Types of tonsillitis and their treatment

Angina or tonsillitis is no longer considered a childhood illness, as was customary in Soviet medicine. Modern medical statistics indicate that this pathology often develops in young people (up to 40 years old). The approximate prevalence of the disease among adults is as follows. With a diagnosis of tonsillitis (the species is not taken into account), an otolaryngologist is contacted:

  • patients aged 28-35 years - approximately every fifth,
  • patients aged 22-27 years - about one in three,
  • patients aged 17-21 years - about half.

And if you try to predict, then a downward trend in the incidence of tonsillitis among the adult population is not expected. Tonsillitis is an inflammatory process in the Pirogov lymphoepithelial ring, but above all in the palatine tonsils (glands). Tonsils are clusters of lymphoid tissue that actually form something like a looped structure in the throat and nasopharynx.

This “ring” is a barrier that prevents bacterial, viral, and fungal infections from entering the body. Therefore, the first blow with an airborne and alimentary method of infection, many pathogens inflict in the palatine tonsils.

Reporting the types of tonsillitis, you need to start with classifications. One of the largest and most comprehensive classifications is the classification of Igor Borisovich Soldatov (MD, professor, academician of the Academy of Medical Sciences of the USSR, for 37 years he headed the department and clinic of otolaryngology of Samara State University, prepared 75 medical sciences and medical sciences, wrote about 2000 scientific papers in total).

The division by species is as follows:

  • Acute tonsillitis is divided into primary and secondary. Primary tonsillitis - catarrhal, follicular, lacunar, ulcerative membranous. Secondary tonsillitis - acute infectious (diphtheria, scarlet fever, typhoid fever, infectious mononucleosis, tularemia) and internal circulatory system pathologies (leukemia and agranulocytosis).
  • Chronic tonsillitis Soldatov also divided into two large categories. Nonspecific, including a compensated and decompensated form, as well as specific, occurring with granulomas infectious etiology (syphilis, tuberculosis, scleroma).

It can be seen that inside the classification of Soldatov the classification of Preobrazhensky is completely placed, based on pharyngoscopic signs.

According to Preobrazhensky allocate sore throats:

  • catarrhal
  • lacunar
  • follicular
  • phlegmonous (paratonsillitis, intratonsillar abscess),
  • herpetic (herpes),
  • peptic ulcerous (necrotic, tonsillitis of Simanovsky - Plaut - Vincent),
  • mixed.

It should be noted that one of the main (and most severe) forms of the described pathology - the intratonsillar abscess in Soldatov, is included in the category of chronic decompensated tonsillitis. The structuring proposed by Soldatov and Preobrazhensky does not take into account the excretion of angina by the type of pathogen, i.e. bacterial, viral and fungal forms. Also, these Soviet classifications do not include rare forms of tonsillitis caused by allergic and autoimmune reactions.

Causes

Despite the apparent diversity, in the causes almost all forms of tonsillitis converge. Of course, sore throats may differ pathogens. But for the full development of the disease, infection must coincide with one general, background, but necessary condition.

Absolutely any form of angina begins due to a violation of the normal functioning of the immune system. A number of factors lead to weakening of cellular (T-lymphocytes, macrophages) and humoral (B-lymphocytes, plasmocytes and immunoglobulins) immunity.

The main weakening factors are as follows:

  • acute (flu, pneumonia) and especially chronic infectious pathologies (HIV, hepatitis and tuberculosis),
  • long-term immunosuppressive therapy (large doses of hormonal drugs, special immunosuppressants),
  • extensive trauma to any etiology (mechanical, thermal, chemical),
  • radiation and chemical therapy in oncology,
  • prolonged living in an environment of environmental crisis (adults are less sensitive to this factor than children),
  • severe chronic disturbances of nasal breathing (for example, with polyps or severe curvature of the nasal septum),
  • long unhealthy lifestyles, including poor nutrition, lack of sleep, constant stress and smoking.

When the immune system weakens noticeably, even opportunistic bacteria can become dangerous to the body.

The most severe course and risk of complications is caused by bacterial tonsillitis. The bacteria that cause the described disease are usually pyogenic, i.e. their activity leads to the formation of purulent exudate. However, the bacterial etiology of angina is less common than viral. About 30% of all cases of tonsillitis and not more than 15% in adults are caused by bacteria. About 80% of all bacterial tonsillitis is due to beta-hemolytic group A streptococcus (BHCA).

The remaining niche is occupied by staphylococci, including St. Aureus (Staphylococcus aureus), Haemophilus influenzae, Pseudomonas aeruginosa, Spirochetes, Chlamydia, Meningococcus, Pneumococcus. Peptic ulcerous sore throat occurs as a result of a symbiosis of two conditionally pathogenic bacteria - the spindle-shaped bacillus of Plaut-Vincent (B. fusiformis) and Vincent’s spirochete (Spirochaeta buccalis). In extremely rare cases, angina provokes anthrax bacillus or typhoid salmonella.

In adults, more than half (approximately 75%) of all tonsillitis occurs due to a viral infection. A complete list of viruses that can cause a sore throat does not exist. Theoretically, almost any virus can cause inflammation of the lymphoid tissue in the Pirogov ring. But the main causative agents are all herpes viruses, Coxsackie viruses, echoviruses, rhinoviruses, other enteroviruses and adenoviruses.

Fungal etiology of tonsillitis is the most rare. Both in children and in adults. One of the typical fungal pathogens is yeast fungi of the genus Candida.

Symptoms

Since the classification of Soldatov is as comprehensive as possible, it is convenient to consider the symptomatic picture of each species according to it.

To begin with, it is necessary to identify non-specific, universal manifestations that are observed with any sore throat:

  • hyperthermia, fever - depending on the type of tonsillitis, peak values ​​and the nature of diurnal fluctuations vary, but at least subfebrile condition will be almost guaranteed,
  • pharyngeal hyperemia, pain when swallowing, enlarged palatine tonsils are almost always recorded - also a symptom without which no sore throat can do,
  • general malaise, feeling of weakness, quite often mild headaches,
  • if the inflammatory process did not capture the larynx (laryngitis was not added), then an extremely important tonsillar symptom marker is noted - the absence of cough and no hoarseness of voice (this immediately casts doubt on the common cold and SARS, because in this case the throat bothers, and arises dry cough).

Types and classification

On the Internet you can find many types of various tonsillitis, they are easy to get confused. Some forms are not official, but exist for the purpose of convenient philistine communication, or to indicate the dominant symptom, for example, allergic tonsillitis.

We list the main types, based on several classifications of such famous professors as B.S. Preobrazhensky, J. Portman, A.Kh. Minkovsky and several textbooks on otorhinolaryngology (V.I. Babiyak, V.T. Palchun).

Classification by the course (nature) of the disease:

Characteristic symptoms and signs

A rapid onset and a smooth recovery lasting no more than 20 days is characteristic.

4 or more times a year, the occurrence of exacerbations of the infectious process in the tonsils. Throughout the year, slight redness in the tonsils is noted. There are many different types of chronic tonsillitis.

Classification by form of disease (also referred to as banal or vulgar tonsillitis, and most often caused by hemolytic streptococcus):

Characteristic symptoms and signs

General intoxication (headache, high body temperature, weakness), pain when swallowing, redness of the tonsils. Tonsil may not be present.

Bilateral lesion of the tonsils. Duration of the disease from 5 to 7 days.

High temperature up to 39 ° C, sore throat, yellowish coating and purulent plugs on reddened tonsils. Bilateral lesion of the tonsils. Duration more than 7 days.

Very high temperature up to 40 ° C, intolerable sore throat, extensive purulent areas on the reddened tonsils. Characteristic bilateral lesions of the tonsils. Duration about 8 days.

It occurs against the background of catarrhal, follicular or lacunar angina or as a consequence of them. Symptoms are similar, but a film forms on the tonsils. Duration from 7 to 14 days.

Phlegmonous (as a complication of various types of tonsillitis)

Unbearable pain when swallowing. Heat. A strong increase in one tonsil. The surface of the tonsil is taut.

Classification due to illness:

Characteristic symptoms and signs

Bacterial (sore throats, as a manifestation of infectious diseases caused by bacteria).

Diphtheria (caused by Löffler's bacillus)

Bilateral lesion of the tonsils. Pain when swallowing, fever. Typical diphtheria plaque in the form of a film of a grayish-white color. The film is removed with difficulty, dense, sinking in water.

Scarlet fever (caused by group A toxigenic streptococcus secreting erythrotoxin)

Against the background of symptoms of scarlet fever: high body temperature, headache, raspberry tongue, red small-pointed rash on the face, tongue, and body (to a lesser extent). The signs characteristic of vulgar tonsillitis (catarrhal, follicular, lacunar) are manifested: pain when swallowing, purulent plugs or plaque on reddened tonsils, pain when swallowing.

