Angina( tonsillitis) - Causes, symptoms and treatment. MF.

The term "angina" has been known since the time of ancient medicine, most often this term is understood as the various painful conditions in the throat, similar in their features. However, in fact, the causes of angina can be completely different. In this regard, all anginas can be divided into three categories: primary, specific and secondary( symptomatic)

Primary angina

Primary angina is understood to be an acute infectious disease predominantly streptococcal, with a relatively short-term fever, general intoxication, inflammatory changes in lymphoidtissues of the pharynx, most often in the palatine tonsils and the nearest to them lymph nodes. Angina is dangerous by the development of autoimmune processes, which, without specific anti-streptococcal medication, can lead to the development of acute glomerulonephritis and rheumatism, accompanied by serious damage to the kidneys and the heart.

The most frequent causative agent of angina is beta-hemolytic streptococcus( up to 90% of all cases).Less often( up to 8%), the cause of angina is a golden staphylococcus, sometimes in combination with streptococcus. Very rarely, the causative agent is streptococcus pneumonia, hemophilic rod, corynebacterium.

The source of infection in angina is a patient with various forms of acute diseases and a carrier of pathogenic microorganisms. The greatest importance is for patients with foci of infection in the upper respiratory tract.

The main way of infection with sore throat is airborne, easily realized in large groups, in close contact with a sick person. Infection can occur with the use of foods contaminated with staphylococcus( salad, milk, minced meat, compote)

Susceptibility to the causative agents of angina in humans varies and largely depends on the state of local immunity of the tonsils: the lower it is, the higher the risk of angina. The risk of the disease increases with hypothermia, overfatigue, under the influence of other unfavorable factors.

The main place of reproduction of pathogens of angina is the palatine tonsils and rarely - lingual tonsils, lateral ridges of the posterior pharyngeal wall. Having overcome the local protection of the tonsils, the causative agent of the sore throat begins to multiply and secrete various substances that cause the inflammatory process. Often, the pathogen and the products of its vital activity penetrate into the nearest( regional) lymph nodes and cause their inflammation. In most cases, the distribution of microbes is limited to the tonsils and lymph nodes, but in some cases, overcoming these barriers, the pathogen causes inflammation of the tissues surrounding the tonsils( paratonzillitis, paratonsillar abscess) and even sepsis. The products of microbial activity, absorbed into the blood, cause toxic damage to the tissues of the body: blood vessels, central and peripheral nervous system, kidneys, liver, myocardium and others.

Tonsils are connected with the heart by the nervous pathways, therefore, with angina, cardiac arrhythmias can occur as a reflex pathway.

Immune processes that develop in response to the introduction of an angina pectoris under certain circumstances( human predisposition, streptococcal infection) can take the wrong, pathological form. At the same time, the resulting immune complexes, deposited on the tissues of the heart, kidneys and the immune system, mistakenly recognizing such tissues as the alien begins to destroy them - rheumatic fever develops. The reason for such processes is, in particular, untimely or ineffective treatment. The risk of autoimmune processes increases with repeated angina. Repeatedly called angina in people who suffer from it every year or at least once every two years.

By its nature, angina can be catarrhal, follicular, lacunar or necrotic. In catarrhal angina, inflammation is confined to the mucous membrane covering the tonsils. With follicular angina occurs suppuration of specific formations of the amygdala - follicles. With lacunar angina, the inflammatory process penetrates deeper into the tissue of the tonsils, the suppurated follicles break through into the lacunae of the tonsils, leaving a purulent coating on the surface of the tonsils.

Lacunar tonsillitis: pharyngeal mucosa inflamed, on tonsils purulent coating

Symptoms of angina

The incubation period with angina lasts 1-2 days. The disease begins acutely: among the full health there are chills, headache, aches in the joints, general weakness, sore throat when swallowing. Manifestations of the disease are most pronounced in lacunar angina: severe chills are noted, body temperature can reach up to 40 °, appetite and sleep are disturbed. The pain in the throat gradually increases, becomes constant, reaches a maximum on the second day. Primary angina is characterized by a symptom of bilateral pain when swallowing. In the absence of pain in general or any vague sensations from the side of the pharynx, the diagnosis of primary angina is uncertain.

