ANGINA

ANGINA (syn: acute tonsillitis) is an acute infectious-allergic disease with a predominant lesion of palatine tonsils. The inflammatory process can also be localized in other clusters of pharyngeal lymphoid tissue - in lingual, pharyngeal tonsils, lateral ridges (lingual, retro-nasal angina, angina of lateral ridges), and also in the larynx (laryngeal angina).

The disease affects children of preschool and school age, as well as adults under the age of 35 - 40 years. There are marked seasonal increases in morbidity during the spring and autumn periods.

The causative agents are most often streptococcus, staphylococcus, pneumococcus, yeast-like fungi of the genus Candida, etc. Significant role in the occurrence of angina can play anaerobic infection , adenoviruses, influenza viruses. Predisposing factors are local and general hypothermia, overheating, dusty atmosphere, decreased reactivity of the body, hypovitaminosis, and sometimes mechanical trauma to palatine tonsils.

Infection can be exogenous or endogenous. Exogenous infection is more common. There are two ways of transmission of pathogens of infection: airborne and alimentary. In the first case, as a rule, infection occurs with close contact with a sick angina. Endogenous infection occurs when there are foci of chronic inflammation (chronic tonsillitis, dental caries , gum disease, etc.) in the mouth or throat, as well as purulent diseases of the nose and paranasal sinuses.

The most common are the so-called vulgar (usual, banal) angina - catarrhal, follicular and lacunar, as well as phlegmonous. There are also sore throats that occur in acute infectious diseases (measles, scarlet fever, diphtheria, etc.), chronic infectious processes (syphilis, tuberculosis), blood diseases (agranulocytosis, lymphatic leukemia, etc.), and special forms of angina, for example, Plauta - Vincent.

Catarrhal angina. The disease usually begins with the appearance of dryness, sagging, sore throat. During the first day, pain is associated with swallowing. Body temperature in adults is subfebrile, in children it can rise to 38 ° C. Patients report general weakness, malaise, headache. When examining the pharynx, moderate swelling and hyperemia of the palatine tonsils and adjacent areas of the palatine arch become apparent. The soft palate and the posterior wall of the pharynx have not been altered, which is one of the differential diagnostic features that distinguish this form of angina from acute pharyngitis. Regional lymph nodes can be enlarged and painful on palpation. Changes in blood are absent or indistinct (small leukocytosis , slight shift of the leukocyte formula to the left, moderate ESR).

Follicular and lacunar angina are characterized by a more pronounced clinical picture. As a rule, there is an acute onset, often chills, an increase in body temperature to 39 - 40 ° C, sometimes higher, especially in children. There are signs of intoxication - weakness, sweating, headache , lumps in the lumbar region and joints, loss of appetite. 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 angina, festering follicles are visible, which translucent through the mucous membrane in the form of small bubbles of yellow-white color. With lacunar angina yellowish-white fibrinous raids are formed, which are located in the mouths of lacunae. These raids may subsequently merge, covering all or almost all of the free surface of the tonsils; They are easily removed with a spatula. In the blood leukocytosis is noted with shift of the leukocyte formula to the left, increased ESR (up to 40-45 mm / h). As a rule, the same patient shows signs of follicular and lacunar angina; Isolated these forms are rare.

Phlegmonous tonsillitis is an acute purulent inflammation of the peripermaladic cellulose tissue. It is usually a complication and develops 1-2 days after the completion of one of the above described forms of the disease. With phlegmonous tonsillitis the process is more often unilateral. There are sharp pains in the throat when swallowing, which sometimes cause the patient to refuse to take even liquid food, a sharp headache , chills, a sense of weakness, weakness, there is a nasal and triasm of the masticatory muscles, the body temperature rises to 38-39 ° C, an unpleasant odor From the mouth, abundant secretion of saliva. Regional lymph nodes are significantly enlarged and painful on palpation.

Acute congestion and swelling of the soft palate often make it difficult to examine the palatine tonsil, which is shifted to the midline and downwards on the side of the lesion. With a significant limitation of the mobility of the soft palate, liquid food flows out of the nose. In cases of high virulence of the microflora and reduced reactivity of the organism, a delayed onset of treatment on the 5th - 6th day in the perimineral cage may form a peritonsillar (paratonsillar) abscess . It is usually localized in front and above the palatine tonsil (anteroposterior abscess). Perhaps abscessing and in the palatine tonsil, but in connection with the anatomical features of its structure (permeated with deep lacunae), these abscesses do not reach large sizes. With the "ripened" peritonsillar abscess against the background of symptoms characteristic of phlegmonous sore throat, a white and yellow segment of the mucous membrane appears - a thin wall of the abscess. After the dissection of the abscess (independent or performed operatively), the patient's condition quickly normalizes.

Complications . Of the local complications, the most common are acute otitis media , acute laryngitis, laryngeal edema, phlegmon of the neck, parapharyngeal abscess , acute cervical lymphadenitis . Often recurring tonsillitis promotes sensitization of the body, against which rheumatism, nephritis , cholecystitis , orchitis , meningitis , etc. can occur.