Streptococcal (most often manifested as catarrhal, follicular, lacunar or fibrinous tonsillitis)

High body temperature. Pain when swallowing. Redness and plaque on reddened tonsils. Purulent plugs with follicular form. Extensive accumulations of pus in the lacunar form. Films with fibrinous form. (see above for details)

Staphylococcal (caused by Staphylococcus aureus)

Manifestations are similar to streptococcal angina. Plaque on tonsils in the form of films, purulent plugs or islets. The pain of swallowing is very severe. The course is more severe and prolonged than that of vulgar tonsillitis.

Simanovsky-Vincent (also referred to as ulcerous-filmy or ulcerative-necrotic, caused by a spindle-shaped wand and spirochete)

It occurs against the background of exhaustion of the body.

Unilateral lesion of the tonsils.

May leak without temperature.

Grayish-yellow film with ulcers on the tonsils.

Putrid breath.

Duration from 7 to 20 days.

Syphilitic (caused by pale treponema)

Rapid rise in body temperature to 38 ° C, pain when swallowing. Unilateral lesion of the tonsils in the form of redness and enlargement. Enlarged cervical lymph nodes.

Viral (tonsillitis, as a manifestation of infectious diseases caused by viruses).

Measles (caused by the paramyxovirus family)

Pain when swallowing, fever, with inflammation of the airways and skin rashes. Swelling of the tonsils. Redness may be in the form of spots or bubbles.

Increased body temperature, pain when swallowing, purulent plaque on the tonsils, possibly a unilateral lesion. The course is lingering.

Herpetic (caused by herpes buccopharyngealis virus, herpes fever virus)

A characteristic feature is vesicle rashes on the mucous membrane of the oral cavity and pharynx, which can also appear on the lips and skin. Body temperature is very high up to 41 ° C. The defeat is bilateral.

Throat infection with herpes zoster virus

A rash of vesicles is characteristic only on one side and tonsil. Pain can pass into the nasopharynx of the eyes and ear. Duration 5-15 days.

Herpangin (the reason is Coxsackie enterovirus)

Sudden start. Body temperature up to 40 ° С. Small vesicles on the tonsils, which burst after 2-3 days and leave erosion. Pain when swallowing. Bubbles can appear on the feet and hands.

Fungal (throat mycosis).

Candidiasis (caused by fungi of the genus Candida)

A sharp start. Moderate temperature. Pain when swallowing, sensation of a foreign body in the throat.

On tonsils curd masses in the form of separate islets.

(caused by Leptotrix fungus, rare form)

On the entire surface of the pharynx and on the base of the tongue are multiple small white dots.

There is practically no pain, body temperature is not high.

Actinomycosis (caused by actinomycetes, a very rare form)

It is a consequence of actinomycosis of the tongue or facial region. It’s hard to open your mouth completely. Difficulty swallowing (a lump of food does not leave immediately). Local swelling of the mucous membrane, which then erupts with the expiration of pus.

Angina, as a manifestation of blood diseases.

Agranulocytic (referred in appearance to ulcerative necrotic)

General malaise, high body temperature, severe sore throat. Ulcerative changes in tonsils. Putrid breath. Characteristic changes in the blood.

Monocytic (the cause of the disease is not clear)

Sore throat, fever. Enlarged liver, spleen and cervical lymph nodes. A long course (raids remain for several weeks and even months). Characteristic changes in the blood.

Angina with leukemia

It occurs against the background of leukemia (blood cancer). Enlarged cervical lymph nodes. Violation of swallowing. Tonsil ulceration. Offensive breath.

Angina, as a manifestation of systemic diseases.

Swelling of the oral mucosa, tonsils. Redness of the pharynx. Not accompanied by plaque and fever. A characteristic connection with the use of a substance inside or the presence of flowering allergenic plants.

Mixed forms.

Stomatitis (can be caused by bacteria, viruses and even fungi)

There may be various manifestations depending on the causes and pathogens. As a rule, signs of stomatitis are characteristic: swelling of the oral mucosa, ulcerative lesions in the oral cavity.

Etiology

Acute tonsillitis or tonsillitis causes more than one pathogen. Most often it is streptococcus and staphylococcus. But, there are cases when, as a result of analyzes, the causes of angina are pneumococci, spirochetes, fungi, adenoviruses, and others. There are also bacteria that cause sore throats.

Acute primary tonsillitis

Acute primary tonsillitis - they account for the bulk of all tonsillitis (both bacterial and viral):

  • Catarrhal form - the inflammatory process affects only the upper epithelial layers of the mucosa, the parenchyma of the palatine tonsils is not involved in the pathological dynamics. In adults, this form often passes “on the feet”, without the formation of purulent exudate, with a slight subfebrile condition (up to 37.5 degrees) and slight malaise while maintaining working capacity. Catarrhal sore throat in adults in most cases is limited to four main symptoms. However, letting the disease drift is not recommended, because against the background of a sluggish catarrhal form, the following two may occur.
  • Follicular and lacunar forms. Often they are combined into one.The main difference between them is that in the follicular form, the infectious foci are deployed in the follicles - numerous point accumulations of lymphoid tissue in the structure of the tonsil. But the lacunar form implies that the main focus is in the gaps of the palatine tonsils - deep channels that, like potholes, pass through them. Hence the differences in the picture of purulent exudate: with follicular tonsillitis, purulent formations on the palatine tonsils look like numerous dots, and with lacunar tonsils they branch, repeating the lines of the gaps. Also, with the lacunar form, pus is formed not on the inside of the epithelium, but on it, so plaques can be easily removed with a spatula or washed with rinses. The temperature rises sharply, can reach pyrethic values ​​- above 39 degrees. But in adults this is rare. The usual temperature with such tonsillitis in an adult is in the region of 38 degrees. Pus in the glands is detected by the end of the second day. Glands themselves and palatine arches noticeably swell. Metatonsillar manifestations (joint pain, in the heart, digestive disorders, etc.) are rare. An unhealthy, febrile blush may occur on the face. The cervical lymph nodes become denser and can be painful on palpation.
  • Peptic ulcerous form (Simanovsky - Plaut - Vincent). By its manifestations, it includes four general symptoms, the form is immediately recognizable by the dirty white or yellowish films on the surface of the palatine tonsils. These films are easily and painlessly removed with a spatula, leaving behind a grayish surface erosion. These lesions heal quickly enough without leaving scars.
  • Herpetic tonsillitis. Despite the name, tonsillitis as such is not. And, as already mentioned above, it is caused not by herpes viruses, but by RNA-containing Coxsackie viruses and ECHO viruses. Symptoms include subfebrile condition, general weakness, hyperemia of the throat and pain when swallowing, but there are additional manifestations indicating herpangin. Here palatine tonsils are almost never affected by the pathogen and are not inflamed (hence the conventionality in assigning pathology to the category of "tonsillitis"). On about the second day, mainly on the hard and soft palate, numerous small, thickened and painful papules appear, similar to hemorrhages. After a couple of days, the papules turn into also painful vesicles with transparent contents. Another two days - and the vesicles burst, leaving slowly healing erosion. Occasionally, vesicles also occur on the body (arms, legs).

General information

What is tonsillitis of the throat? Tonsil diseases are known to everyone and almost every person at one age or another has suffered acute inflammation of the tonsils (acute tonsillitis - OT), which today is one of the most common diseases of the upper respiratory tract in all age groups, second only to SARS. Moreover, many patients who have undergone acute tonsillitis, there is a chronicization of the pathological process with the development of chronic tonsillitis. Below is what tonsillitis looks like (a photo of the throat in an adult).

Many do not understand what the difference is and in everyday life are confused in terminology angina and tonsillitis. There is no difference between the terms “acute tonsillitis” and “tonsillitis” and in most cases acute tonsillitis means tonsillitis. That is, there is no contradiction in the terminology of acute tonsillitis and tonsillitis, in fact, these are synonyms and in practice OT is often denoted by the term "tonsillitis", however, the code for MKB-10 "tonsillitis" is absent as such. Also, the term "purulent tonsillitis" is often used in everyday life, although the medical term "purulent tonsillitis (tonsillitis)" does not exist. Nevertheless, in everyday life of colloquial speech, this term is often used to describe a condition in which pus is visually visible on the tonsils.While in medical terminology, the presence of purulent plaque on the tonsils is referred to as the follicular / lacunar form of tonsillitis.

