyngeal ring, most often of the tonsils, caused by streptococci or staphylococci, rarely by other microorganisms, viruses and fungi (see more Etiology ⇨). Angina is also called an exacerbation of chronic tonsillitis.

Acute tonsillitis

Acute tonsillitis of the tonsils
ICD-10J 03 03.
ICD-10-KMJ35.01
ICD-9034.0 034.0
ICD-9-KM474.00
DiseasesDB12507
MedlinePlus000639
eMedicinemed / 1811
MeshD014069 and D014069

Sore throat is known since ancient times. Described angina in the writings of Hippocrates (IV — V century BC. E.), Celsus (II century AD.). The manuscripts of Abu Ali Ibn Sina (Avicenna, XI century) mention intubation and tracheotomy for asphyxia due to angina.

The most common vulgar (ordinary, banal) tonsillitis: catarrhal, lacunar, follicular, fibrinous, phlegmonous, herpetic and ulcerative-membranous.

Catarral Edit

Catarrhal sore throat develops acutely, the patient complains of a sensation of burning, dryness, tingling, and then there is a slight pain when swallowing. Observed clinic astheno-vegetative syndrome. Temperature, as a rule, subfebrile. On examination, the tonsils are hyperemic, somewhat enlarged, in places can be covered with a thin film of mucopurulent exudate. Tongue dry, lined. There is a slight increase in regional lymph nodes. Typically, the clinical manifestations disappear within 3-5 days.

Follicular Edit

Follicular tonsillitis debuts with a rise in body temperature to 38-39 ° C. The clinic begins with the occurrence of severe pain in the throat when swallowing, often radiating to the ear. Depending on the severity of intoxication, there is a headache, lower back pain, fever, chills, and general weakness. In general, a blood test is neutrophilic leukocytosis, eosinophilia, increased ESR. Most often, the regional lymph nodes are enlarged, their palpation is painful, in some cases there is an increase in the spleen. Children may have vomiting, meningism, stupefaction, diarrhea. There is a hyperemia of the soft palate, tonsils, on the surface of which numerous round, somewhat towering yellowish or yellowish-white dots are visible. The duration of the disease is 5-7 days.

Lacunary Edit

Lacunar angina proceeds with symptoms similar to follicular, but more severe. With it, yellowish-white deposits appear on the background of the hyperemic surface of enlarged tonsils. The duration of the disease is 5-7 days. In some cases, follicular or lacunar tonsillitis can develop according to the type of fibrinous sore throat, when the basis for the formation of the film is bursting suppurative follicles or when the lacunar sore throat fibrinous film spreads from the area of ​​necrotic epithelium in the mouths of the lacunas.

Fibrinous Edit

Fibrinous sore throat is characterized by the formation of a single continuous bloom of whitish-yellow color, which may extend beyond the tonsils. This type of sore throat can develop from a lacunary or can flow independently with the presence of a continuous film in the first hours of the disease. In the latter case, there is an acute onset with high fever, chills, severe symptoms of general intoxication, sometimes with signs of brain damage.

Phlegmonous (intra-tonsillary abscess) Edit

Phlegmonous sore throat is relatively rare. Its development is associated with purulent fusion of the tonsil area. The defeat is usually one-sided. The amygdala is enlarged, hyperemic, its surface is tense, painful on palpation. On examination, the forced position of the head, an increase in regional lymph nodes, painful on palpation, is characteristic. Complaints of sore throat when swallowing, talking, headache, fever up to 39-40 ° C, symptoms of general intoxication. During pharyngoscopy: the amygdala is enlarged, hyperemic, its surface is tense, painful on palpation. Characteristic is the trism of the masticatory muscles, asymmetrical pharynx due to the displacement of the uvula and the amygdala to the healthy side. The mobility of the soft palate is limited.

Herpetic Edit

Herpangina often develops in childhood. Its causative agent is Coxsacki A. virus. The disease is highly contagious, transmitted by airborne droplets and rarely by the fecal-oral route. Herpetic sore throat debuts acutely, fever appears, the temperature rises to 38-40 ° C, pain in the throat when swallowing, headache, muscle pain in the abdomen, can be vomiting and diarrhea. In the area of ​​the soft palate, uvula, small reddish bubbles are visible on the palatine arches, on the tonsils and in the posterior pharyngeal wall. After 3-4 days the bubbles burst or dissolve, the mucous membrane becomes normal.

Peptic ulcer Edit

The cause of ulcerative-film sore throat is considered a symbiosis of spindle-shaped sticks and spirochetes of the oral cavity, which often live in the oral cavity in healthy people. Morphological changes are characterized by necrosis of the yawning surface of one tonsil with the formation of an ulcer. The patient complains of a feeling of awkwardness and a foreign body when swallowing, putrid breath, increased salivation. Body temperature is usually not elevated. In the blood of moderate leukocytosis. Regional lymph nodes are enlarged on the affected side. The duration of the disease is from 1 to 3 weeks, sometimes it lasts several months.

In angina in more than 50% of cases, the main etiological role belongs to β-hemolytic streptococcus group A.

  • Bacteria are the most common β-hemolytic streptococcus group A, less commonly staphylococcus or a combination thereof.
  • Viruses - most often adenoviruses (types 1–9 type), Koksaki enterovirus, herpes virus.
  • Spirochete Vincent in symbiosis with a spindle-shaped stick (ulcerative-membranous angina).
  • Mushrooms of the genus Candida in symbiosis with pathological cocci.

Predisposing factors: local and general hypothermia of the body, reduced local and general immunity, tonsil injury, the state of the central and autonomic nervous system, nasal breathing, chronic inflammatory processes in the mouth, nose and paranasal sinuses.

In acute primary tonsillitis clinical picture manifested symptoms of tonsil - varying degrees of severity of pain in the throat when swallowing, signs of intoxication, hyperemia, swelling tonsils (catarrhal angina) fibropurulent bloom at the mouths of the gaps (lacunar angina), painting "starry sky" (follicular sore throat), removed by a greyish-yellow bloom, under which are found superficial slightly painful ulcers (ulcerative and film sore throat), regional lymphadenitis.

Sore throat begins with a sore throat and a sharp rise in body temperature to 39–40 ° C (sometimes up to 41 ° C). Sore throat is usually severe and sharp, but can be moderate. Lymph nodes are enlarged. They feel well under the lower jaw and at the same time cause pain. Sore throat can also occur at lower body temperatures - from 37 to 38 ° C, but with more damage to the throat.

Differential Diagnosis Edit

Sore throat is often the case with SARS, especially of adenoviral origin, but the lymph nodes are relatively rarely enlarged.

Strong inflammation of the tonsils and persistent enlargement of the lymph nodes is one of the main symptoms of infectious mononucleosis, which can be confirmed by a detailed blood test.

Instrumental diagnostics Edit

The main diagnostic technique for recognition is pharyngeal examination of the pharynx, as well as evaluation of complaints and anamnesis of the disease. Also, to determine the type of infection, a smear of mucus or pus is taken, which is taken from the tonsils. The biomaterial is sent to different types of analyzes:

  • Sowing on a nutrient medium - is the transfer of particles of mucus or pus from the tonsils to a special nutrient medium in which microorganisms begin to multiply rapidly, forming colonies (allows you to determine their type, as well as sensitivity and resistance to the antibiotic)
  • Rapid antigen tests are specially designed tests that respond to particles of a particular type of microorganism (often used to detect beta-hemolytic streptococcus from group A),
  • PCR analysis - allows you to set the species of microorganisms that inhabit the oropharynx by fragments of their DNA, which are found in mucus.

Of the complications of sore throat, acute otitis media, acute laryngitis, laryngeal edema, phlegmon of the neck, pharyngeal abscess, and acute cervical lymphadenitis are most common.

The most dangerous complications of angina:

  • in the early stages - pharyngeal abscesses (formation of large cavities filled with pus), the spread of infection in the chest through fascial spaces of the neck with mediastinitis formation, into the cranial cavity with the development of inflammation of the brain membranes (meningitis), toxic shock (poisoning of the body with microbes and the breakdown of body tissues), sepsis ("blood infection", that is, the penetration of infection into the blood and its distribution throughout the body),
  • in later periods (after 2-4 weeks) - acute rheumatic fever, glomerulonephritis (inflammation of the kidneys of non-infectious origin, leading to serious health disorders, up to renal failure).