Differential diagnosis is carried out with scarlet fever, diphtheria, measles, influenza, acute pharyngitis, with tonsil lesions in leukemia, infectious mononucleosis. Of great importance are the nature of local changes found in the examination of the pharynx and larynx; Results of laboratory research methods. Suspicion of diphtheria should occur even after a general examination: the patient is weak, pale, adynamic, the temperature response may be poorly expressed (within the subfebrile). There is an increase in cervical lymph nodes and marked edema of the cellulose neck. With lacunar angina, yellow-white raids are localized within the tonsils, easily removed with a spatula, and an unchanged surface of the amygdala is detected; Diphtheria attacks are dirty gray, go beyond the tonsils, they are hardly removed with a spatula, after removal of the plaque, an eroded area is exposed. With lacunar angina, the lesion is bilateral, with diphtheria it is often one-sided (especially with mild and moderate severity). If suspected diphtheria of the patient's throat, it is necessary to immediately hospitalize in the boxed department of the infectious hospital.

Treatment is usually at home. In the first days of the disease before the normalization of body temperature, the bed rest is prescribed. Recommend a plentiful drink (fruit juices, tea with lemon, milk, alkaline mineral water) and a vitamin-rich diet. It is necessary to monitor the function of the intestine. Medicines should be used strictly individually, depending on the nature of the angina, the state of other organs and systems. With a mild course of the disease without severe intoxication, sulfanylamide preparations are prescribed inside. In severe cases, with severe intoxication, antibiotics are indicated. Patients with rheumatism and kidney disease regardless of the form of angina from the first day of the disease prescribe antibiotics, acetylsalicylic acid 0.5 g 3 - 4 times a day and ascorbic acid 0.1 g 4 times a day to prevent exacerbation.

For the rinse use warm solutions of potassium permanganate, boric acid, furacilin, sodium hydrogen carbonate, sodium chloride, as well as decoctions of sage and chamomile. Children who do not know how to gargle are given (every 30 to 60 minutes) to drink non-hot tea with lemon or fruit juices. With regional lymphadenitis, warming compresses are indicated for the night and a warm dry bandage around the neck in the afternoon. Apply steam inhalation. In the process of treatment, it is necessary to observe the state of the cardiovascular system, to conduct repeated urine and blood tests in order to detect complications in a timely manner and begin treatment. With protracted lymphadenitis in outpatient conditions, locally use the sollyx, UHF currents. In the case of severe disease and when complications arise, the patient must be hospitalized.

The prognosis is usually favorable, however, with repeated angina, complications are possible.

Prevention . Measures to prevent angina are divided into individual and general. Since angina is an acute infectious disease, the patient should be placed in a separate room, often ventilate it and conduct a wet cleaning. For the patient, a special dish is given, which after each use is given with boiling water or boiled. Near the patient's bed, a spoon with disinfectant solution is placed to spit out saliva. Limit the patient's contact with others, especially with children, since they are most susceptible to angina.

To prevent angina, it is important to timely sanitize the foci of chronic infection (carious teeth, chronic tonsillitis, purulent lesions of the paranasal sinuses, etc.), eliminate the causes that impede free breathing through the nose (in children, most often adenoids).

Of great importance are also the tempering of the body, the correct mode of work and rest, the elimination of various hazards, such as dust, smoke (including tobacco), excessively dry air, alcohol intake, etc. The general measures for the prevention of angina include the elimination of hazards in the workplace and In a life, employment by various kinds of sports. Persons often sick with angina (both adults and children) are subject to follow-up.

Special forms of sore throat. Among them, the Simanovsky-Plauta-Vincent's angina, or ulcerative-pleous angina, is more common. It is caused by a spindle-shaped rod in symbiosis with the usual spirochaete of the oral cavity. This disease often occurs in people who are exhausted and weakened by various diseases, suffering from hypovitaminosis.

The state of the patient usually changes little. Often he appeals for help in connection with the appearance of an unpleasant putrefactive smell from the mouth and drooling. In uncomplicated cases, body temperature is usually normal or subfebrile, only sometimes the disease begins with a high temperature (38 ° C and above) and chills. In the blood there may be a mild leukocytosis . Later, pain occurs when swallowing and an increase in regional lymph nodes that are painful on palpation. In uncomplicated course, the duration of the disease is 2-3 weeks. Patients with severe forms of the disease must be hospitalized. With pharyngoscopy, the defeat, as a rule, of one amygdala is detected. This amygdala is hyperemic, enlarged in size, covered with a greyish-yellow loose coating that is easily removed, and underneath it there is a slightly bleeding ulcer with a grayish-yellow bottom and uneven edges. Ulceration, in addition to the amygdala, can spread to the arches, and sometimes to other parts of the oropharynx, the mucous membrane of the cheeks, gums.

Complications are rare, but if they occur, it is difficult (arthrosis bleeding, hard palate perforation, gum destruction, etc.).

The diagnosis is established on the basis of the clinical picture and the results of bacteriological investigation - the detection in the film or in the detachable ulcer of a large number of spindle-shaped rods and spirochetes of the oral cavity.

Treatment . Rinsing of the mouth with solutions of hydrogen peroxide, potassium permanganate, dusting of the ulcer surface with powder of wasarsol. In the absence of effect, penicillin, nicotinic acid is prescribed.