Causes of angina in adults

Whatever angina develops in adults, the reasons always lie in infections. Pathogens are often the substrate streptococci - this is bacteria, in appearance resembling a chain. Among them, the most insidious enemy for tonsils - beta - hemolytic group A (received the name because of the love of growth on media containing blood). It accounts for about 1/2 of all acute tonsillitis among the child population and young people. Other bacteria also affect the tonsils; microbiological examination reveals other types of streptococci, staphylococci, pneumococci, a hemophilic bacillus, intracellular cunning mycoplasmas, chlamydia. Diphtheria bacillus can be a terrible causative agent of angina.

Viruses also involved in the development of the disease: adenoviruses, Coxsackie virus, herpes virus family, cytomegalovirus, rhinovirus, influenza virus, parainfluenza, etc.

IN cold time years, angina in adult patients is provoked precisely viral infection.

It happens that tonsil tissue is affected mushrooms, for example, the genus Candida.

Infectious agents enter the nasopharynx in two ways:

  1. Of the environment when communicating with sick people or by eating, swallowing infected products (for example, milk infected with staphylococcus).
  2. Of internal environment organism: if there is acute sinusitis, untreated caries, any purulent inflammation (bacteria spread with blood). Severe blood diseases cause, including the development of acute tonsillitis.

Predisposes to the occurrence of tonsillitis by inhalation of polluted air, drinking ice and cold water, general hypothermia - any conditions that worsen local blood supply. Tonsillopharyngitis occurs more often in winter and in spring, during the circulation of various respiratory viruses, including influenza.

Catarrhal sore throat: symptoms and treatment

The medical meaning of the word "catarrhal" comes from the Greek "cataralis", which means swelling, expiration. This term describes well this angina, which is manifested by edema, redness and the formation of a serous (transparent or slightly unclear) substance on the mucous membrane of the tonsils.

Catarrhal tonsillitis is often not an independent form, but the initial stage of follicular or lacunar tonsillitis, and is less often manifested as a separate pathology, as a rule, it proceeds easily and quickly (on average 6-7 days).

Pathogenesis

The causative agent of angina excretes the products of its vital activity, which are alien to the human body. As a result, the immune system gives the answer in the form of local inflammation. This occurs due to increased blood flow to the lesion site. Immunoglobulins, leukocytes, and chemically active substances in the blood that are aimed at fighting bacteria are heard with blood.

Acute secondary tonsillitis

Secondary acute infectious tonsillitis. In fact, they are not tonsillitis in full (the exception is scarlet fever). Rather, it is a complex symptomatic complex of a disease of another class. A striking example is diphtheria. Diphtheria is an infectious pathology caused by a Löffler wand.

Features of diphtheria, simultaneously emitting the disease against the background of real tonsillitis, are as follows:

  1. Pirogov’s lymphoepithelial ring also serves as a gateway for infection, but the main threat goes to the whole body due to toxins produced by the stick (the main targets are the heart, connective and cartilage tissue in the joints and kidneys, less commonly the central nervous system), so pain can begin early with diphtheria in the extremities, in the region of the heart, problems with urination, diphtheria toxin has a very dangerous property of blocking the synthesis of many proteins in the body, which ultimately leads to mass cell death.
  2. The temperature rises smoothly with diphtheria, and in adults almost never exceeds 38 degrees.
  3. A special difference is that the glands are covered with a web-like coating, which then turns into a dirty gray film, the film goes far beyond the tonsils, covering the palate, and is poorly removed with a spatula, leaving bleeding erosion.
  4. Sore throat is expressed to a much lesser extent than with real tonsillitis.
  5. Symptoms of toxic poisoning appear (dizziness, nausea, confusion).
  6. Cervical lymph nodes are inflamed to a lesser extent and moderately painful, but on the other hand, severe edema of the subcutaneous fatty tissue in the neck is often observed, and the bovine neck syndrome occurs.
  7. With angina, a runny nose is rare, but it happens, with diphtheria, a runny nose never happens (the stick does not multiply in the mucous membrane of the nasal passages).
  8. The incubation period for diphtheria is slightly longer than for angina, and can reach up to 6 days.

DTP vaccination is considered a preventive measure of protection, but its use is very controversial, as For a child’s body, this vaccine itself can cause significant harm. Adults tolerate the injection much better (revaccination every 10 years after 14 years).

Scarlet fever is, in fact, any of the main three angina. But the fact is that scarlet fever occurs when the human body (in 80% of cases it is the body of a child and only in 20% of an adult) encounters the main tonsillar pathogen, hemolytic streptococcus, for the first time.

Then, in addition to the classic symptoms of angina, additional ones arise:

  • raspberry granular tongue (about 3 days of illness),
  • scarlet rash on the chest, lower back, ankles, in the knee-elbow bends,
  • peeling of the epidermis at the site of the rash.

Acute tonsillitis

This is an acute inflammation of one / several components of the pharyngeal lymphadenoid ring (inflammation of the tonsils, usually the palatine) of a viral or bacterial etiology with a primary lesion of the parenchyma, follicular and lacunar apparatus of the tonsils. The code for acute tonsillitis according to MKB-10 is J03.

It should be noted that according to the modern concept (Wikipedia), tonsillitis should be understood as the development of the inflammatory process of tonsils in excess of their physiological norm, proceeding with clinical symptoms. This is due to the fact that the palatine tonsils, in connection with their main function - the formation of immunity - are in a physiologically permanent inflammatory process, which is confirmed by histopathological studies of the tonsils of a healthy patient. With normal immunity on the mucous membrane of the palatine tonsils and in their depths, in crypts and gaps, resident conditionally pathogenic microflora is constantly present in natural concentrations, which does not cause an inflammatory process.

However, in cases of their intensive reproduction or from outside, palatine tonsils activate their function, thereby normalizing the human condition and do not manifest any clinical signs. This is the so-called "minimized" physiological inflammation (defensive reaction), which differs from the "classic" in the absence of changes in the structure of cells and tissues. However, if the balance between the body’s defenses and activated pathogenic microflora with increased antigenic activity is disturbed, the “minimized” inflammatory process in the tonsils is out of control and a classic acute inflammation of the tonsils (tonsillitis) develops with the formation of a specific clinical picture of the disease.

However, often the inflammatory process extends to the throat tissue, in such cases we are talking about acute tonsillopharyngitis, which is typical for the manifestation of acute respiratory infection. If we talk about the differences between pharyngitis and tonsillitis, then in general we can say that these are various diseases according to the etiology, pathomorphological signs and clinical manifestations. What other combinations are there? Much less often, throat and larynx infections simultaneously develop (pharyngitis-laryngitis).However, in clinical practice, the difference pharyngitis, laryngitis, tonsillitis essential and fundamental, since the localization of the inflammatory process varies: with tonsillitis - in the tonsils, pharyngitis - in the pharyngeal mucosa, with laryngitis - in the larynx, especially their manifestations are not included in the topic of the article.

In general, the high incidence of acute tonsillitis, the contagious nature of the infection and the high risk of chronicity of the pathological process with the development of serious complications require high alertness and care in treatment. Unfortunately, a significant number of people have no wariness in relation to acute tonsillitis, many do not know what is dangerous and carry it “on their feet”, and treatment in many cases does not extend beyond gargling with various solutions, which can lead to very sad consequences of tonsillitis for the patient, since in acute HHSA-tonsillitis, local therapy cannot replace antibiotic therapy and does not affect the risk of developing late autoimmune complications.

Provocative factors

There are a number of factors that can lead to the appearance of acute tonsillitis. It is impossible to get rid of a sore throat forever, which means that, provided the immunity is reduced and one of the following factors is affected, you can get sick again.

  1. Hypothermia.
  2. Overwork.
  3. Lowering the body's immune defenses.
  4. Recently transferred viral infections (INFLU, ARVI, etc.).
  5. The presence of diseases such as sinusitis, sinusitis, adenoids, caries, otitis media.
  6. Poor nutrition.
  7. Dampness.
  8. A sharp change in temperature in the environment.
  9. Contaminated air.
  10. Unfavorable living conditions.

Chronic tonsillitis compensated.

This is nothing more than a chronic follicular / lacunar form. The catarrhal form is not mentioned, because with relapse it quickly goes into one of the following two. According to Soldatov, “compensated” means that the immune system still relatively successfully restrains the spread of the pathogen. She can no longer completely neutralize the pathogenic agent, but keeps it in a state of a smoldering focus of infection.

Chronic compensated sore throats are determined by a number of conditions:

  • the patient suffered from exacerbation at least 3 times in the last year,
  • upon examination, tonsils are enlarged, friability is increased, exudate appears when pressed with a spatula, lacunae are enlarged, but with all this, the tonsils have practically no redness,
  • a smear shows several dozen types of pathogens, and a large number of streptococci and staphylococci are found in the crypts of lacunae,
  • a general blood test shows small changes in the leukocyte formula: a slight decrease in neutrophils, weak lymphocytosis, etc.,
  • the patient complains of constant malaise, fatigue, evening subfebrile condition.