The main recommendations: antibiotics, bed rest in the first days of the disease, non-irritating, soft and nutritious diet, vitamins, heavy drinking.

  • In the treatment of bacterial sore throats use different types of antibiotics and antimicrobial drugs of synthetic origin (depending on the sensitivity of the microbe and the patient's response to drugs), various local antiseptics, which are available in the form of a spray or aerosol, as well as tablets, lozenges and lozenges.
  • In the treatment of fungal sore throats (such a disease is provoked mainly by a fungus of the genus Candida), antifungal drugs are used. Fungal sore throat often occurs after long-term antibiotic treatment.

At temperatures above 38 degrees, antipyretic drugs may be prescribed. In case of bacterial etiology of angina, in many cases an antibiotic is prescribed that is active against coccal flora (streptococci and staphylococci); the course lasts at least 7 days. The purpose of antibiotics for streptococcal group A infection is to avoid rheumatic fever as a possible complication.

Due to the lack of evidence base, it can be argued that the widely advertised "immunomodulators" and "antiviral against all SARS" do not work against SARS or against the tonsillitis and pharyngitis caused by viruses.

To prevent angina, timely rehabilitation of chronic infection foci (carious teeth, chronic tonsillitis, purulent lesions of the paranasal sinuses, etc.), elimination of the causes of nasal breathing is necessary.

A sore throat can be contagious (especially for scarlet fever), so the patient should be placed in a separate room, often ventilated and wet cleaned, and children and elderly people should not be allowed to go to it. For the patient emit a special dish, which after each use boil or pour over boiling water.

What is acute tonsillitis

This is an infectious disease that is accompanied by inflammation of the tonsils. The peculiarity of tonsillitis is that without proper treatment, it flows into the chronic form. As a result, a person has periodically inflamed tonsils. Angina often affects children, often in the cold season. Adults suffer from this disease less often. This is explained as follows: with age, the mucous membrane of the tonsils becomes less susceptible to microbes.

Primary angina develops as an independent disease due to the defeat of the tonsils mucosa by pathogenic microorganisms. The main causative agents of such tonsillitis are:

  • Bacteria. Streptococcus group A is the causative agent of angina in 85% of cases. Staphylococcus aureus or pneumococcus can also provoke the disease, since these microorganisms are part of the natural microflora of the human mucosa. If the immune system is weakened, the bacteria begin to actively proliferate. A specific type of sore throat is caused by the causative agent of syphilis - Vincent's spirochete.
  • Viruses. Caused angina are less common. The causes are viruses of influenza, herpes, Epstein-Barr, adenoviruses, rhinoviruses, enteroviruses.
  • Fungi. Because of them, specific candidal tonsillitis develops. It is caused by fungi of the genus Candida.

Since reduced immunity is observed more often in the autumn-winter period, the incidence of angina at this time is higher. It is transmitted by airborne droplets or domestic. Separately allocated acute tonsillitis, unspecified. Such a diagnosis is made if the doctor failed to identify the causative agent of the disease. Secondary tonsillitis develops against the background of other diseases or the action of negative external factors. In this case, the following main reasons are highlighted:

  • foci of chronic infection in the body, for example, with pharyngitis, otitis, sinusitis, caries,
  • excessive smoking
  • stress, overwork,
  • inhalation of polluted air
  • long-term uncontrolled antibiotics,
  • poor nutrition,
  • avitaminosis,
  • mucosal injury to the tonsils,
  • hypothermia,
  • rhinitis, sinusitis and other disorders of nasal breathing,
  • drinking cold drinks
  • transferred ARVI.

Classification

Depending on the cause, the sore throat is divided into primary and secondary. There is another classification of this disease. According to her types of tonsillitis are allocated depending on the nature and depth of the lesion of the tonsils. Also, the classification takes into account the severity of the disease. So, the following main types of angina are distinguished:

  • Fibrinous. It causes the formation of a white film on the spot of the exposed follicles, which consists of blood plasma containing fibrin.
  • Catarral. The mildest form of a sore throat, in which inflammation affects only the surface of the tonsils.
  • Follicular. The infection process affects only the lymphoid tissue of the tonsils.
  • Phlegmonous. It is rare, accompanied by purulent fusion of individual parts of the tonsils.
  • Necrotic. It develops slowly, differs in the formation of a film on the surface of the tonsils, with the removal of which bleeding begins.
  • Lacunar. Inflammation extends to the lacunae of the tonsils, which expand and fill with pus.
  • Herpetic. Characteristic for children 5–9 years old, in adults it is relatively rare. The cause is the Coxsackie virus, which causes small bubbles of red color on the tonsils.

Symptoms of acute tonsillitis

Sore throat acute course is characterized by pronounced symptoms. The incubation period is 2-3 days. The temperature rises in most patients, and sometimes reaches a level of 38-39 degrees. In addition to her, other symptoms appear:

  • aches and weakness in muscles
  • sleep disturbances
  • chills,
  • a sharp deterioration in well-being,
  • loss of appetite
  • hyperemia and swelling of the tonsils, because of which they can completely block the lumen of the throat,
  • unpleasant throat sensation, tickling, burning, pain,
  • swelling of the lymph nodes under the lower jaw (lymphadenitis).

Each form of angina can be recognized by a number of distinctive features. For example, acute catarrhal tonsillitis develops very quickly. First, a sore throat appears, then an itch. After several hours, these symptoms give way to pain, which makes it difficult to swallow. On the mucous throat can be seen redness and thin films. Against the background of these symptoms, the temperature rises to 39 degrees. Other forms of angina have other symptoms:

  • Lacunar. On the tonsils appear purulent plugs, which are easily peeled off without bleeding. The temperature is kept at 39-40 degrees.
  • Follicular. The temperature rises to 38–39 degrees. The mucous throat swells, the root of the tongue and the upper palate become uneven in color. A person feels an extreme degree of weakness, even fainting.
  • Fibrinous. Against the background of temperature under 40 degrees, there is a white patina on the tonsils, stupefaction, diarrhea, vomiting, severe chills.
  • Herpetic. In addition to small vesicles on the mucous membrane of the tonsils and posterior pharyngeal surface, such a sore throat causes a temperature below 40 degrees, nausea, diarrhea, pain in the abdomen and throat.
  • Phlegmonous. Accompanied by pain when swallowing, a temperature of more than 39.5 degrees, severe signs of intoxication, pain when you press on the lymph nodes.
  • Necrotic. This is the most severe form of angina, in which dark patches appear on the tonsils, which go deep into the tissue. When you try to remove it starts bleeding. The patient has nausea, vomiting, fever, confusion.
  • Ulcerative-membranous. It is provoked by spirochetes and spindles. The disease causes unilateral necrosis of the tonsils, which is accompanied by a sensation of a foreign body in the throat, profuse salivation, unpleasant smell from the mouth.

Complications

Although many people do not take angina seriously, this disease is dangerous, especially in the chronic form. If the disease enters the toxic-allergic stage, pain in the heart and joints may appear due to allergization and intoxication of the body. As a result, even the usual ARVI or flu will be very difficult. Complications of sore throat and tonsils themselves. They may appear areas of hyperplasia, atrophy, or scarring.

In advanced cases, tonsillitis causes complications to other organs, mainly on the heart, joints and kidneys. Common effects include:

  • psoriasis,
  • neck phlegmon,
  • bronchitis,
  • otitis,
  • paratonsillar abscess,
  • meningitis,
  • laryngitis,
  • pyelonephritis,
  • pneumonia,
  • rheumatic fever,
  • glomerulonephritis,
  • polyarthritis.

Definition of the disease. Causes of disease

Acute tonsillitis - a disease of an infectious nature with airborne transmission, accompanied by severe general intoxication syndrome, a local manifestation of which is inflammation of one or several lymphatic follicles of the pharyngeal ring.

