Sore throat ( tonsillitis) - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Infectious Diseases

term "angina" is known since the days of ancient medicine, most often this term is understood the various disease states in the throat, similar in their characteristics.However, in fact causes sore throats may be completely different.In this regard, all of angina can be divided into three categories: primary, specific and secondary (symptomatic)

Primary angina

Under primary angina understand - an acute infectious disease with predominantly streptococcal etiology, with a relatively short-term fever, general intoxication, inflammatory changesin the lymphoid tissues of the throat, more often - in tonsils and nearest thereto lymph nodes.Angina risk of developing autoimmune processes without specific protivostreptokokkovogo treatment can lead to the development of acute glomerulonephritis and rheumatic fever accompanied by severe damage to the kidneys and heart.

most common cause of angina is a beta-hemolytic streptococcus (up to 90% of all cases).Less commonly (up 8%), the cause of a sore throat become

s Staphylococcus aureus, sometimes in conjunction with strep.Very rare pathogen is Streptococcus pneumoniae, Haemophilus influenzae, Corynebacterium.

source of infection is a patient with angina various forms of acute disease and a carrier of pathogens.The most important are patients with foci of infection in the upper respiratory tract.

main route of infection angina airborne easily implemented in large teams, in close communion with the sick person.Infection can occur when using products aureus colonization (salad, milk, minced meat, fruit compote)

susceptibility to pathogens angina in humans varies and is largely dependent on the state of local immunity of the tonsils: the lower it is, the higher the risk of angina.The risk of disease increases with colds, fatigue, under the influence of other adverse factors.

main breeding place angina agents are the palatine tonsils and rarely - lingual tonsils, the side bolsters on the back wall of the pharynx.Overcoming local protection of the tonsils, tonsillitis pathogen begins to multiply and secrete a variety of substances that cause inflammation.Often, the agent and the products of its life penetrate into the next (regional) lymph nodes and cause their inflammation.In most cases, the spread of germs is limited to the tonsils and lymph nodes, but in some cases, overcome these barriers, the pathogen causes inflammation of the tissue surrounding the tonsils (paratonsillitis, peritonsillar abscess), and even sepsis.Products of vital activity of microbes, soaked in blood, cause toxic damage of tissues of the body: blood vessels, central and peripheral nervous system, kidneys, liver, myocardium and other.

Tonsils neural pathways associated with the heart, so angina, disruption of the heart may occur by reflex.

Immune processes developing in response to the introduction of the pathogen tonsillitis, under certain circumstances (human predisposition, streptococcal infection) may receive incorrect, pathological form.At the same time the immune complexes are deposited in the tissues of the heart, kidneys and immune system mistakenly recognizing tissues such as the alien begins to destroy them - developing rheumatic fever.The cause of such processes is, including the untimely or ineffective treatment.The risk of autoimmune processes increases with repeated tonsillitis disease.Repeated called angina in people who suffer from it every year or at least every two years.

By its nature, a sore throat can be catarrhal, follicular, lacunar or necrotic.When catarrhal sore throat inflammation limited to the mucosa covering the tonsils.If tonsillitis happens festering specific formations tonsils - follicles.When lacunar angina inflammation penetrates deeper into the tissue of the tonsils, festering follicles break in the gaps of the tonsils, leaving a festering raid on tonsil surface.

lacunar tonsillitis: mucous membrane of the pharynx is inflamed, purulent plaque on the tonsils

Symptoms of angina

incubation period for angina lasts 1-2 days.Disease begins acutely: among full health appear chills, headache, aching joints, general weakness, pain in the throat when swallowing.Manifestations of the disease are most pronounced when lacunar angina: noted a strong fever, body temperature can reach up to 40 °, disturbed appetite and sleep.Pain gradually amplified in the throat becomes constant, reaching a maximum on the second day.For primary symptom of angina is characterized by bilateral pain when swallowing.If there is no pain at all or some vague feelings on the part of the throat of the primary diagnosis of angina is uncertain.

Rash is not angina.

mandatory for primary angina is to increase and tenderness of the lymph nodes in the area of ​​the lower jaw angles: they are easy to move with feeling.

On examination of the pharynx can be seen reddened (erythematous), enlarged tonsils, dotted with yellowish formations (2-3 mm) in follicular and fibrinopurulent raids irregular shape with lacunar angina.