Usually, the items listed are enough for the otolaryngologist to make a conclusion about the chronic course of tonsillitis. But there is a separate classification regarding chronic tonsillitis.

Chronic tonsillitis is divided into 3 groups:

  • Group 1 - often, generally passes asymptomatically, but there is still a focus of infection, so the patient is a carrier (the level of infectivity varies individually),
  • Group 2 - a toxic-allergic form of type 1, manifests itself with weak, lubricated symptoms (fatigue, frequent mild sore throat when swallowing, spontaneous temperature increase to 37 degrees),
  • Group 3 - toxic-allergic form of type 2, the symptoms are expressed, in fact, this prolonged exacerbation, which has periods of "plateau" and peak periods, occurs with extremely weakened immunity and threatens numerous complications (myocarditis, meningitis, autoimmune pathologies).

The last 3 group indicates that in the body the compensatory role of immunity has weakened significantly.

Treatment

It is desirable that the treatment of catarrhal angina occurs under the supervision of a physician. Usually assigned:

  • Antibacterial drugs, including sulfonamides. They are the main treatment for tonsillitis.
  • Gargling can be done with antiseptics (furatsilin), and preferably with physiological saline (salt solution in water: 1 teaspoon of salt per liter of warm water).
  • Antipyretic drugs at a body temperature above 38 ° C.
  • To relieve symptoms, sprays are used to reduce pain and sucking pills.
  • Together with the beginning of the use of antibiotics, it is necessary to carry out physiotherapy with Vitafon, since it enhances the effect of drugs, improves lymph flow, removes toxins from the affected areas, cleanses tissues and stimulates the immune system to fight infection.

During treatment, it is necessary to control the cardiovascular system, several times to pass urine and blood for analysis, in order to timely identify possible complications.

Diagnosis of angina in adults

The therapist or ENT establishes the fact of a disease such as angina in adults, the diagnosis is in stages.

  1. Local inspection. It is carried out using a spatula and a special mirror for visual assessment of the condition of the glands and surrounding tissues.
    Uncomplicated tonsillitis is usually catarrhal or follicular. Catarrhal tonsillitis is a commonplace inflammation, glands enlarge, swell, bright red, covered with a small amount of whitish plaque.
    The follicular form got its name due to the formation of many follicles - vesicles filled with pus-like contents. The surface of the tonsils resembles a starry sky: white or yellowish clusters clearly stand out on the reddened mucosa.
  2. Quick tests. If angina has arisen against the background of a commonplace ARI, then there will be data on the presence of such patients in the patient’s environment, there will be discharge from the nose, coughing.
    If the doctor suspects that the hemolytic streptococcus plays a major role, a quick diagnosis is performed using Streptatest. This kit, sold in many pharmacies, allows you to establish the involvement of streptococcus in the beginning of a sore throat in 5 minutes. The specificity of the test is not 100%, a negative result does not exclude the possibility of infection with hemolytic streptococcus.
  3. Laboratory sowing. In doubtful cases, the contents of the follicles and part of the plaque are taken, inoculation is performed in the laboratory, which allows reliable identification of the causative agent of acute tonsillopharyngitis.
  4. Blood analysis. An indirect sign of a bacterial infection is a change in the general analysis of the blood. White cells grow - white blood cells, with a numerical predominance of the fraction of stab cells, an indicator such as ESR rises. A routine blood test will help distinguish between types of tonsillitis. For example, a different picture is characteristic for infectious mononucleosis than for other bacterial tonsillitis.

Chronic tonsillitis

Chronic tonsillitis (photo of the throat below) is a common infectious and allergic disease with a predominant lesion of the lymphoid tissue of the pharyngeal tonsils (palatine, less often - pharyngeal or lingual tonsils) and their persistent inflammation. Chronic tonsillitis code according to ICB-10: J35.0. It proceeds with periodic exacerbations (tonsillitis). Exacerbation of chronic tonsillitis develops most often against the background of hypothermia, stress. Initially, a chronic disease (arising without previous sore throats) CT is extremely rare (in 3-3.5%). As a rule, the focus of infection focuses in the tonsils, isolated inflammation of the lingual tonsils is extremely rare.

Chronization of the pathological process contributes to the treatment of acute inflammation of the tonsils (early withdrawal / improper selection of antibacterial drugs), diseases of the paranasal sinuses, persistent severe disturbance of nasal breathing, chronic catarrhal rhinitis, carious teeth, etc.A distinctive feature of the chronic tonsillar focus is a pronounced infectious activity, which is due to the presence of lymphogenous connections of the tonsils with distant organs, which contributes to the direct spread of infectious, toxic, metabolic and immunoactive products.

It is this feature that contributes to the formation of moderately expressed / expressed toxic-allergic reactions from various systems and the manifestation of diseases / decompensations associated with chronic tonsillitis (frequent sore throats, tonsillogenic intoxication of the body, the development of paratonsillar abscesses, pericarditis, endocarditis, polyarthritis, myocarditis, glomerulonephritis, hepatitis and etc.). It should be noted that tonsillar pathology is associated in most cases with Streptococcus pyogenes (GBSA).

The prevalence of CT among the population varies widely: from 5 to 37% in adults and from 15 to 63% in children. Often, a disease is diagnosed only in connection with an examination for another disease in the development of which chronic tonsillitis plays a significant role. In many cases, CT, remaining unrecognized for a long time, acquires negative factors of a tonsillar focal infection, which significantly weakens the patient’s health, reduces working capacity and worsens his quality of life, and a number of patients form negative psychosomatics.

How is the disease transmitted?

Acute tonsillitis is mainly transmitted by airborne droplets. That is, you can get infected through a kiss, common dishes, when using one towel, bed linen, if the patient sneezes and coughs nearby.

It is for this that patients should isolate themselves from the rest. Of course, ideally, it is advisable to send the patient to a hospital where he will not be in contact with healthy people. But, there are times when this does not work out, then you can just prepare him a separate room.

How long is treated at home? In about the same way as in a hospital, the main thing is to fulfill all the requirements. Sore throats in adults require easier treatment than in children. The room should be regularly ventilated; it is not recommended to go in there except for a doctor. Separately, the patient should have his own set of bedding, a towel, and utensils.

Follicular tonsillitis

Follicular tonsillitis (ICD code 10 - J03) is the most common form of angina, in which purulent inflammation spreads to the structural components of the tonsils - follicles. This pathology is more severe than catarrhal tonsillitis.

Chronic tonsillitis decompensated.

Among the decompensated chronic tonsillitis, the most striking example is phlegmonous tonsillitis. Paratonsillitis is instantly recognizable due to one characteristic manifestation - approximately 2 days after the onset of the disease in the patient’s throat, always only on one side, a protrusion, swelling is visualized. And in the next few days it is unlikely to resolve, but will grow further, sometimes until the throat is completely closed. This is a phlegmon, purulent abscess.

This happens when the pathogen penetrates deep into the tonsil parenchyma, causing severe inflammation in the underlying structures. The rapid growth of the purulent bladder inside the gland begins. An abscess is subject to mandatory opening and flushing. Paratonsillitis almost never occurs immediately. It is preceded by protracted chronic forms of lacunar or follicular tonsillitis.

Specific tonsillitis

These sore throats that occur with syphilis and tuberculosis are treated symptomatically in parallel with the therapy of the underlying disease.

Hyperemia without purulent exudate with catarrhal sore throat.

Purulent "points" on the tonsil with follicular tonsillitis.

Branching purulent pattern on tonsils with lacunar tonsillitis.

A characteristic swelling (abscess on the left) with phlegmonous tonsillitis.

A grayish film on the tonsil with angina of Simanovsky - Plaut - Vincent.

Vesicles on the palate with herpetic sore throat.

Diphtheria film on the palate.

Complications of tonsillitis in adults

Dangerous local and are common in angina disease in adults complications.

TO local include: the development of an abscess on the tonsils, in the pharyngeal space, the transition of infection to nearby organs with the development of a purulent process in the sinuses (sinusitis, frontal sinusitis).

Spread of infection by lymphatic and circulatory vessels causes purulent foci in the joints, heart, kidneys. Acute rheumatic fever fever (previously it was called rheumatism) is more characteristic of children, but can also develop in adulthood.

Classification

Distinguish between acute and chronic tonsillitis. In turn, acute tonsillitis is divided into:

  • Primary (catarrhal tonsillitis, follicular tonsillitis, lacunar tonsillitis and ulcerative membranous tonsillitis).
  • Secondary - develop: with various acute infectious diseases (tonsillitis with yersiniosis, diphtheria, tularemiainfectious mononucleosis, typhoid fever, scarlet fever etc.), against the background of diseases of the blood system (leukemia, agranulocytosis, Alimentary Toxic Aleikia and etc.).