Acute tonsillitis is caused by bacterial, viral and fungal pathogens, as well as bacterial, viral-bacterial, fungal-bacterial associations. The source of infection is a sick or bacillicarrier.

Streptococcus pyogenes, Streptococcus group A (GAS), is the most common cause of bacterial pharyngitis in children and adults.

Other causative agents of acute tonsillitis:

  • Staphylococcus (Arcanobacterium haemolyticum, Neisseria gonorrhoeae, Corynebacterium diphtheriae),
  • anaerobes (Pseudomuscular bacillus),
  • mycoplasma (m. pneumoniae),
  • chlamydia
  • adenoviruses type 1–9,
  • enterovirus Coxsackie,
  • herpes simplex virus,
  • flu virus
  • Epstein-Barr virus and others.

Among mycoses, the most frequent development of acute tonsillitis is caused by Candida fungi in symbiosis with pathogenic and conditionally pathogenic cocci.

Necrotizing tonsillitis is caused by the Spirochete Plauta-Vincent in symbiosis with the spindle-shaped stick of Vincent.

Pathogenesis of acute tonsillitis

Congenital and adaptive immune responses of the body are fundamental for protection against streptococcal pharyngitis. The body's immune responses also contribute to severe post-streptococcal immune diseases. However, until recently, little was known about them.

Cellular mediators of innate immunity used in protecting the body against group A streptococcus include epithelial cells, neutrophils, macrophages and dendritic cells (DCs), which secrete a number of soluble inflammatory mediators such as antimicrobial peptides (AMP), eicosanoids, including PGE2 and leukotriene B4 (LTB4), chemokines and proinflammatory cytokines. Th1 and Th17 responses play a significant role in adaptive immunity in human tonsil tissues.

Diagnosis of acute tonsillitis

In addition to the clinical minimum, which includes OAK, OAM, an annual fluorography study, is mandatory:

  • determination of antistreptolysin-O in serum,
  • taking a swab from the throat and nasal passages on diphtheria cornebacterium,
  • taking a smear to determine the sensitivity of microorganisms to antibiotics.

Other diagnostic methods:

  • in most cases, an ECG is shown,
  • in some cases, it will be reasonable to assign a serological test for viruses of respiratory infections,
  • molecular biological blood test for Epstein-Barr virus,
  • microscopic examination of tonsil and gonococcus smears,
  • bacteriological examination of mucus from the tonsils and the posterior pharyngeal wall on anerobic microorganisms,
  • mycological examination of nasopharyngeal swabs on candida fungi,
  • determination of C-reactive protein.

Although Streptococcus Group A pharyngitis (GAS) is the most common cause of bacterial pharyngitis in children and adolescents, many viral and bacterial infections mimic the symptoms of pharyngitis. Emergency clinicians should recognize the symptoms of pharyngitis GAS and use appropriate diagnostic and treatment tools to effectively treat with antibiotics.

In people with acute pharyngitis, differential diagnosis is made between pharyngitis caused by hemolytic streptococcus A, infectious mononucleosis and other causes of viral pharyngitis.

Treatment of acute tonsillitis

If there are indications for hospitalization, the patient is issued a referral for hospitalization to a non-stop hospital at the infectious hospital. When treating on an outpatient basis, the next day a request for an active home visit is sent to the district physician at the clinic where the patient is attached.

Isolation of the patient, frequent airing of the room, wet cleaning, ultraviolet irradiation of the air in the room with the patient. The patient is given a separate set of dishes, it is unacceptable to use shared towels, toothbrushes.

In the period of temperature increase, the patient is shown a semi-episodic regimen, and as the syndrome of intoxication and fever subsides, the ward is used (up to the 7th day of normal body temperature). The patient is shown an abundant warm drink of at least 1.5-2.0 liters of fluid per day. During therapy in the hospital, it is shown the introduction of saline with ascorbic acid to reduce the symptoms of intoxication. With an increase in t of the body above 38 degrees, it is necessary to reduce it by taking 500 mg of paracetomol, 200-400 mg of ibuprofen or 500 mg of paracetomol in combination with 200 mg of ibuprofen (drugs ibuklin, brustan). With the ineffectiveness of the measures provided possible intramuscular injection of the lytic mixture (analgin 50% 1 ml + dimedrol 1% 1 ml), prednisolone in a dose of 30-60 mg (1-2 ml).

The patient is prescribed gargling with antiseptic solutions. In the pharmaceutical market there are common, affordable and at the same time effective antiseptics with a wide spectrum of activity and low resistance of microorganisms to them. These drugs include chlorhexidine, Miramistin, Yoks.

The antibacterial (bactericidal) effect of the Jocks solution is realized by iodine in its composition. The solution is diluted at the rate of 5 ml (1 tsp) per 100 ml of water. Rinse the throat at least 4 times a day. Before applying the spray rinse the throat with plain water to remove mucus. Apply spray at least 4 times a day.

It is obligatory to prescribe an etiotropic drug to combat the causative agent of tonsillitis. In the outpatient setting, the most convenient is the oral administration of drugs, in the hospital rational parenteral administration.

When confirming the role of Cornebacterium diphtheria in the development of the disease, the introduction of horse anti-diphtheria serum is of primary importance. Before the introduction of the main therapeutic dose is carried out twice a biological sample. At the first stage, 0.1 ml of diluted serum from the ampoule marked in red is injected intracutaneously into the flexion surface of the forearm. With proper administration, a small, tight-to-touch nodule is formed on the skin. In the forearm of the second hand injected into / to 0.1 ml of saline as a control. The time of observation of the patient is 20 minutes. The sample is considered negative if the diameter of the papule or hyperemia at the injection site is not more than 10 mm. In the second stage, 0.1 ml of undiluted serum, marked in blue, is injected subcutaneously into the outer surface of the shoulder. In the absence of an adverse reaction, after 30 minutes the main dose of the drug is administered intramuscularly.

A single dose of serum is:

  • with localized forms 10 000 - 20 000 IU,
  • larynx diphtheria 40 000 - 50 000 IU,
  • with subtoxic form 40 000 - 50 000 IU,
  • toxic 50 000 - 80 000 IU,
  • hemorrhagic 100 000 - 120 000 IU.

In the absence of a therapeutic effect, the administration of serum can be repeated after 12-24 hours using the same doses.

Among the antibacterial drugs, the prescription of macrolides is recommended: clarithromycin, midecamycin or josamycin:

  1. Clarithromycin is recommended in the dosage of 500 mg once a day by mouth for at least 7-10 days.
  2. Midecamycin at a dosage of 400 mg 3 times a day by mouth for at least 7-10 days.
  3. Dzhozamitsin is applied in a dosage of 500-1000 mg twice a day inside. The duration of therapy is at least 7-10 days.

Therapy of gonococcal tonsillitis is carried out in a dermatovenerologic dispensary. Appointed 0.5 mg ceftriaxone intramuscularly or 0.5 mg inside levofloxacin once inside. Due to the high risk of concomitant chlamydial infection, doxycycline, 600 mg is prescribed together with cephalosporins. the drug is prescribed in 2 doses with an interval of 1 hour (3 tablets of 100 mg 2 times).

In general viral infections (infectious mononucleosis, generalized herpes infection, severe flu), the development of acute tonsillitis is usually associated with the activation of conditionally pathogenic flora of the oropharynx. In addition to antiviral therapy, antibiotics are prescribed, as is the case with regular primary bacterial tonsillitis.

The first-line drugs are clavulated penicillins. The use of non-clavaged penicillin for the treatment of upper respiratory tract infection is not recommended due to the high resistance of microflora to this antibacterial drug.

Amoxicillin clavulonate is taken in a dosage of 875 + 125 mg 3-4 times a day by mouth for at least 7 days.