Angina in the recovery stage, after a discharge of purulent masses can see the expanded gap

In severe cases of angina in the tonsils may occur areas of necrosis (necrosis) of dark gray color, which are then rejected, and in their place are formed tissue defectsup to 1 cm, often of irregular shape with a rough bottom.

paratonsillitis and peritonsillar abscess (quinsy) occur as a complication of tonsillitis.

paratonsillitis and peritonsillar abscess are two phases of the same process, at first there is an inflammation of tissue around the tonsils - paratonsillitis, then there is their purulent fusion - formed an abscess.These complications occur 2-3 days after a sore throat.There is pain when swallowing more than one side, the temperature rises sharply.Opening the mouth is difficult, there is increased salivation.Typically the patient's head position: to reduce the stress of the affected tissues, it tilts it in a sick way.On examination of the pharynx a marked asymmetry: the affected tonsil strained and shifted to the center, edematous soft palate, the tongue is displaced to one side.

I would like to put together signs and symptoms that should cause a person to seek medical advice immediately:

excitement, alternating with lethargy, pale skin, alternating bluish color, impaired consciousness, the rapid decline in body temperature, decreased amount of urine - symptoms of severe complications of the disease - infectious-toksicheskogo shock.Convulsions, fainting - signs of damage to the nervous system and the appearance of hemorrhages - violation of vascular permeability and blood coagulation.Long term, more than five days the temperature preservation - a sign of ineffectiveness of antibiotic treatment.The emergence of a sense of lack of air, dull pain in the chest, pain in the lumbar region or the lateral areas of the abdomen in conjunction with urinary morbidity, change in color of urine - symptoms of cardiac disease and kidney failure.Increased pain in the throat, difficulty opening the mouth, difficulty swallowing - a sign (possibly purulent) inflammation of the tissue around the tonsils.

Specific angina

Diphtheria pharynx , can have similar symptoms with a simple (primary) angina.There are three forms of diphtheria throat: localized - plaque is not beyond the tonsils, common - raid beyond the tonsils of the soft palate, the back wall of the pharynx and toxic - a swelling in the throat and subcutaneous tissue of the neck.The defeat of the tonsils at the first two forms of diphtheria is characterized by the formation of dense raids, hardly removed from the surface of the tonsils, the underlying tissues after withdrawal bleed attacks, filmed the film is not pounded and does not dissolve in water.

Diphtheria pharynx: dense, poorly acting in film raids on the tonsils

Without the diphtheria serum disease progresses - a mild form turn into a more severe form of common or toxic.

Fungal sore throats are caused by the yeast, while reducing the overall reactivity of the body, long-term treatment with antibiotics.These are different from primary angina slight fever, mild intoxication.On the surface of the tonsils formed loose, "cheesy" attacks, which are easily removed, revealing a smooth, inflamed mucous membranes (so-called "patent slimy").

Vincent's angina - caused by the presence of symbiosis (living together) organisms that live in the mouth: the spirochetes and fusiform bacillus.If you have poor oral health, tobacco abuse, they can acquire pathogenic properties.Against the background of mild intoxication, on one side, developing necrotizing process.During the 2 days on the amygdala appears grayish-white coating, and for 4-5 days at the site of plaque formed a deep ulcer with jagged edges and dirty-gray down.Plaque can be spread across the amygdala and beyond, but never goes over to the other side.The disease lasts for about 2 weeks.

Secondary angina

In many infectious and non-communicable diseases, in addition to the defeat of various organs and systems there are so-called secondary angina - a common set of symptoms of the disease, in which there are changes in anginal throat.Such changes can occur with influenza, acute respiratory viral infections, scarlet fever, tularemia, infectious mononucleosis, measles, tuberculosis, syphilis, diseases of the blood-forming organs (leukemia, agranulocytosis).

angina of scarlet fever in catarrhal and follicular, lacunar form appears on the first day of illness, the primary distinguished by a bright color of the mucous membranes (mouth of the flaming) and disappears at 4-5 day illness.To distinguish this sore throat from the initial permit typical of scarlet fever symptoms: bright color of the mucous throat, bright red with prominent papillae ( "raspberry") language, red cheeks, combined with pale nasolabial triangle, point rash with a typical localization in the abdomen, inner thighs,flexion of the hands and feet.

Angina at syphilis develops in the oral mechanism of injury.After three to four weeks after infection increases one amygdala, the temperature slightly increases.A few days later on the amygdala appears chancre.The most common form of erosive lesions: in the amygdala appears regularly shaped, 0.5-1 cm in diameter erosion with crisp edges and a smooth, shiny bottom.Angina in secondary syphilis appears as whitish plaques on the tonsils with a diameter of 0.5 cm, towering above the surface, surrounded by a red rim.In secondary syphilis affects both tonsils.