Rashes with angina do not happen.

Mandatory for primary angina is an increase and soreness of the lymph nodes in the region of the corners of the lower jaw: when feeling, they easily shift.

When examining the pharynx, one can see flushed( hyperemic), enlarged tonsils, with point yellowish formations( 2-3 mm) with follicular and fibrinous-purulent deposits of irregular shape in lacunar angina.

Angina in the recovery stage, after the purulent mass has departed, extended lacunas

can be seen. In severe cases of tonsillitis, tonsil necrosis may appear in the tonsils, which are then discarded, and defects in tissue up to 1 cm are formed in their place, oftenirregular shape with an uneven bottom.

Paratonzillitis and paratonsillar abscess( phlegmonous angina) occur as a complication of angina.

Paratonzillitis and paratonzillar abscess are two phases of the same process, first there is inflammation of the tissues near the amygdala - paratonzillitis, then their purulent melting occurs - an abscess is formed. These complications occur 2-3 days after sore throat. There is pain when swallowed more on one side, the temperature rises sharply. Opening the mouth is difficult, there is increased salivation. Characteristic position of the patient's head: in order to reduce the tension of the affected tissues, he tilts it to the sore side. When the pharynx is viewed, a marked asymmetry is noted: the affected amygdala is tense and shifts towards the center, the soft sky is swollen, the tongue is shifted to the side.

I want to put together signs and symptoms that should make a person go to the doctor immediately:

Excitement, changing confusion, pale skin, followed by bluish color, impaired consciousness, rapid decrease in body temperature, decrease in the amount of urine - signs of a terrible complication of the disease - infectious-toxicshock. Convulsions, syncope - signs of damage to the nervous system, and the appearance of hemorrhages - violations of the permeability of blood vessels and blood coagulation. Long-term, more than five days, the preservation of temperature is a sign of inefficiency of antibacterial treatment. The appearance of a feeling of lack of air, dull pain behind the sternum, pain in the lumbar region or lateral areas of the abdomen, combined with painful urination, a change in the color of urine - signs of heart and kidney damage. Increased pain in the throat, difficulty opening the mouth, difficult swallowing - a sign( possibly purulent) of inflammation of the tissues near the tonsils.

Specific sore throats

Diphtheria of throat , may have a similar symptomatology with a simple( primary) sore throat. There are three forms of diphtheria of throat: localized - plaque does not go beyond the tonsils, common - the raid goes beyond the tonsils to the soft palate, the posterior wall of the pharynx and the toxic - with swelling in the throat and subcutaneous tissue in the neck. The defeat of the tonsils in the first two forms of diphtheria is characterized by the formation of dense raids that are difficult to remove from the surface of the tonsils, the underlying tissue after bleeding is bleeding, the film is not triturated and does not dissolve in water.

Diphtheria of throat: tight, poorly removed attacks on tonsils

Without the introduction of antidiphtheria serum, the disease progresses - the mild form becomes more severe or toxic.

Fungal sores are caused by yeast-like fungi, with a decrease in the overall reactivity of the body, prolonged treatment with antibiotics. Such anginas differ from primary by a slight increase in temperature, weak intoxication. On the surface of the tonsils are formed loose, "curdled" raids, which are easily removed, exposing a smooth, inflamed mucous membrane( the so-called "varnished mucosa").

Angina Simanovsky-Plaut-Vincent - are caused in the presence of symbiosis( cohabitation) of microorganisms living in the oral cavity: spirochetes and spindle-shaped rod. With poor care of the oral cavity, tobacco abuse, they can acquire pathogenic properties. Against the backdrop of mild intoxication, on one side, a ulcerative necrotic process develops. Within 2 days, a grayish white coating appears on the amygdala, and on 4-5 days, a deep ulcer with uneven edges and a dirty gray bottom forms on the site of the plaque. Plaque can spread throughout the amygdala and beyond, but never crosses to the other side. The disease lasts about 2 weeks.