Chronic tonsillitis. What are the forms? There are 2 main author's classifications of HT.

Classification I.B. Soldatova - the author highlights:

  • Chronic compensated tonsillitis. What is this form? It is characterized by the presence of only local signs of chronic inflammation of the tonsil tissue and the absence of influence on the general condition of the body.
  • Chronic decompensated tonsillitis. As a rule, the decompensated form is accompanied by the phenomena of decompensation and involves the manifestations of diseases / types of decompensation associated with chronic tonsillitis: frequent relapses of tonsillitis, paratonsillitis / paratonsillar abscesses, the presence of tonsillogenic intoxication (general malaise, subfebrile temperature and decreased ability to work), the appearance of tonsilogenic organs and functional disorders and diseases due to chemotherapy (endocarditis, polyarthritis, pericarditis, myocarditis, glomerulonephritis, hepatitis and etc.).

Classifications B.S. Preobrazhensky / V.T. Palm tree. The authors distinguishes simple and toxic-allergic (TAF) forms. In turn, TAFs are divided according to the degree of intoxication into TAF I and TAF II.

  • Simple form - it is characterized by the presence of only local signs. The presence of concomitant diseases may be less common, but they do not have a common infectious basis with chemotherapy.
  • TAF I - it is characterized by local signs of inflammation of the tonsils and the presence of moderate toxic-allergic reactions (periodic low-grade fever, joint pain, episodes of fatigue, general weakness, malaise, fatigue, decreased performance, poor health, intermittent functional disorders with side of the cardiovascular system, periodic increase / pain on palpation of the lymph nodes, decreased ability to work, laboratory deviations HALE). Concomitant diseases may be present that do not have a common infectious basis, but the toxic-allergic pathogenesis of the disease aggravates the course of the concomitant disease.
  • TAF II - characterized by the presence of local signs of inflammation of the tonsil tissue and severe toxic-allergic reactions (prolonged low-grade fever, asthenic syndrome, fatigue, intermittent pain in the joints / heart region, short-term heart rhythm disturbance - extrasystole, sinus tachycardia/arrhythmia, functional disorders of the infectious genesis of the kidneys, vascular system, liver, joints.

Common symptoms

  • Fever.
  • General malaise.
  • Headache.
  • Chills.
  • Fast fatiguability.

Angina has symptoms of general intoxication.They say that the human body is struggling with the pathogen. Many believe that increasing body temperature in a disease is bad. In fact, on the contrary, if it is not, it means that there is no immunity either, and the disease can progress. If, in this case, no measures are taken in the near future, everything could be fatal. In children, tonsillitis greatly affects well-being than in adults.

Sore throat prophylaxis in adults

For the disease of angina in adults, prevention is not determined by the general formula. Timely administration will help reduce risk. vaccines from influenza, pneumococcus, this is especially relevant for frequently ill patients who suffer several exacerbations of chronic tonsillitis annually, patients from 60 years old, patients of any age with a history of diseases heart and kidney.

Advice on keeping as much as possible is not superfluous. healthy lifestyleincluding sports and household activity, use quality food products. With annual outbreaks of seasonal colds - to the maximum to take care, less likely to attend mass meetings.

Specific symptoms

  1. Sore throat, persistent or swallowing. Since the tonsils are enlarged, it will hurt a person to take a sip. At first they have a weak character, but gradually increase. It becomes painful to become desktop that you have to change the diet, because it is no longer possible to eat solid food, and swallow large pieces.
  2. Tonsils red and enlarged. Pathogens act on the tonsils, secrete toxins on the mucosa, as a result of which they give a response and become inflamed.
  3. Lymph nodes are enlarged and sharply painful. The soreness of the lymph nodes is the stronger, the stronger the infection. The pain suggests that there are toxins in the lymphatic system. In general, lymph nodes play a significant role in the body's defense system. They can destroy sources of infection, increasing in the process.

Causes of tonsillitis

Acute tonsillitis in the vast majority of cases is caused by viruses, among which are often found adenovirusvirus parainfluenza, influenza A virus and B, Epstein-Barr virus, Coxsackie, enteroviruses and retroviruses. 25-30% of cases of OT have a bacterial etiology. The leading bacterial agent (in 90-95% of cases) is a streptococcal throat infection - B-hemolytic group A streptococcus (abbreviation - BSA), less often streptococci of other groups (C and G), much less often - gonococci, mycoplasmas, chlamydia, diphtheria bacillus . It is even less common fungal tonsillitis. It is believed that in children under 3 years of age, viral tonsillitis predominates (70-90%), and after 5 years streptococcal tonsillitis is more frequent (up to 30-50% of cases).

The etiology of chronic tonsillitis in most cases is directly related to the transferred tonsillitis. Recently, despite the generally recognized role of group A β-hemolytic streptococcus in the etiology of chronic tonsillitis and tonsilogenic diseases of other organs, a staphylococcal infection in the throat (Staphylococcus aureus), which is often sown in chronic tonsillitis in children, has been gaining an increasing role.

The leading causes of chronic tonsillitis are the histological / anatomical and topographic features of the tonsils (the presence of favorable conditions for the colonization and vegetation of microflora in the gaps), the violation of the protective and adaptive mechanisms of tonsillar tissue, including a decrease in the barrier function of the mucous membrane.

Lacunar angina

Lacunar angina (ICD code 10 - J03) is the most severe form, characterized by the widespread spread of purulent inflammation and accumulation of pus in the gaps (grooves between the structural elements of the tonsils).

Types of sore throat

There are several classifications of acute tonsillitis.

By severity:

By nature (form):

  1. Catarrhal.
  2. Follicular.
  3. Lacunar.
  4. Phlegmonous.

These are the most common forms, in fact there are many. In angina, the causes are the same, any species caused by the same pathogens will have the same symptoms and treatment. An exception is Pseudomonas aeruginosa, where a characteristic symptom of angina in adults and children is pus.

How is angina of various forms manifested? The separation of angina in forms is conditional, because they have the same mechanism of occurrence. That is, it is one and the same pathological process that can progress to a greater degree and have complications or remain in place. The first symptoms will be the same, this is a syndrome of general intoxication. Then, specific symptoms appear in acute tonsillitis, while the duration of the course is approximately the same.

Epidemiology

The reservoir and source of viral and bacterial infection (BHSA) is a sick person, and much less often an asymptomatic carrier. How is a bacterial and viral pathogen transmitted? The main routes of infection are the airborne droplet and contact, including direct contact with secretions from the upper respiratory tract. The highest incidence rate occurs in late autumn, winter and early spring. Depending on the etiology, risk factors are:

  • Contact with a patient or with an asymptomatic carrier.
  • The presence of chronic inflammatory processes in the nasal cavity / paranasal sinuses and mouth.
  • Weakened immunity.
  • Decrease in the general reactivity of the organism to cold, in conditions of sharp seasonal fluctuations (temperature and humidity).
  • Constitutional predisposition to tonsillitis (in children with lymphatic – hyperplastic constitution).
  • State of the central nervous system and autonomic nervous system.
  • Tonsil injuries.

Is tonsillitis contagious? Yes, with a viral etiology, the incubation period is 1–6 days, and the infectious period is 1–2 days before the onset of the disease and up to 3 weeks after the symptoms subside (depending on the type of virus). Infection occurs approximately in 2/3 of people who were in contact with the patient. With streptococcal etiology (GABA), the incubation period varies from 12 hours to 4 days, and the infectious period from 24 hours from the start of antibiotic treatment or if the antibiotic was not used, 5-7 days after the symptoms disappear. The risk of infection at 25%.

Complications and consequences

Each type of tonsillitis, if ignored, can go into another more severe form. And this new pathology will be considered a complication of the previous one. For example, chronic catarrhal sore throat will lead to the appearance of a purulent, lacunar or follicular form, and they, in the chronicle, lead to intra-tonsillar abscess. And phlegmon can already give such complications that will endanger life. For example, the spread of purulent exudate along the cervical toward the central nervous system, the penetration of pus into the chest cavity, general sepsis, etc.

Relapses of the abscess are an indication for tonsillectomy. The type of pathogen greatly depends on the risk of metatonsillar complications (rheumatoid arthritis, chronic myocarditis, meningitis, glomerulonephritis). So, hemolytic streptococcus secretes toxins, which are similar in structure to the receptors of the body's own cells in many tissues. This is a direct risk of developing autoimmune pathologies.

Complications in 95% of cases occur when treatment was untimely, inadequate, or nonexistent.