2-3 generation cephalosporins and macrolides

II generation cephalosporins:

Cefuroxime tablets 250 mg is prescribed at the rate of 1 tablet 2 times a day inside,

III generation cephalosporins:

  • Cefixime tablets 400 mg is prescribed at the rate of 1 tablet 1 time per day inside,
  • Cefotaxime in vials of 1 g intramuscularly per 2 ml of 2% lidocaine, adding for better dissolution 1 ml of NaCI 0.9% 2 times a day, possibly in / in a drip for at least 30 minutes,
  • Ceftriaxone vials of 1.0 g / m for 2 ml of 2% lidocaine, adding for better dissolution 1 ml of NaCI 0.9% 2 times a day, possibly in / in the drip for at least 30 minutes.

In most cases, fluoroquinolones, carbapenems and linkosamines are used as reserve drugs. Tetracycline antibiotics have gone out of practice due to the high resistance of the flora to them and the impossibility of use in pregnant women and in pediatric practice.

To prevent the development of candidiasis on an individual basis, the question of the appointment of an antifungal drug.

For the treatment of fungal tonsillitis, the appointment of systemic antimycotics is mandatory. It includes oral administration of antifungal antibiotics for 10–14 days (levorin, nystatin, amphotericin B, ketoconazole, fluconazole). Locally appointed rinsing antiseptics and inhalation with miramistin.

If necessary, the patient is given a certificate of incapacity for work or a student’s certificate of release from work and attendance of classes, respectively.

Approximate terms of disability:

  • catarrhal tonsillitis - 5-6 days,
  • follicular - 6-8 days,
  • lacunar - 8-9 days,
  • fibrinous - 11-12 days,
  • phlegmonous - 13-14 days.

The average period of temporary disability is 10-12 days.

Recovery Criteria:

  1. normalization of body temperature for 5 days,
  2. no sore throat and pain on palpation of the submandibular lymph nodes,
  3. no pathological abnormalities in the general analysis of blood, general analysis of urine and on the ECG film.

It is possible to provide a note from the attending physician to the employer in any form about transferring to lightened work and getting rid of night shifts for 2 weeks if possible. Students and schoolchildren are granted exemption from physical education for 2 weeks.

Forecast. Prevention

With timely initiated therapy, the prognosis is favorable. With the use of modern diagnostic methods and high-quality antibacterial drugs, early and late complications of the disease are sporadic (with late treatment and self-treatment of the patient).

It is recommended to avoid hypothermia and contact with patients with acute respiratory infections, vaccination against influenza and pneumonia, bracing measures. As a means of preventing exacerbations of pharyngitis and recurrent tonsillitis, drugs of bacterial origin have proven effective, in particular, complexes of antigens - lysates, the most frequent causative agents of inflammatory diseases of the upper respiratory tract, oral cavity and pharynx.

These drugs include IRS-19, 1 dose of the drug in each nasal passage 2 times a day for 2 weeks during the off-season and before the expected outbreaks of acute respiratory infections.

Imudon 6 tablets per day. The tablets dissolve (without chewing) every two hours. The course of therapy is 20 days.

For convalescents establish patronage medical observation during the month. On the first and third week, a study of blood and urine tests is carried out, and if necessary, an ECG study.

All patients with chronic tonsillitis who have suffered more than two sore throats in the last three years are subject to mandatory follow-up in the D3 group (2 times a year).

Medical expert articles

Symptoms of sore throats begin acutely: a burning sensation, dryness, tickling, and then a mild sore throat, which is worse when swallowing. The patient complains of indisposition, fatigue, headache. Body temperature is usually low-grade, in children it can rise to 38.0 degrees. C. The tongue is usually dry, white coated. A slight increase in regional lymph nodes is possible.

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Symptoms of catarrhal angina

Symptoms of angina in children are more severe, often with high fever and intoxication. The disease can turn into another, more severe form (follicular, lacunar). From acute catarrh of the upper respiratory tract, influenza, acute and chronic pharyngitis, catarrhal angina is characterized by a predominant localization of inflammatory changes in the tonsils and palatine arches. Although catarrhal sore throat compared with other clinical forms of the disease differs relatively easy course, it must be borne in mind that after the catarrhal sore throat can also develop severe complications. The duration of the disease is usually 5-7 days.

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Symptoms of follicular angina

A more severe form of inflammation, involving not only the mucous membrane, but also the follicles themselves. Symptoms of sore throat begin acutely, with a rise in temperature of up to 38-39 C. A severe pain in the throat appears, sharply aggravated when swallowing, and radiation to the ear is often possible. Intoxication, headache, weakness, fever, chills, sometimes pain in the lower back and joints are expressed. In children, often with increasing temperature, there is vomiting, symptoms of meningism may occur, and confusion may occur.

In children, the symptoms of angina usually occur with severe symptoms of intoxication, accompanied by drowsiness, vomiting, and sometimes convulsive syndrome. The disease has a pronounced course with increasing symptoms during the first two days. The child refuses to eat, infants show signs of dehydration. On the 3-4th day of the disease, the child's condition improves somewhat, the surface of the tonsils is cleared, but the sore throat persists for 2-3 days.

The duration of the disease is usually 7-10 days, sometimes up to two weeks, while the end of the disease is recorded by the normalization of the main local and general indicators: pharyngoscopic picture, thermometry, blood and urine indicators, as well as the patient's well-being.

Lacunar angina is characterized by a more pronounced clinical picture with the development of purulent-inflammatory process in the orifices of the lacunae with further spread to the surface of the tonsil. The onset of the disease and the clinical course are almost the same as in the case of follicular angina, but lacunar tonsillitis is more severe. The phenomena of intoxication come to the fore.

At the same time as the temperature rises, a sore throat appears, with hyperemia, infiltration and swelling of the tonsils, and with marked infiltration of the soft palate, speech becomes slurred, with a nasal shade. The regional lymph nodes become enlarged and painful on palpation, which causes pain when the head turns. The tongue is coated, the appetite is reduced, the patients feel an unpleasant taste in the mouth, there is a smell from the mouth.

The duration of the disease is up to 10 days, with a prolonged duration of up to two weeks, taking into account the normalization of functional and laboratory indicative.

Symptoms of phlegmonous sore throat

Intra-tonsillar abscess is extremely rare, it is an isolated abscess in the depth of the amygdala. The cause is represented by tonsil injury with various small foreign objects, usually of an alimentary nature. Defeat is usually one-sided. The amygdala is enlarged, its tissues are strained, the surface can be hyperemic, and the palpation of the amygdala is painful. In contrast to paratonsillar abscess, with intratungsular abscess, general symptoms are sometimes not significant. Intra-tonsillar abscess should be differentiated from the often observed small superficial retention cysts, translucent through the epithelium of the tonsils in the form of yellowish rounded formations. From the inner surface, such a cyst is lined with crypt epithelium. Even with suppuration, these cysts can be asymptomatic for a long time and can only be detected by accidental examination of the pharynx.

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Symptoms of atypical angina

The group of atypical angina includes relatively rare forms, which in some cases complicates their diagnosis. The causative agents are viruses, fungi, a symbiosis of a spindle-shaped stick and spirochetes. It is important to take into account the clinical and diagnostic features of the disease, because it is not always possible to verify the causative agent with laboratory methods when the patient first visits the doctor, the result is usually obtained only after a few days. At the same time, the appointment of etiotropic therapy in these forms of angina is determined by the nature of the pathogen and its sensitivity to various drugs, therefore an adequate assessment of the characteristics of local and general body reactions in these forms of angina is especially important.

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Symptoms of a sore throat ulcerative-necrotic nature

The ulcer-membranous, angina of Simanovsky Poluut-Vensan, fusospirochetosis angina is caused by the symbiosis of the spindle-shaped stick (You. Fusiformis) and the spirochetes of the oral cavity (Spirochaeta buccalis). In usual time the disease proceeds sporadically, differs in rather favorable current and small contagiousness. However, during the years of social upheaval, with insufficient nutrition and the deterioration of the hygienic living conditions of people, a significant increase in the incidence is noted and the severity of the disease increases. Of the local predisposing factors, insufficient care for the oral cavity, the presence of carious teeth, and oral respiration, contributing to the drying of the oral mucosa, are important.

