Angina

ANGIN (acute tonsillitis) is an acute common infectious disease with a predominant lesion of palatine tonsils. Inflammatory process can be localized in other clusters of lymphadenoid tissue of the pharynx and larynx - in lingual, guttural, nasopharyngeal tonsils. Then, respectively, speak of lingual, guttural or retro-nasal angina. Infection can be exo- (more often) or endogenous (autoinfection). There are two ways of transmission of infection: airborne and alimentary. Endogenous infection occurs from the oral cavity or pharynx (chronic inflammation of the palatine tonsils, carious teeth, etc.). The source of infection can also be purulent diseases of the nose and its paranasal sinuses.

Etiology. The most common pathogens of infection are staphylococcus aureus, streptococcus (especially hemolytic), pneumococcus. There is information about the possibility of angin viral etiology. Predisposing factors: local and general cooling, decrease in the reactivity of the organism. Angina more often sick children of preschool and school age and adults up to 35-40 years, especially in the autumn and spring periods.

Symptoms, course. Pain when swallowing, malaise, fever. There are frequent complaints of pain in the joints, headache, periodic chills. The duration of the disease and local changes in the palatine tonsils depend on the form of the angina. With rational treatment and compliance with angina, an average of 5-7 days. There are catarrhal, follicular and lacunar forms of angina. In fact, these are different manifestations of the same inflammatory process in the palatine tonsils.

Angina catarrhal. Usually begins suddenly and is accompanied by a perspiration, uneven pain in the throat, general malaise, subfebrile temperature. Changes in the blood are not clearly expressed or absent. When examining the pharynx (pharyngoscopy), there are moderate swelling, hyperemia of the tonsils and adjacent areas of the palatine arch; The soft palate and back of the throat are unchanged. Regional lymph nodes can be enlarged and painful on palpation. Catarrhal angina may be the initial stage of another form of angina, and sometimes the manifestation of one or another infectious disease.

Angina lacunar and follicular are characterized by a more pronounced clinical picture. Headache, sore throat, malaise, general weakness. Changes in blood are more significant than with catarrhal angina. Often, the disease begins chills, raising the temperature to 38-39 grams. C and above, especially in children. There is a high leukocytosis -20 ¬ 10 (ninth degree) / n and more with a shift of the white blood formula to the left and high ESR (40-50 mm / h). Regional lymph nodes are enlarged and painful on palpation. With pharyngoscopy, marked hyperemia and swelling of palatine tonsils and adjacent areas of the soft palate and palatine arches. With follicular sore throat, festering follicles visible through the mucous membrane appear as small yellow-white vesicles. With lacunar angina also form yellowish white raids, but they are localized in the mouths of lacunae. These raids may subsequently merge with each other, covering all or almost all of the free surface of the tonsils, and easily removed with a spatula. The division of anginas into follicular and lacunar is conditional, since the same patient can have both follicular and lacunar angina at the same time.

Angina phlegmonous. Acute purulent inflammation of the peripermaladic tissue. More often is a complication of one of the forms of angina described above and develops 1 -2 days after the angina has ended. The process is more often one-sided, characterized by a sharp pain in the throat when swallowing, headache, chills, a sense of weakness, weakness, nasal congestion, triasm of the masticatory muscles, an increase in body temperature to 38-39 g. With, an unpleasant smell from a mouth, plentiful allocation of a saliva. Changes in the blood correspond to an acute inflammatory process. Regional lymph nodes significantly increased

And painful on palpation. With pharyngoscopy, sharp hyperemia and puffiness of the soft palate tissues are noted on the one hand. The palatine tonsil on this side is displaced to the median line and down. Due to the puffiness of the soft palate, it is not often possible to examine the amygdala. The mobility of the affected half of the soft palate is significantly limited, which can lead to the leakage of liquid food from the nose. If the first 2 days of vigorous treatment of phlegmonous sore throat is not started, then on the 5th-6th day, a limited abscess may form in the circumfluorocellular tissue - the peritonsillar (paratonsillar) abscess. With a high virulence of the microflora and a decreased reactivity of the body, the abscess can form, despite active treatment, earlier than usual (on the 3-4th day after the onset of the disease).

With a formed peritonsillar abscess, you can see a thin section of the mucosa of white-yellow color - a translucent abscess. After an independent or surgical dissection of the abscess, a rapid reverse development of the disease occurs. In recent years there have been protracted forms of phlegmonous tonsillitis with periodic abscessing, which is due to the irrational use of antibiotics.

Inflammatory changes in the lymphadenoid glottis ring do not always indicate angina. Differential diagnosis should be conducted with scarlet fever, diphtheria, measles, influenza (see Infectious Diseases), acute catarrh of the upper respiratory tract, including acute pharyngitis, with acute blood diseases