Secondary sore throats

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

Angina in scarlet fever appears in the catarrhal and follicular lacunar form on the first day of the disease, differs from the primary one by a brighter color of the mucous membranes( glowing pharynx) and disappears on the 4th-5th day of the disease. To distinguish this sore throat from the primary one allows typical symptoms for scarlet fever: bright stain of mucous throat, bright red with pronounced papillae( "crimson") tongue, red cheeks in combination with pale nasolabial triangle, punctate rash with typical localization in the abdomen, inner thighs,the flexural surface of the hands and feet.

Angina with syphilis develops with the oral mechanism of the lesion. Three to four weeks after infection, one tonsil increases, and the temperature rises slightly. A few days later on the amygdala there is a hard chancre. Most often there is an erosive form of lesions: on the amygdala appears a regular shape, 0.5-1 cm in diameter, erosion with clear edges and a smooth, shiny bottom. Sore throat with secondary syphilis looks like whitish plaques on amygdala 0.5 cm in diameter, towering above the surface, surrounded by a red rim. In secondary syphilis, both tonsils are affected.

Angina in tularemia , usually on the one hand, can be bilabial, pleated or necrotic. On the surface of the tonsils are formed islets of a yellowish white coating, which then merge, forming a thick, coarse film similar to diphtheria. Lymph nodes of the neck considerably increase, they become painful, they merge into conglomerates, then they are suppressed. With tularemia, the liver and spleen increase.

Angina in leukemia occurs with a high( 39-40 ° C) temperature, headache, chills. Often there are nasal bleedings, on the skin and mucous membranes there are hemorrhages. Angina, initially catarrhal, takes on a necrotic character: dirty-gray deposits appear, after their rejection, bleeding defects with an uneven surface open. The diagnosis is refined after a blood test: the number of leukocytes can exceed the norm by more than 20 times.

Angina in agranulocytosis has a ulcerative-necrotic character, similar in appearance to angina in leukemia. In the blood, in the analysis, almost complete absence of leukocytes( granulocytes.) Is detected.

Angina in infectious mononucleosis usually appears from the first days of the disease, but it can develop on 5-6 days. In the lacunae of the tonsils appears a loose, rough coating, which is easily removed. To distinguish this sore throat allows a symptom characteristic of a mononucleosis: defeat of lymph nodes: axillary, cervical, inguinal, occipital, subclavian, bovine. The liver and spleen are enlarged.

Sore throat with enterovirus infection or herpangina begins with an increase in temperature to 40 ° C, on tonsils appears a bubble rash, after their opening appears superficial sores covered with a thin whitish coating. The disease lasts 6-7 days.

The diagnosis of sore throat consists of symptoms characteristic of angina. If necessary, bacteriological studies are conducted to determine the pathogen and its sensitivity to antibiotics. For the purpose of early diagnosis of complications, electrocardiography and biochemical blood tests are performed.

Treatment of sore throat

Given that the angina in the vast majority of cases is caused by streptococci, and rheumatism, glomerulonephritis and myocarditis occur precisely with streptococcal infections, treatment is started with penicillin antibiotics. The most effective against beta-hemolytic streptococci is benzylpenicillin. In the presence of an allergy to penicillins, antibiotics from the macrolide group( erythromycin, azithromycin) are prescribed. Usually, after a short course of penicillins, intramuscularly injected long-acting penicillin preparations - bicillin 3-5.Popular sulfonamides( co-trimoxazole) and tetracyclines( doxycycline) in angina are ineffective.

In addition to antibiotic therapy, a patient with angina needs to perform detoxification in the form of a plentiful drink, and in severe cases in the form of intravenous infusions of glucose solutions, sodium chloride. Short-term, with poorly tolerated heat, prescribe analgesics: paracetamol, aspirin.