Often the disease manifests itself as a single symptom of a sore throat - a feeling of awkwardness, a foreign body when swallowing. Often, the only reason for going to a doctor is a complaint about the unpleasant putrid breath that has appeared (salivation is moderate). Only in rare cases, the disease begins with fever and chills. Usually, despite pronounced local changes (raids, necrosis, ulcers), the patient's general condition suffers little, the temperature is low-grade or normal.

Usually one amygdala is affected, a bilateral process is extremely rare. Usually pain when swallowing is insignificant or completely absent, the unpleasant putrid breath from the mouth draws attention. The regional lymph nodes are moderately enlarged and slightly painful on palpation.

Dissociation attracts attention: pronounced necrotic changes and insignificance of common symptoms of angina (no pronounced signs of intoxication, normal or subfebrile temperature) and lymph node reactions. In its relatively favorable course, this disease is an exception among other ulcerative processes of the pharynx.

However, without treatment, ulceration usually progresses and within 2-3 weeks it can spread to most of the surface of the amygdala and go beyond it - to the arms, less often to other parts of the pharynx. When the process spreads deep into it, erosive bleeding can occur, perforation of the hard palate, destruction of the gums. The addition of a coccal infection can change the overall clinical picture: a general reaction occurs, which is characteristic of angina caused by pyogenic pathogens, and the local reaction - hyperemia near ulcers, severe pain when swallowing, salivation, putrid breath from the mouth.

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Symptoms of viral sore throats

They are divided into adenoviral (the causative agent is often the adenovirus 3, 4, 7 types in adults and 1, 2 and 5 in children), influenza (the causative agent is the influenza virus) and herpes. The first two types of viral tonsillitis are usually combined with lesions of the mucous membrane of the upper respiratory tract and are accompanied by respiratory symptoms (cough, rhinitis, hoarseness), sometimes there is conjunctivitis, stomatitis. diarrhea.

Herpes sore throat, which is also referred to as vesicular (vesicular, vesicular-ulcerous), is observed more frequently in other species. The causative agents are Coxsackie virus A9, B1-5, ECHO virus, human herpes simplex virus type 1 and 2, enteroviruses, picornavirus (the causative agent of foot and mouth disease). In summer and autumn, it may be in the nature of epidemic, and during the rest of the year it usually appears sporadically. The disease is more common in young children.

The disease is highly contagious, transmitted by airborne, rarely fecal-oral routes. The incubation period is from 2 to 5 days, rarely 2 weeks. Symptoms of sore throat are characterized by acute events, fever up to 39-40 C, difficulty swallowing, sore throat, headache and muscle pain, sometimes vomiting and diarrhea. In rare cases, especially in children, the development of serous meningitis is possible. Together with the disappearance of the vesicles, usually by the 3rd or 4th day, the temperature normalizes, the enlargement and soreness of the regional lymph nodes decreases.

Often the symptoms of angina are one of the manifestations of an acute infectious disease. Changes in the pharynx are non-specific and can be diverse: from catarrhal to necrotic and even gangrenous, therefore, with the development of angina, one should always remember that it can be the initial symptom of any acute infectious disease.

Symptoms of tonsillitis in diphtheria

Diphtheria pharynx occurs in 70-90% of all cases of diphtheria. It is believed that this disease is more common in children, but the increase in the incidence of diphtheria in the last two decades and in Ukraine is noted mainly due to unimmunized adults. Children of the first years of life and adults over 40 years of age are seriously ill. The disease is caused by a diphtheria bacillus, a bacillus of the genus Corynebacterium diphtheriae, its most virulent biotypes, such as gravis and intermedius.

The source of infection is a patient with diphtheria or a bacterial carrier of toxigenic strains of the pathogen. After a postponed illness, convalescents continue to secrete diphtheria sticks, but most of them stop carriage for 3 weeks. The release of convalescents from diphtheria bacteria can be hindered by the presence of chronic foci of infection in the upper respiratory tract and a decrease in the overall resistance of the organism.

According to the prevalence of the pathological process, localized and common forms of diphtheria are distinguished; according to the nature of local changes in the pharynx, catarrhal, insular, membrane and hemorrhagic forms are distinguished, depending on the severity of the course - toxic and hypertoxic.

The incubation period lasts from 2 to 7, rarely up to 10 days. In milder forms of diphtheria, local symptoms predominate, the disease proceeds as a sore throat. In severe forms, along with local symptoms of angina, signs of intoxication develop rapidly as a result of the formation of a significant amount of toxin and its massive flow into the blood and lymph. Light forms of diphtheria are usually observed in vaccinated, severe - in people who do not have immune protection.

In catarrhal form, local symptoms of angina are manifested by dim hyperemia with cyanotic tinge, moderate edema of tonsils and palatine arches. Intoxication symptoms in this form of diphtheria of the pharynx are absent, the body temperature is normal or subfebrile. The reaction of the regional lymph nodes is not pronounced. Diagnosis of the catarrhal form of diphtheria is difficult, since there is no characteristic sign of diphtheria — fibrinous raids. Recognition of this form is possible only through bacteriological examination. In case of catarrhal form, recovery can occur on its own, but after 2-3 weeks, isolated paresis, usually soft palate, mild cardiovascular disorders appear. Such patients are dangerous in epidemiological terms.

The island form of diphtheria is characterized by the appearance of single or multiple islands of fibrinous overlays of a grayish-white color on the surface of the tonsils outside the lacunae.

The attacks with the characteristic hyperemia of the mucous membrane around them persist for 2-5 days. Subjective sensations in the pharynx are mild, regional lymph nodes are slightly painful. The temperature of the gel is up to 37-C, headache, weakness, and indisposition can be noted.

The membranous form is accompanied by a deeper lesion of the tonsil tissue. Palatine tonsils are enlarged, hyperemic, moderately edematous. On the surface of them formed solid deposits in the form of films with a characteristic bordering area of ​​hyperemia around. Initially, the plaque may be in the form of a translucent pink film or arachnoid mesh. Gradually, the delicate film is impregnated with fibrin and by the end of the first (beginning of the second) day it becomes dense, whitish-gray in color with a pearl luster. Initially, the film goes away easily, further necrosis becomes more and more deep, the plaque turns out to be tightly welded to the epithelium with fibrin filaments, is removed with difficulty, leaving the ulcer defect and bleeding surface.

The toxic form of diphtheria of the pharynx is quite a severe defeat. The onset of the disease is usually acute patient can call the hour when it originated.

Symptoms of sore throat are characteristic, allowing to identify the toxic form of diphtheria before the appearance of the characteristic swelling of the subcutaneous fatty tissue of the neck: severe intoxication, edema of the pharynx, reaction of regional lymph nodes, pain syndrome.

Severe intoxication is manifested by an increase in body temperature to 39-48 ° C and persistence at this level for more than 5 days, headache, chills, severe weakness, and anorexia. pale skin, adynamia. The patient noted pain when swallowing, drooling, difficulty breathing, cloyingly sweet smell from the mouth, open nasal. Pulse frequent, weak, arrhythmic.

Pharyngeal edema begins with the tonsils, extends to the arms, the tongue of the soft palate, the soft and hard palate, paratonsillar space. Edema diffuse, without sharp boundaries and protrusions. The mucous membrane over the edema is intensely hyperemic, with a cyanotic hue. On the surface of enlarged tonsils and edema palate, you can see a grayish web or a gelatinous translucent film. The raids extend to the palate, the root of the tongue, the mucous membrane of the cheeks. Regional lymph nodes enlarged, dense, painful. If they reach the size of a chicken egg, this indicates a hypertoxic form. Hypertoxic fulminant diphtheria is the most severe form, developing, as a rule, in patients over 40 years of age. representatives of the "non-immune" contingent. It is characterized by a vigorous onset with a rapid increase in severe signs of intoxication: high temperature, repeated vomiting, impaired consciousness, delirium, hemodynamic disorders of the type of collapse. At the same time, significant edema of the soft tissues of the pharynx and neck develops with the development of phenomena of pharyngeal stenosis. The forced position of the body, trismus, rapidly increasing gelatinous edema of the pharyngeal mucosa with a clear demarcation zone separating it from the surrounding tissues is noted.