Angina with tularemia , usually on one side, may be catarrhal, membranous or necrotic.On the surface of the tonsils islands formed a yellowish-white bloom, which then merge to form a thick, coarse film is similar to diphtheria.Significantly swollen lymph nodes in the neck, become painful, merged into conglomerates, and then suppurate.When tularemia increased liver and spleen.

Angina at leukemia occurs with high (39-40 ° C) temperature, headache, chills.Most nosebleeds occur on the skin and mucous membranes appear hemorrhage.Angina, initially catarrhal, necrotizing takes character: raids appear dirty-gray, after their rejection of bleeding open defects with a rough surface.The diagnosis to be confirmed after blood tests: white blood cell count may exceed the norm by more than 20 times.

Angina with agranulocytosis has necrotizing character who looked similar to angina in leukemia.In the blood, in the analysis, reveal an almost complete lack of white blood cells (granulocytes.)

Angina in infectious mononucleosis usually appears in the first days of illness, but may also develop in the 5-6 day.The gaps of the tonsils appears loose, gritty plaque, which can be easily removed.To distinguish this allows angina characteristic symptom of mononucleosis - the defeat of the lymph nodes: axillary, neck, groin, neck, subclavian, BTE.Increased liver and spleen.

Angina with enterovirus or gerpangina infection begins with a rise in temperature to 40 ° C, appears on the tonsils rash with blisters, after the autopsy appear superficial ulcers, coated with a thin whitish bloom.Lasts 6-7 days of illness.

diagnosis of angina is composed of typical for angina symptoms.If necessary, a bacteriological study to determine pathogen and its sensitivity to antibiotics.In order to carry out early diagnosis of complications electrocardiography and biochemical blood tests.

treatment of angina

Given that angina in most cases is caused by streptococcus, and rheumatic fever, glomerulonephritis and myocarditis occur exactly in streptococcal infections are treated with penicillin antibiotics.Most effective against beta-hemolytic streptococci benzylpenicillin.If there is an allergy to penicillin prescribed macrolide antibiotics (erythromycin, azithromycin).Usually, after a short course of penicillin intramuscularly administered drugs long-acting penicillin - bitsillin 3-5.Popular sulfonamides (cotrimoxazole) and tetracyclines (doxycycline) are not effective in angina.

Besides antibiotic therapy patient with angina is necessary to conduct detoxification as copious drinking, and in severe cases by intravenous infusion of glucose solutions, sodium chloride.Briefly, when poorly tolerated the heat, prescribed analgesics: paracetamol, aspirin.

Patients with recurrent angina appoint immunostimulants: leucogen sodium nukleinat.As bracing drugs prescribed vitamins: ascorbic acid, B vitamins, simple multivitamin.After treatment with antibiotics prescribed drugs normalize intestinal microflora (baktisubtil, Linex).Gargling is necessary more hygienic purpose - rinsing with an antiseptic effect no significant effect on the pathogens, so for this purpose to use a solution of baking soda warmed enough.To relieve pain in the throat, you can use the lozenges and sprays containing ingredients (menthol, peppermint oil, local anesthetics), reducing the sensitivity of the mucous membrane, but they can not be abused as a pain - a sign of inflammation, and local anesthetics produce only an appearance of well-being.

In marked inflammation of the lymph nodes can be used warming treatments: dry heat, physiotherapy.

Treatment of secondary angina in terms of the impact on the cause (etiotropic treatment) may differ significantly from the treatment of primary angina (See the articles about the treatment of the relevant diseases), in terms of impact on individual symptoms (fever, pain, inflammation, intoxication) - similar to and heldby the same means as the primary treatment of angina.

Folk remedies for the treatment of angina

traditional treatments aim to reduce inflammation in the throat, strengthening the body's defenses, speedy recovery from illness.For these purposes, used plant teas with anti-inflammatory effect (chamomile, sage, oak bark), teas and infusions of berries with a high content of vitamins (currant, cranberry, wild rose).Russian bath and sauna have a tonic effect, help eliminate toxins, but should be used in the recovery period.As the only independent method of treatment of folk methods are not suitable.

Prevention angina

Prevention angina aims to identify individuals predisposed to the disease, with chronic infection.For such people is set monitoring, is the treatment of foci of infection in the oral cavity, nasopharynx.