Catarrhal tonsillitis

Acute onset of the disease. A sensation of soreness, dryness and burning appears in the throat, and then a slight soreness when swallowing joins. The patient is worried about fatigue, general malaise, headache, fever, usually low-grade. On pharyngoscopy, diffuse hyperemia and swelling of the edges of the palatine arches and tonsils, the tongue is coated, dry.

Often there is a slight increase in the adjacent lymph nodes.The course of catarrhal tonsillitis usually proceeds relatively easily and without complications. The duration of the disease is 3-5 days. Minor changes in the peripheral blood of an inflammatory nature are noted.

Follicular tonsillitis

OT of this form is characterized by a more pronounced inflammation of the tonsils with damage to the parenchyma and follicular apparatus. It begins with severe sore throat and sudden chills with a sharp increase in temperature to 40 ° C. Intoxication phenomena (headache, sharp general weakness, pain in joints, muscles and heart) are expressed. Less commonly observed phenomena dyspepsia.

Palatine tonsils are sharply swollen and hyperemic. Purulent whitish-yellowish formations (plugs) the size of a pinhead are visible on the surface of the follicle. Sharply expressed regional lymphadenitis. The figure below shows a photo of the throat with tonsillitis follicular form and a photo of traffic jams in the throat.

The surface of the tonsils, in the expression of N.P. Simanovsky, becomes like a map of the "starry sky".

Is it contagious and how is it transmitted

Angina is an extremely contagious pathology (not counting some rare cases such as HIV-angina). The degree of infectiousness varies from pathogen to pathogen, but in general it is almost always very high. The patient is dangerous to others, starting from the incubation period and until the moment of full recovery (sometimes the chance to infect another person is still 7-10 days after recovery).

  1. The main, the main - the airborne droplet, it is not difficult to get infected, being and 30 minutes with the patient in one, poorly ventilated room.
  2. Alimentary path - through common dishes, unfinished food or unfinished drink (therefore, the patient should have strictly separate dishes, and it is recommended to throw away the remaining food).

Children are more susceptible to infection than adults.

Quinsy

This form of angina also has another name, this is an intratonsillar abscess. Such a second name was given to angina, because an isolated abscess forms in the thickness of the tonsil. It is found much less often than the previous ones, but everything is evenly common. Symptoms of phlegmonous tonsillitis, what, and how are they manifested?

Angina in an adult and a child has a one-sided lesion and the cause is injuries, cuts in the tonsils with small foreign objects, or there is a second reason that is nutritional in nature.

Due to the fact that the lesion has unilateral symptoms, it may be less pronounced. Tonsils are hyperemic, increase in size, their tissues tighten, pain appears on palpation.

With an unfavorable course, the disease can have such complications as paratonsillitis, pharyngeal abscess, acute rheumatic fever, etc.

Lacunar tonsillitis

The onset of the disease and general symptoms are similar to follicular tonsillitis. However, in most cases, lacunar tonsillitis is more severe than follicular. What does it look like on pharyngoscopy? The picture is as follows: on the strongly hyperemic surface of the tonsil-enlarged tonsils, islands of yellowish-white raids appear widely covering it (photo of the cork above), while individual plaque patches often merge and cover a significant part of the tonsil, but do not go beyond it. Plaque is removed easily and usually without damage to the epithelial layer. On day 2–5 during the period of plaque separation, the severity of symptoms decreases, but the temperature until the inflammation of the regional lymph nodes subsides remains subfebrile. The duration of the disease is 5-7 days, with the development of complications it can have a protracted course.

In addition to palatine tonsils, other clusters of lymphadenoid tissue located on the root of the tongue (lingual tonsillitis), in the nasopharynx, can be involved in the acute inflammatory process (retronasal tonsillitis, tubular tonsillitis) Sometimes inflammation spreads throughout the pharyngeal lymphadenoid ring, causing an exacerbation.It should be noted that in cases of tonsillitis of viral etiology, especially occurring against the background of acute respiratory viral infections, the patient may have a runny nose, cough and nasal congestion, the temperature during a viral infection is closer to 38, not 39 ° C.

During pregnancy

In pregnant women, the main problem of treating angina is that they are contraindicated in most effective drugs. In particular, many antibiotics. Especially, this is true for the first trimester of pregnancy. Take any medicine. In the graph of contraindications, along with allergies, it is often worth "pregnant and lactating women." Among antibiotics, macrolides are the safest. Penicillins are acceptable, but with caution. However, if absolutely necessary, any drug can be prescribed under strict medical supervision.

Purulent tonsillitis

What is purulent tonsillitis? This is a general descriptive term that characterizes the totality of symptoms of a purulent-inflammatory process. Purulent can be called follicular, lacunar, fibrinous, staphylococcal and other tonsillitis, manifested by purulent spots or plaque. What a purulent sore throat looks like can be seen in the figure below:

How many days does purulent sore throat last?

Purulent tonsillitis is very diverse for its reasons, in addition, the condition of the body greatly affects the duration of the disease, so it is difficult to answer this question precisely. You can only say that the duration of the disease should not be more than 20 days and less than 6, otherwise you are dealing with another pathology. With a follicular or lacunar form, recovery occurs in about 10 days.

Is purulent tonsillitis contagious?

Contagiousness (contagiousness) largely depends on the causative agent of the infection. Conventional streptococcal tonsillitis, occurring in the form of follicular or lacunar, will not affect others, since exactly the same streptococcus strains are present in the oral cavity of each person. But this does not relieve the patient and his loved ones from anxiety for the following reason.

The pathogen can be precisely identified only after a visit to a doctor and clinical trials, diphtheria can never be excluded in advance, therefore, for any sore throat, a set of quarantine measures must be observed:

  • providing the patient with separate dishes and food,
  • when contacting relatives with the patient, it is advisable to wear cotton-gauze dressings (do not forget to change the dressings once every 2-3 hours),
  • exclude the use of common household items,
  • wash hands often (sick and close),
  • to exclude the patient’s contact with children, because they are especially susceptible to angina.

It is especially important that the cotton-gauze dressing fit snugly to the face without leaving cracks, since purulent sore throat is transmitted mainly through the air (airborne droplet) and, more rarely, through unwashed hands and dishes.

Tests and diagnostics

Diagnosis of acute tonsillitis in most cases is straightforward and is based on patient complaints and instrumental data (pharyngoscopy) examination of the patient. For the diagnosis of "chronic tonsillitis", a thorough medical history, examination of the patient, instrumental and laboratory examination are important. With pharyngoscopy, enlarged loose tonsils, sometimes filled with purulent contents, inflammation of the palatine arches are determined. A button probe is used to determine the depth of the gaps, the presence of adhesions and adhesions. On palpation of the cervical lymph nodes - regional lymphadenitis.

A more complex and extremely important task is to determine the etiological factor of tonsillitis, since it is he who determines the treatment. To diagnose bacterial and viral tonsillitis, a bacteriological study of the material from the posterior pharyngeal wall and palatine tonsils is performed, which has high sensitivity (90%) and specificity (95-99%).However, the cultural method does not make it possible to differentiate the active infectious process from GHSA-carriage. Rapid diagnostic methods of A-streptococcal antigen in swabs taken from the throat allow you to get an answer after 15-20 minutes, but despite the high specificity of the rapid tests (95-98%), however, the 1st generation tests are characterized by relatively low sensitivity (about 60-80%), that is, with a negative result, streptococcal etiology of the disease cannot be completely excluded. Therefore, it is important to use the rapid tests of the second generation, which have high specificity (94%) and sensitivity (about 97%) in relation to HHSA.

Also, for the differential diagnosis of bacterial and viral tonsillitis, the modified Centor / McIsaac scale is used (table below).

It is based on an assessment of five indicators (body temperature> 38 ° C, presence / absence of cough, plaque on the tonsils / their increase, soreness and enlargement of the cervical lymph nodes, patient age) with assigning 1 criterion to each criterion. When summarizing the scores, it is presumably possible to determine the etiology of tonsillitis, where a sum of 3-5 scores with a confidence of 35-50% indicates HBSSA-induced tonsillitis, and from -1 to 2 points indicates a low risk (2-17%) of HBHSA infection.

Differential diagnosis of tonsillitis is carried out with a number of diseases that accompany tonsil disease, and above all, paratonsillar abscessinfectious mononucleosis, diphtheria, yersiniosis, gonococcal tonsillitis, acute thyroiditis, candidiasis, leukemia, agranulocytosis and etc.

How and how to treat purulent tonsillitis in adults?

Purulent sore throat before treatment is studied for signs inherent in a particular pathogen. It is necessary to fully collect an anamnesis (a set of signs and complaints), conduct a full diagnosis and find out the cause of the disease, since there are pathogens that require highly targeted antibiotics.