Complications of diphtheria are associated with the specific action of the toxin. The most dangerous are complications of the cardiovascular system, which can occur with all forms of diphtheria, but more often with the toxic, especially II in the III degree. The second place in frequency is occupied by peripheral paralyzes, which usually have the character of polyneuritis. They can occur in cases of abortively occurring cases of diphtheria, their frequency is 8-10%. The most frequently observed paralysis of the soft palate is associated with damage to the pharyngeal branches of the vagus and glossopharyngeal nerves. In this case, it takes nasal, nasal shade, liquid food gets into the nose.the palatine curtain hangs sluggishly, immobile during phonation. Rarely observed paralysis of the muscles of the extremities (lower - 2 times more often), even less often - paralysis of the abducent nerves, causing convergent strabismus. Lost functions are usually fully restored after 2-3 months, less often - through longer periods. In young children, and in severe cases in adults, the development of laryngeal stenosis and asphyxia in diphtheria (true) croup can be a serious complication.

Symptoms of angina with scarlet fever

It occurs as one of the manifestations of this acute infectious disease and is characterized by a feverish state, general intoxication, a punctate rash, and changes in the pharynx, which can vary from catarrhal to necrotic angina. The toxigenic hemolytic streptococcus group A acts as the causative agent of scarlet fever. The transmission of infection from the patient or bacilli carrier occurs mainly through airborne droplets; children between the ages of 2 and 7 are most susceptible. The incubation period is 1-12 days, usually 2-7. The disease begins acutely with a rise in temperature, malaise, headache and sore throat when swallowing. In severe intoxication, repeated vomiting occurs.

Symptoms of tonsillitis usually develop before the onset of a rash, often simultaneously with vomiting. Sore throat with scarlet fever is a permanent and typical symptom of it. It is characterized by bright hyperemia of the pharyngeal mucosa ("flaming throat"), extending to the hard palate, where a clear boundary of the zone of inflammation is sometimes observed against the background of the pale mucous membrane of the sky.

By the end of the first day (less often on the second day) of the disease, a bright pink or red punctate rash appears on the skin with a hyperemic background, accompanied by itching. It is especially abundant in the lower abdomen, on the buttocks, in the groin, on the inner surface of the limbs. The skin of the nose, lips, chin area remains pale, forming the so-called nasolabial triangle Filatov. Depending on the severity of the disease, the rash lasts from 2-3 to 3-4 days or longer. The tongue becomes bright red by the 3-4th day, with the papillae protruding on the surface - the so-called crimson tongue. Palatine tonsils are edematous, covered with a greyish-dirty coating, which, unlike diphtheria, is not continuous and is easily removed. The attacks can extend to the palatine arches, the soft palate, the tongue, the floor of the oral cavity.

In rare cases, mainly in young children, the larynx is involved in the process. Developed edema of the epiglottis and the outer ring of the larynx can lead to stenosis and require urgent tracheotomy. Necrotic process can lead to perforation of the soft palate, defect of the uvula. As a consequence of the necrotic process in the pharynx, bilateral small necrotic otitis and mastoiditis can be observed, especially in young children.

Recognition of scarlet fever in a typical course is not difficult: an acute onset, a significant increase in temperature, a rash with its characteristic appearance and location, a typical lesion of the pharynx with a reaction of lymph nodes. With erased and atypical forms of great importance is the epidemic history.

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Symptoms of tonsillitis with measles

Measles is an acute, highly contagious infectious disease of viral etiology, occurring with intoxication, inflammation of the mucous membrane of the respiratory tract and lymphadenoid pharyngeal ring, conjunctivitis, spotty-papular rash on the skin.

The spread of the causative agent of infection, the measles virus, occurs through airborne droplets. The most dangerous for others around the patient in the catarrhal period of the disease and on the first day of the rash. On the 3rd day of the appearance of the rash, contagiousness decreases sharply, and after the 4th patient is considered non-infectious. Measles belongs to childhood infections, it is more common for children between the ages of 1 and 5 years of age, but people at any age can get sick. The incubation period is 6-17 days (usually 10 days). During measles there are three periods: catarrhal (prodromal), periods of rash and pigmentation. According to the severity of symptoms of the disease, primarily intoxication, distinguish mild, moderate and severe for measles.

In the prodromal period, on the background of moderate fever, catarrhal phenomena develop on the part of the upper respiratory tract (acute rhinitis, pharyngitis, laryngitis, tracheitis), as well as signs of acute conjunctivitis. However, often the symptoms of angina are manifested in the form of a lacunar form.

First, the measles enanthema appears as red spots of various sizes on the mucous membrane of the hard palate, and then quickly spreads to the soft palate, the arms, the amygdala and the back wall of the pharynx. Merging, these red spots cause a diffuse hyperemia of the mucous membrane of the mouth and pharynx, resembling a picture of banal tonsillopharinitis.

The pathognomonic early sign of measles, observed 2-4 days before the onset of the rash, is represented by Filatov Koplik's spots on the inner surface of the cheeks, in the area of ​​the parotid duct. These whitish specks of 1-2 mm in size, surrounded by a red rim, appear in an amount of 10–20 pieces on a sharply hyperemic mucosa. They do not merge with each other (the mucous membrane appears to be sprinkled with drops of lime) and disappear after 2-3 days.

In the period of rash, along with increased catarrhal phenomena of the upper respiratory tract, a general hyperplasia of the lymphadenoid tissue is observed: the palatine and pharyngeal tonsils swell, and the increase in the cervical lymph nodes is noted. In some cases, mucopurulent plugs appear in the gaps, which is accompanied by a new rise in temperature.

The pigmentation period is characterized by a change in the color of the rash: it begins to darken, acquires a brown tint. First comes the pigmentation on the face. then on the trunk and on the limbs. A pigmented rash usually lasts 1-1.5 weeks, sometimes longer, then a small, scaly, peeling. Complications of measles are mainly associated with the addition of secondary microbial flora. Most often observed laryngitis, laryngotracheitis, pneumonia, otitis media. Otitis seems to be the most frequent complication of measles, usually occurs during pigmentation. Usually there is catarrhal otitis, purulent is relatively rare, however, there is a high likelihood of developing bone and soft tissue necrotic lesions of the middle ear and the transition process to chronic.

Symptoms of tonsillitis in blood diseases

Inflammatory changes in the tonsils and mucous membranes of the mouth and pharynx (acute tonsillitis, symptoms of tonsillitis, stomatitis, gingivitis, periodontitis) develop in 30-40% of hematological patients already in the early stages of the disease. In some patients, oropharyngeal lesions are the first signs of a disease of the blood system and their timely recognition is important. The inflammatory process in the pharynx with blood diseases can be very diverse - from catarrhal changes to necrotic ulcers. In any case, infection of the oral cavity and pharynx can significantly worsen the health and condition of hematological patients.

Symptoms of monocytic angina

Infectious mononucleosis, Filatov's disease, benign lymphoblastosis is an acute infectious disease, observed mainly in children and young people, occurring with lesion of the tonsils, polyadenitis, hepatosplenomegaly and characteristic blood changes. The causative agent of mononucleos most researchers now recognize the Epstein-Barr virus.

The source of infection is the sick person. Infection occurs through airborne droplets, the entrance gate is represented by the mucous membrane of the upper respiratory tract. The disease is classified as low contagious, the transmission of the pathogen occurs only through close contact. More often sporadic cases are observed, family and group outbreaks are very rare. In persons older than 35-40 years, mononucleosis is extremely rare.

The duration of the incubation period is 4-28 days (usually 7-10 days). The disease usually begins acutely, although sometimes in the prodromal period there is malaise, sleep disturbance, loss of appetite. Mononucleosis is characterized by a clinical triad of symptoms: fever, symptoms of angina, adenosplenomegaly and hematological changes, such as leukocytosis with an increase in the number of atypical monocuclear cells (monocytes and lymphocytes). The temperature is usually around 38 ° C rarely high, accompanied by moderate intoxication, the temperature rise is usually observed within 6-10 days. The temperature curve may have a wave-like and recurring nature.