Patients with recurrent angina are prescribed immunostimulants: leukogen, sodium nucleate. As restorative drugs prescribe vitamins: ascorbic acid, B vitamins, simple multivitamins. After treatment, antibiotics prescribe drugs that normalize the intestinal microflora( bactisubtil, linex).Rinse throat is necessary for a hygienic purpose - rinses with antiseptic effect do not have a significant effect on the pathogenic microflora, therefore for these purposes it is sufficient to use a heated solution of baking soda. To ease the pain in the throat, you can use troches and sprays containing components( menthol, mint oil, local anesthetics) that reduce the sensitivity of the mucous membrane, but you can not abuse them, because pain is a sign of the inflammatory process, and local anesthetics create only the appearance of well-being.

In cases of severe inflammation of the lymph nodes, warming procedures can be used: dry heat, physiotherapy.

Treatment of secondary angina in part of the effect on the cause( etiotropic treatment) can differ significantly from the treatment of primary angina( see in the articles on the treatment of the corresponding diseases), with regard to the effects on individual symptoms( fever, pain, inflammation, intoxication) - similar and carried out by thosethe same means as treatment of primary angina.

Folk remedies for treatment of sore throat

Folk methods of treatment are aimed at reducing inflammatory phenomena in the pharynx, strengthening the defenses of the body, prompt recovery after illness. For these purposes, decoctions of plants with anti-inflammatory action( chamomile, sage, oak bark), teas and berries with high content of vitamins( currants, cranberries, dogrose) are used. Russian sauna and sauna have a general strengthening effect, contribute to the elimination of toxins, but should be applied during the recovery period. As the only independent method of treatment, folk methods are not suitable.

Prevention of sore throat

Prophylaxis of angina is aimed at identifying people who are predisposed to the disease, having foci of chronic infection. For such people, surveillance is established, treatment of foci of infection in the oral cavity, nasopharynx is carried out. As measures to break the mechanism of transmission are used: ventilation and cleaning with disinfectants facilities. Compliance with the technology of cooking will prevent the food path of infection. Hardening, sports, nutrition and sleep, smoking cessation contribute to strengthening the body as a whole, and increases the resistance not only to the causative agents of angina. In organized groups, it is possible to carry out emergency prophylaxis with bicillin.

Consultation of a doctor on the subject of angina:

What is the difference between chronic tonsillitis and frequent angina?
After angina, even if frequent, there comes a full recovery, and chronic tonsillitis is a chronic illness in which exacerbations are possible. Repeated angina occurs after a person's contact with streptococcal infection, and exacerbations of chronic tonsillitis develop after eating cold foods, cold water, general supercooling. Chronic tonsillitis is characterized by changes in the throat: the formation of adhesions of the tonsils with palatine arch, cicatricial changes of the tonsils, purulent masses in the lacunae of the tonsils without obvious manifestations of intoxication.

Symptoms of chronic tonsillitis: cicatricial changes of tonsils, adhesions with palatal arms

To avoid sore throats, it is better to remove tonsils?
The so-called lymphoid ring of the pharynx, which includes the palatine tonsils - is a protective barrier in the path of pathogens. To remove tonsils is necessary in the event that they ceased to carry their function and themselves became a source of infection, for example, in chronic tonsillitis.

I have a sore throat. I drank a penicillin antibiotic course, which the doctor recommended me, but the angina does not go away and the temperature still holds, what antibiotic else do I have to drink?
Before the appointment of another antibiotic, it is desirable to clarify the type of pathogen by bacterial inoculation, with the sensitivity of the microbe to different types of antibiotic.

What is the maximum and minimum course of antibiotics for angina?
The antibiotic is usually prescribed for 7 days, the maximum course is two weeks, when treating strep throat with penicillin injections, the course can be completed on the third day with the introduction of bicillin.

I'm against antibiotics. I think that I can cope with my sore throat with accessible folk methods.
In practice, this often happens, especially when doctors are engaged in overdiagnosis. Nevertheless, by refusing the antibiotic for real angina caused by a specific pathogen, it is necessary to realize that you are taking responsibility and increasing the likelihood of possible complications leading to disability and even death.

Doctor therapist Sokov S.V.