Before treating purulent tonsillitis in an adult, it is important to accurately determine the form of the disease and identify the pathogen. Most of the purulent sore throats are vulgar forms (follicular, lacunar or fibrinous), and doctors prescribe treatment aimed at eliminating the most likely cause - streptococcus. For this, antibacterial agents of a wide spectrum of action are used, as a rule, of the penicillin series.

General recommendations

The doctor will say how to treat sore throat, and relatives and friends can be helped to comply with the patient's recommendations, which will help accelerate the healing process. This is the first aid for angina from relatives, before the doctor arrives.

  • Isolation of a patient with acute tonsillitis.
  • Complete rest and bed rest is required, otherwise how to quickly get rid of a sore throat without it?
  • Restriction of physical activity in the first time after recovery.
  • Drink plenty of water (water, teas, juices, compotes).
  • A special diet that is gentle. It involves the use of finely chopped food, a soft consistency that will not irritate the mucous membrane of the throat. An advantage is given to the dairy and vegetable diet, which will be rich in vitamins.
  • You can treat the throat by rinsing (chamomile, calendula, furatsilinom, soda), this is the first aid for angina.
  • Inhalation for the throat with calendula, chamomile, or with essential oils.
  • With angina, treatment is lubrication of the throat with Lugol.
  • The use of analgesics, antipyretic drugs.

You can be treated for a long time, but if you do not follow these recommendations, then recovery will not come soon.

Drug treatment

Medications for purulent sore throat:

  • antibacterial (we will consider in more detail below),
  • antiseptic gargles (furatsilin),
  • antiseptics for mechanical cleaning of tonsils from pus (Lugol),
  • antipyretic (usually paracetamol),
  • anti-inflammatory
  • painkillers (sprays, sucking tablets),
  • antiviral drugs (for viral infection).

Antibiotics for purulent sore throat

Antibacterial therapy is perhaps the most important part of the treatment of most tonsillitis and is the exact answer to the question: "How to quickly cure purulent tonsillitis?". The most commonly used antibiotic for purulent tonsillitis is penicillin and its derivatives, since it precisely affects the common cause of the disease - streptococcal infection. But the uncontrolled use of antibiotics has led to the fact that penicillin-resistant strains of streptococcus are increasingly appearing (by the way, in Europe, antibiotics are not released without a prescription).

With a reduced sensitivity of streptococcus to the entire penicillin series or with allergic reactions to penicillin, antibacterial drugs are selected from the group:

  • cephalosporins,
  • macrolides
  • sulfonamides (very rare, if only the remaining groups of antibacterial agents for one reason or another cannot be used).

Only a doctor should decide which antibiotic to use and what to do with purulent tonsillitis. This is due to the very high toxicity of most drugs. Moreover, with an illiterate calculation of the dosage and duration of use, there is a risk of “raising” resistant strains of streptococcus or another microbe and, thereby, complicate the treatment.

In order to enhance the effect of the antibiotic, the body needs to provide more intensive blood supply to the affected areas (throat) and good lymphatic drainage. All this allows the apparatus "Vitafon", which due to sound waves provides a deep and directed increase in blood circulation in the throat, as a result, the effectiveness of antibiotics and body resistance increases significantly.

What is better to gargle?

Before gargling with purulent sore throat, you should understand why this procedure is necessary. Rinsing has two purposes:

  1. Moisturizing the throat. This provides a softening and lubrication of the withered mucosa, which helps to relieve pain with purulent tonsillitis.
  2. Removal of pus and plaque from the mucous membrane of the tonsils.

In addition to these two goals, the task of inhibiting bacterial growth (antiseptic) is usually added, but the main problem of angina is that all microorganisms are inside the tonsil, where the antiseptic cannot get, so rinsing with antiseptics will not have a serious effect.

Almost all possible solutions will fulfill these goals, for one simple reason: the basis of any solution is water, because it is precisely this that allows you to remove pus and ease the course of purulent tonsillitis. Therefore, the best way to gargle is slightly salted water (1 teaspoon of salt per liter of water)

It happens that on the Internet they suggest using hydrogen peroxide for gargling with purulent sore throat, we do not recommend using this tool for other purposes, you can learn more about the mechanisms of action of hydrogen peroxide on the human body here.

Surgery

How to treat sore throat, if medications do not help? In rare cases, acute tonsillitis requires surgical treatment. Namely, when the disease becomes chronic and the tonsil is destroyed. With frequent tonsillitis, the lymphoid tissue ceases to do its job, the functions die out over time, and the infection can penetrate the bloodstream and reach any organ or system.

To prevent possible consequences, you need to cut the changed tonsils. The operation is performed if angina is repeated more often than 3 times a year, when conservative treatment does not help and when chronic tonsillitis extends beyond the tonsils and spreads to the nearest sites.

The operation also has contraindications, such as diabetes mellitus, hemophilic infection, and heart disease.

Diet

It is difficult for patients with acute tonsillitis to eat the usual food.And how to quickly cure a sore throat without a diet, but nothing. When swallowing, severe pain appears, and so as not to aggravate the situation and not irritate the tonsils, a sparing diet is prescribed.

Food should be finely chopped, ideally using a blender. Porridge, light soups, mashed soups, mashed potatoes are welcome. It is necessary to exclude temporarily from the diet sweet, spicy, salty, sour.

Drinking regimen should be strengthened. This is not only plain water, but also all kinds of teas, juices, compotes, etc.

Angina occurs in both adults and children. The difference in the clinical picture is that children suffer this disease harder. If you do not know in time how to cure a sore throat and start the process, the disease can progress, go into a more severe form. But, nevertheless, it is better to prevent its appearance by simply observing a number of simple preventive measures.

How to smear the throat with purulent tonsillitis?

In addition to rinsing, there are procedures for mechanical cleaning of tonsils with lugol. This antiseptic agent kills microorganisms located only on the surface of the tonsils. Unfortunately, the antiseptic does not penetrate deep into the tissues where the bulk of bacteria such as streptococcus are located, but, on the whole, lugol helps fight purulent tonsillitis.

  • you can’t use Lugol more than twice a day, because in large quantities it can damage the mucous membrane of the esophagus and stomach,
  • lugol is not desirable during pregnancy and lactation,
  • Lugol is contraindicated in case of thyrotoxicosis and with an allergy to it.

Inhalation

On the Internet, inhalation of both steam and nebulizers is actively promoted for any diseases of the upper respiratory tract. However, the effectiveness of inhalation with purulent tonsillitis is doubtful. From steam, you can get a burn of an already damaged mucous membrane, and inhalations through a nebulizer are completely useless, since the bulk of the devices create too small particles that do not settle in the mouth and throat.

Consequences and Complications

From the philistine point of view, tonsillitis is a mild disease that you should not pay special attention to. Unfortunately, this simple pathology can create very complex health problems that can result in both systemic pathologies and local complications.

They can be expressed as diseases of the kidneys, joints, and heart. It would seem where the throat and where are the kidneys? But the fact is that the proteins (structural elements) of the sore throat pathogen are similar in structure to the proteins that make up our heart, kidneys and joints.

Immunity, in this case, is the main culprit in the complications. Each time, when bacteria enter the body, it starts the synthesis of protective proteins (antibodies), which selectively attach to foreign substances (streptococcus proteins) in such a way that they lose all their properties (are destroyed).

An antibody is a substance (protein) with a simple chemical program to attach to a specific amino acid sequence. An antibody does not distinguish its own from a stranger, therefore, performing its functions, it attaches to both streptococcus and the tissues of the joints, heart and kidneys. As a result, both Streptococcus and our cells are destroyed. It manifests itself as myocarditis, jade or rheumatism.

The purulent process can spread from the tonsils to the surrounding tissues, which is the cause of the following complications:

  • Paratonsillitis. Purulent inflammation penetrates into the fiber surrounding the tonsil. Long-term antibiotic treatment is required.
  • Retropharyngeal, parapharyngeal and other abscesses. Severe complications are characterized by massive accumulation of pus in a limited space near the pharynx. Surgical treatment.
  • Phlegmonous tonsillitis (see the corresponding section in the article).
  • Phlegmon of various locations. Phlegmon is an infiltration (impregnation) of tissues with pus.Extremely serious complication, which requires immediate surgical intervention and aggressive antibiotic therapy.

If you let the treatment drift or “profess” a fundamental refusal of antibiotics, then just 9 days is enough and tonsillitis can become deadly!

Mononucleous

It occurs in the information space as monocytic, mononuclear, mononucleous tonsillitis. All this manifestation of such an infectious disease as mononucleosis, which is transmitted by airborne droplets or contact-household routes, is characterized by damage to the system of mononuclear phagocytes (cells responsible for the destruction of a bacterial agent).