Early detection of regional (occipital, cervical, submandibular), and then distant (axillary, inguinal, abdominal) lymph nodes is characteristic. They are usually palpation plastic consistency, moderately painful, not soldered, redness of the skin and other symptoms of periadenitis, as well as suppuration of the lymph nodes, is never observed. Simultaneously with an increase in lymph nodes for 2-4 days of the disease, an increase in the spleen and liver is observed. The reverse development of enlarged lymph nodes of the liver and spleen usually occurs on the 12-14th day, by the end of the febrile period.

An important and permanent symptom of mononucleosis, which is usually guided in the diagnosis - the occurrence of acute inflammatory changes in the pharynx, mainly from the palatine tonsils. A slight hyperemia of the pharyngeal mucosa and an increase in the tonsils are observed in many patients from the first days of the disease. Monocytic angina can occur in the form of lacunar membranous, follicular, necrotic. Tonsils dramatically increase and are large, uneven, nodular formations protruding into the pharyngeal cavity and, together with an enlarged lingual tonsil, make it difficult to breathe through the mouth. Offensive gray patches remain on the tonsils for several weeks or even months. They can be located only on the tonsils, but sometimes extend to the arms, the back of the pharynx, the root of the tongue, the epiglottis, recalling the picture of diphtheria.

The most characteristic symptoms of infectious mononucleosis are represented by changes in peripheral blood. In the midst of the disease, moderate leukocytosis and significant changes in the blood formula (pronounced mononucleosis and neutropenia with the presence of a nuclear left shift) are observed. The number of monocytes and lymphocytes increases (sometimes up to 90%), plasma cells and atypical mononuclear cells appear, characterized by large polymorphism in size, shape and structure. These changes reach a maximum by the 6-10th day of the disease. During the recovery period, the content of atypical mononuclear cells gradually decreases, their polymorphism becomes less pronounced, plasma cells disappear, but this process is very slow and sometimes drags on for months and even years.

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Symptoms of angina with leukemia

Leukemia is a neoplastic blood disease with a mandatory damage to the bone marrow and the replacement of normal hemopoietic germs. The disease can be acute or chronic. In acute leukemia, the bulk of tumor cells are represented by low-differentiated blasts, in chronic, it consists mainly of mature forms of granulocytes or red blood cells, lymphocytes or plasma cells. Acute leukemia is observed approximately 2-3 times more often than chronic.

Acute leukemia occurs under the guise of a serious infectious disease, affecting mainly children and young people. Clinically, it is necrotic and septic complications due to impaired phagocytic function of leukocytes, pronounced hemorrhagic diathesis, severe progressive anemia. The disease is acute with high fever.

Changes on the part of the tonsils can occur both at the onset of the disease and at later stages. In the initial period, simple hyperplasia of the tonsils is observed against the background of catarrhal changes and edema of the pharyngeal mucosa. In the later stages, the disease becomes septic in nature, symptoms of a sore throat develop, first lacunar, then ulcerous-necrotic. The surrounding tissues are involved in the process, necrosis can spread to the palatine arches, the back of the pharynx, and sometimes to the larynx. The frequency of pharyngeal lesions in acute leukemia is from 35 to 100% of patients. Hemorrhagic diathesis, also characteristic of acute leukemia, may also manifest as petechial skin rashes, subcutaneous hemorrhages, and gastric hemorrhages. In the terminal phase of leukemia, necrosis often develops at the site of hemorrhage.

Changes in the blood are characterized by a high content of leukocytes (up to 100-200x10 9 / l). However, leukopenic forms of leukemia are also observed, when the number of leukocytes decreases to 1.0-3.0x10 9 / l. The most characteristic symptom of leukemia is the prevalence of undifferentiated cells in the peripheral blood - various types of blasts (hemogystioblasts, myeloblasts, lymphoblasts), up to 95% of all cells. Changes are also noted on the part of red blood: the number of erythrocytes progressively decreases to 1.0-2.0x10 12 / l and the concentration of hemoglobin, and the number of platelets also decreases.

Chronic leukemia, unlike acute, is a slowly progressive disease, prone to remission. The defeat of the tonsils, oral mucosa and pharynx is not so pronounced. It usually occurs in older people, men get sick more often than women. The diagnosis of chronic leukemia is based on the identification of high leukocytosis with a predominance of immature forms of leukocytes, a significant increase in the spleen in chronic myeloid leukemia and a generalized increase in lymph nodes in chronic lymphocytic leukemia.

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Symptoms of angina with agranulocytosis

Agranulocytosis (agranulocyte angina, granulocytopenia, idiopathic or malignant leukopenia) is a systemic blood disease characterized by a sharp decrease in the number of white blood cells with the disappearance of granulocytes (neutrophils, basophils, eosinophils) and ulcerative necrotic lesion. The disease occurs predominantly in adulthood, women get agranulocytosis more often than men. The agranulocyte reaction of hematopoiesis can be caused by various adverse effects (toxic, radiation, infectious, systemic lesion of the hematopoietic apparatus).

Symptoms of tonsillitis are initially erythematous and erosive, then quickly become ulcerated-necrotic. The process can spread to the soft palate, not limited to soft tissues and moving to the bone. Necrotic tissue breaks up and is rejected, leaving deep defects. The process in the pharynx is accompanied by severe pain, a violation of swallowing, copious salivation, putrid odor from the mouth. The histological picture of the lesion in the throat is characterized by the absence of an inflammatory response. Despite the presence of a rich bacterial flora, there is no leukocytic inflammatory reaction and suppuration in the lesion focus. When making a diagnosis of a granule of octosis and determining the prognosis of the disease, it is important to assess the state of the bone marrow detected during the puncture of the sternum.

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Pseudomembranous (non-diphtheritic, difteroid) tonsillitis

The etiological factor is pneumococcus or streptococcus, rarely staphylococcus, is rare and is characterized by almost the same local and general symptoms as pharyngeal diphtheria. Streptococcus may be associated with corynebacterium diphtheria, which causes the so-called streptodiphtheria, characterized by an extremely severe course.

The final diagnosis is established according to the results of bacteriological examination of pharyngeal smears. In the treatment of diphtheroid forms of tonsillitis, in addition to the above described for lacunar angina, before establishing the final bacteriological diagnosis, it is advisable to include the use of diphtheria serum.

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Acute ulcerative amygdalitis

Moure's disease - a form of sore throat is characterized by an insidious onset without pronounced general phenomena with minor and notoriously unspecified pain when swallowing. Bacteriological examination revealed a variety of pathogenic microorganisms in symbiosis with a nonspecific spirillus microbiota. When pharyngoscopy at the upper pole of one of the palatine tonsils is determined necrotizing ulcer, while in the amygdala itself, any parenchymal or catarrhal inflammatory phenomena are absent. Regional lymph nodes are moderately increased, body temperature rises to 38 ° C at the height of the disease.

At the initial stage of diagnosis, this form of tonsillitis is easily confused with syphilitic chancre, in which, however, neither its characteristic signs, nor massive regional adenopathy, or Simanovsky-Plaut-Vincent's angina are observed, in which, unlike the form in question, a thuso-chyle microbiota is determined from a pharyngeal smear. The disease lasts for 8-10 days and ends with a spontaneous recovery.

Topical treatment with gargles with 3% solutions of boric acid or zinc chloride.

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Terminology

Two palatine glands, or tonsils, or tonsillitis (tonsilla palatina), - are important elements of the so-called. pharyngeal lymphoid ring (syn. "lymphoepithelial ring Pirogov-Valdeyera") Performing a local immune and barrier function at the entrance to the digestive and respiratory tracts. Palatine tonsils are speckled and riddled with complexly arranged tubules (lacunae, crypts) with follicle bags opening in them, such a structure contributes not only to the efficient functioning of this paired organ with a sufficiently compact size, but also to exudate clusters, which, against the background of unfavorable conditions, facilitates the introduction of various microorganisms and the onset of an infectious-inflammatory process.