Viral sore throat

Viruses are a common cause of tonsillitis, including bacterial. Almost always, they strongly suppress local immunity in the throat and open the way for secondary infection in the form of streptococcus.

Viral tonsillitis can also be a consequence of a general illness of the body, for example, very often tonsillitis develops with measles or HIV infection.

Korea

Measles is an acute contagious (contagious) infectious disease characterized by intoxication, skin rash, inflammation of the mucous membranes of the respiratory tract and the lymphoid pharyngeal ring (tonsils). Transmitted by airborne droplets.

One of the common manifestations of measles is measles, which can occur easily with a slight reddening of the tonsils, but sometimes streptococcus joins and the tonsillitis becomes purulent.

With HIV infection

Frequent manifestations of HIV infection are pathologies of the upper respiratory tract and infections of the external mucous membranes (eyes, mouth and nose).

Due to damage to the immune system (human immunodeficiency virus), tonsillitis is most likely to be caused by a bacterium from the normal microflora of the oral cavity (streptococcus). And it will manifest itself in the form of symptoms characteristic of purulent tonsillitis in the form of follicular, lacunar, fibrinous, etc. (see in the corresponding section).

Herpetic tonsillitis (herpangina)

With herpetic, herpes and herpangina, a very confusing situation. In view of the similarity of symptoms (vesicles or papules), similar names have historically been formed, but pathogens can be completely different viruses. Many medical schools also have different names, with the Internet adding fuel to the fire in the form of many incompetent articles on the topic of viral sore throats.

In order not to get confused, we will consider separately:

  1. Herpetic tonsillitis (herpanginum).
  2. Herpes sore throat.
  3. The defeat of the pharynx by the herpes zoster virus.

Bacterial

Bacterial tonsillitis is an infectious lesion of the tonsils with various bacteria, usually streptococcus. It manifests itself in the form of a follicular, lacunar or fibrinous form with all the symptoms and signs characteristic of them (see the relevant sections above).

Different infectious agents (bacteria) have some similar symptoms and complaints, but there are also characteristic differences, which we will consider later.

Streptococcal tonsillitis

The main part of bacterial tonsillitis is streptococcal tonsillitis, while such a term does not exist in official medicine. The fact is that the causative agent of most types of tonsillitis is streptococcus (various strains of beta-hemolytic streptococcus group A), so this name does not reflect the main characteristics of the disease.

Most often, streptococcal angina manifests itself in the form of the main forms of the disease (disassembled at the beginning of the article):

  • catarrhal
  • follicular
  • lacunar
  • fibrinous
  • phlegmonous.

And also a streptococcal infection can join any sore throat:

  • viral
  • fungal
  • necrotic ulcer
  • mononucleosic, etc.

For streptococcal sore throat, the following symptoms are characteristic:

  • body temperature may vary depending on the severity of the disease (38-40 ° C),
  • tonsils enlarge and become red, can be covered with a film, purulent plaque or purulent plugs,
  • the lymph nodes on the neck can be enlarged to varying degrees,
  • sore throat while eating, and severe cases even at rest.

Scarlet fever

Many mothers know firsthand about a disease such as scarlet fever. Against the background of it, angina of various forms almost always occurs (catarrhal, follicular or lacunar)

Scarlet fever is an acute infectious disease characterized by a sore throat, a small-pointed rash and a tendency to purulent processes on the skin.

Diphtheria

Diphtheria is an acute infectious disease manifested by damage to the oropharynx with the formation of fibrinous plaque on the tonsils and possible damage to the cardiovascular and nervous systems. The cause is the pathogen - diphtheria bacillus (Löffler's bacillus). It is transmitted by airborne droplets and by household routes, the incubation period is from 2 to 10 days. There are diphtheria of the skin, eyes, genitals, nasopharynx and oropharynx (diphtheria angina).

Peptic ulcer (necrotic)

Doctors call this pathology the angina of Simanovsky-Plaut-Vincent.

Ulcerative necrotic tonsillitis is a characteristic lesion of one palatine tonsil in the form of areas of necrosis (death) of the tonsil mucosa and the formation of ulcers. The causative agents are spindle-shaped rod and spirochete of the oral cavity. It is quite rare and occurs against a background of a decrease in general and local immunity.

Fungal tonsillitis

Fungal tonsillitis is an inflammation of the mucous membrane of the tonsils, caused by various kinds of infectious fungi. There are several varieties of pathology, the most common of them is candidal tonsillitis, the causative agent of which are fungi of the genus Candida.

Larynx

Laryngeal tonsillitis is a pharyngeal disease characterized by damage to the lymphoid tissue near the larynx (part of the respiratory tract, located below the pharynx). It differs from laryngitis in the depth of inflammation and the predominant lesion of lymphoid tissue. Laryngitis, unlike laryngeal tonsillitis, is characterized by inflammation of only the mucous membrane of the larynx.

Stomatitis

Stomatitis is an inflammation of the oral mucosa. Probably, the reasons can be various microorganisms (bacteria, viruses, fungi), and in some cases it is a manifestation of an allergic reaction to a product. Until now, this pathology has not been fully studied, especially, difficulties arise in identifying the causes.

Stomatitis tonsillitis occurs as a consequence or complication of protracted stomatitis, which greatly weakens local immunity, as a result, control over the multiplication of streptococcus in the oral cavity is lost and tonsils are damaged.

Allergic

Allergic tonsillitis is not an independent disease, is a manifestation of the general pathology of the body - allergies.

As a result of exposure to an allergen (food or pollen), an allergic reaction occurs in the form of:

  • hyperemia (redness) of the tonsils and pharynx,
  • swelling of the tonsils and pharynx,
  • may be accompanied by an allergic rhinitis,
  • there is no increase in temperature and signs of intoxication.

Chronic

All of the above types of tonsillitis mainly occur in acute form, that is, they quickly arise, last no more than one month and eventually end in recovery.

Chronic tonsillitis is a long-term (more than 1 month) inflammation of the mucous membrane of the tonsils, which does not end with a complete recovery and is accompanied by periodic exacerbations.

Treatment of chronic sore throat, depending on the causes, severity and variety, is:

  1. Medication (most often antibacterial),
  2. Surgical:
    • tonsillectomy,
    • sanitation of foci of infection in the tonsils (partial removal),
  3. Physiotherapeutic:
    • laser therapy
    • Quartzing
    • vibroacoustic therapy (relevant to produce in conjunction with antibiotic therapy and after surgical treatment).

Conclusion

Summing up the line under all sore throats, we can draw several important conclusions:

  1. Sore throat is not a mild cold that can be carried on legs.
  2. With a plaque on the tonsils, severe pain when swallowing and high body temperature (38-39 ° C), it is vital to visit a doctor.
  3. Angina can cause severe complications in the heart, kidneys, or joints that occur if you ignore the doctor’s instructions regarding antibiotic therapy.
  4. Angina in most cases is very well treated with broad-spectrum antibiotics. Relief occurs on the second day.
  5. Together with antibacterial therapy, physiotherapy is performed with the Vitafon apparatus to improve lymph flow and blood circulation. In addition to the obvious physical effect of vibroacoustic therapy, there is also a hidden biochemical therapy that cannot be felt immediately. It consists in saturating our body with an inalienable resource - microvibration. It is present in our body continuously, and is necessary for the implementation of immune processes, protein biosynthesis (metabolism - metabolism), cleaning and tissue regeneration. During an illness, the body increases the need for microvibrations of tissues, which the only existing Vitafon medical device can make up for.
  6. With bacterial tonsillitis, no rinsing, lubrication, inhalation or sucking of the tablets will replace the antibiotics.
  7. Not all sore throats require antibiotics for treatment, be careful and do not take them unnecessarily.

Bibliography:

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  2. Ovchinnikov Yu.M., Gamov V.P. Diseases of the nose, pharynx, larynx and ear. Textbook. - M .: Medicine, 2003.
  3. Palchun V.T., Magomedov M.M., Luchikhin L.A. Otorhinolaryngology. - M.: GEOTAR-Media, 2011.
  4. Berezov T.T., Korovkin B.F. Biological Chemistry: Textbook. - M.: Medicine, 1998.
  5. Novitsky V.V., Goldberg E.D., Urazova O.I. Pathophysiology: a textbook. - M.: GEOTAR-Media, 2009
  6. Fedorov V.A., Kovelenov F.Yu., Koven D.V., Ryabchuk F.N., Vasiliev A.E. Body resources. Immunity, health and longevity. - SPb .: Vita Nova, 2004
  7. Semenov V.M. Infectious Disease Guide - M .: MIA, 2008

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