Rapidly and rapidly developing inflammation of a pair of tonsils is called acute tonsillitis. In common vernacular it is much more often. called angina- from lat. “Squeeze”, “squeeze” (throat), this term is also quite official and is used in international medical documentation, although it will eventually become outdated and will probably be finally replaced by a diagnosis of tonsillitis, more accurate and better in line with the canons of medical derivation.

It should be emphasized that Tonsillitis, like other inflammatory processes, can occur with different dynamics - in acute, subacute or chronic form.. The semantics of the word "sore throat" implies the acute course, chronic sore throat does not exist, whereas chronic tonsillitis occurs very often, especially in pediatrics.

The question remains whether the exacerbation of chronic tonsillitis is correctly called angina: the clinic is similar, but the therapeutic strategy differs from the approach to treating the primary acute process.

It remains to add that such a complaint as a sore throat, and such a diagnosis as acute tonsillitis (angina in one form or another clinical form), are among the most common in the practice of the ENT doctor.

As follows from the above, a sore throat in all cases is infectious inflammatory process. In the role of a pathogen, beta-hemolytic streptococcus is usually sown, less often other coccal or rod-shaped bacterial cultures (staphylococcus, pneumococcus, conditionally pathogenic Klebsiella, etc.). Often the infection is polymicrobial. Specific forms of acute tonsillitis are also distinguished - the example is usually referred to as Simanovsky-Plaut-Vincent's sore throat (necrotizing ulcerous-membranous fusospirochetosis), caused by a combination of an anaerobic spindle-shaped fusobacterium with Vincent spirochete colonizing the oral cavity.

However, acute tonsillitis can be not only bacterial. There are tonsillitis fungal, viral (herpetic, adenoviral, etc.), as well as a combined etiology, - when, for example, cocci and fungi of the genus act as symbiotic copophogens Candida.

Any modern educated person, even without being an expert, can easily list the main risk factors: weakening of local and general immunity, presence of foci of chronic infection (especially in the immediate vicinity of the tonsils, i.e., nasopharynx, oral cavity, organs of hearing and vision, upper respiratory tract, esophagus, etc.), smoking, nasal obstruction respiration and, in general, impaired natural ventilation of the nasopharynx, hypovitaminosis, unbalanced diet.

Unlike the primary (simple, banal) tonsillitis, angina, secondary (symptomatic) develops against and due to scarlet fever, mononucleosis, agranulocytosis and other diseases.

Given the diversity of potential pathogens, a variety of ways of spreading infection are possible the patient, if he is treated at home, should be maximally isolated from contacts with healthy family members (including separate dishes, towels, etc.).

Symptomatology

Leading symptom - sore throat, especially when swallowing and eating. The intensity of the pain syndrome can vary from quite tolerable to severe. In different cases, the severity also differs. symptoms of general intoxication (increase in body temperature from 37 ° C to 40 ° C or more, weakness, general malaise, headache, loss of appetite, sleep disturbances, increase and soreness of regional lymph nodes) and local inflammation in the tonsils (swelling, hyperemia).

The above are the most typical, common manifestations of acute tonsillitis. Other symptoms may differ so significantly that it is the basis for the selection of several relatively independent clinical forms.

Catarrhal sore throat is the most common and, fortunately, the least severe form. Manifests itself burning, "sore throat". As a rule, in the syndrome of infectious intoxication occurring on the background of subfebrile, asthenic component is expressed. On the tonsils may appear mucopurulent plaque. With sufficient immune response, symptoms are reduced in a few days.

Follicular sore throat, also quite common, usually manifests high fever, severe radiating pain in the throat, severe intoxication, feverish state (up to symptoms of central nervous system depression), gastrointestinal disturbances, vomiting. Multiple suppuration of small follicles gives the tonsils a characteristic "starry sky", spontaneous dissection leads to accumulations of pus. The active phase of the disease lasts about a week.

Lacunar angina It is, in fact, a heavier follicular version. Often added pains in muscles and joints, cardialgia. Tonsils, as a rule, are covered with purulent bloom in the form of films.

Fibrinous sore throat, in turn, can be considered as the next phase in the development of lacunar tonsillitis: a solid yellowish white bloom is formed, covering not only the tonsils, but also adjacent areas.

Quinsy characterized by common, diffuse purulent-inflammatory process in the parenchyma of the amygdala (usually one of the two). The muscles of the temporomandibular joint often spasm.. For heavy.

Gangrenous sore throat (necrotizing tonsillitis Vincent, see above) is characterized by mass cell death of the affected tonsil, putrid breath from the mouth, deep ulceration with the formation of defects due to purulent fusion of the tissue. Body temperature in most cases remains moderately elevated or normal..

Herpetic (viral) tonsillitis is found more often in childrendiffers especially acute onset and high contagiousness, polymorphic severe symptoms (including from the gastrointestinal tract), which, however, is quickly reduced. Tonsils are covered with small red inflamed vesicles..

As is often the case in medical practice, the prevalence and popularity of the disease does not guarantee from serious complications. The dynamics of acute tonsillitis can result in an intra- or paratonsillar abscess, triggering the start of a rheumatic process, glomerulonephritis, the rapid spread of infection in some cases results in meningitis or secondary inflammations of other localization, as well as life-threatening infectious-toxic shock or sepsis.

Drug therapy

The main direction of medical treatment of angina is etiotropic therapy. It is carried out to eliminate the cause of the disease. Preparations are chosen depending on the type of pathogen that caused the tonsillitis:

  • Antibiotics: penicillins (Flemoklav, Augmentin), cephalosporins (Zinnat, Ceftriaxone), macrolides (Azithromycin, Hemomitsin). Used with the bacterial nature of the disease. The goal is to stop the reproduction of pathogenic bacteria. Antibiotics are taken orally, in severe cases, an injection can be administered. One of the antibacterial drugs used topically. This is spray Bioparox.
  • Antiviral: Kagocel, Arbidol, Ingavirin, Ergoferon. They are prescribed for viral tonsillitis to stop the virus. The drugs are taken orally in the form of tablets.
  • Antifungal: Fluconazole, Nystatin. Used with specific fungal form of tonsillitis. To stop the reproduction of fungi of the genus Candida use antimycotic agents. They are intended for oral administration.

Antihistamines are used as symptomatic therapy. They help relieve inflammation and swelling of the tonsils. For this purpose, Suprastin, Cetrin, Diazolin are used. Paracetamol or Ibuprofen is used as antipyretic. To relieve the symptoms of tonsillitis, local therapy is also carried out, including the following procedures:

  • Irrigation of tonsils with antiseptics. Effective are the drugs sprays Kameton, Proposol and Geksoral, Lugol solution, Stopangin, Ingalipt. The procedure is carried out 3-4 times a day. Each involves 2-3 injections into the throat.
  • Resorption pills or lozenges. Such agents have anti-inflammatory, analgesic and sometimes antibacterial effects.

Separately, it is worth noting the rinsing procedure. It is carried out with a frequency of 1 time every 1.5-2 hours. It is recommended to periodically change the rinses. After the procedure, you can not drink for about half an hour. For rinsing solutions are used:

  • soda,
  • sea ​​or table salt,
  • Chlorhexidine,
  • herbal decoctions,
  • Miramistina,
  • hydrogen peroxide,
  • Furacilin.

Folk remedies

Additions to the main therapy can be folk remedies, but only with the permission of the doctor. Alternative medicine for tonsillitis helps only to ease the symptoms. The following recipes are considered effective:

  • Mix 1 tbsp. l sugar with 1 tbsp. l lemon juice. Use the tool for 1 tsp. 3 times every day until the sore throat disappears.
  • For a glass of hot water, take 1 tbsp. l chamomile flowers, mix the ingredients. Let the medium stand for about 40 minutes, cool to a warm state. Gargle with chamomile decoction 5-6 times a day. Duration of use - 7-10 days.
  • Combine natural honey, potato starch, butter in equal proportions. Stir the ingredients, take 1 tsp. mix in your mouth and dissolve. Perform the procedure 3-4 times a day until the disappearance of unpleasant symptoms in the throat.

Watch the video: Tonsils and Adenoids Surgery (December 2019).

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