Angina: symptoms, treatment
- Causes of sore throat
- Classification of angina
- Symptoms of sore throat
- Other varieties of angina
- Possible complications
- Diagnosis of sore throat
- Treatment of angina
Infectious disease, accompanied by acute inflammation of the palatine tonsils and / or other lymphoid formations of the pharynx, in clinical practice is called angina. In the absence of adequate treatment, this pathological process can lead to the development of complications and the defeat of various internal organs.
Angina is a disease that has been known to mankind since antiquity. Description of operations for the removal of tonsils were discovered in the writings of the legendary Paracelsus. Based on this, we can assume that in those early times, angina was one of the rather serious and dangerous diseases.
After the introduction of bacteriological methods into medical practice, angina began to be classified according to the pathogen that triggered the development of the pathological condition, and after the discovery of the diphtheria bacillus in 1884 by Edwin Clebs, it became possible to differentiate angina from diphtheria.
Causes of sore throat
The most characteristic causative agents of infection are staphylococci, streptococci, pneumococci, some representatives of the genus diplokokkov and enteroviruses.
Ways of infection:
- Air-droplet (the most characteristic way of transmission).
- Enteral (along with contaminated dairy products).
- Hematogenous (with blood flow from organisms and tissues infected with the pathogen).
- Endogenous (in patients suffering from gastroenteritis, purulent sinusitis, chronic tonsillitis and caries).
- Artificial (when performing surgical operations on the nasopharynx and nasal cavity (traumatic angina)).
Most often, people who have sensitization and reactivity of the organism are lowered by angina, or congenital immaturity of physiological systems is noted or there are chronic pathological processes in the ENT organs. However, an important role in the development of the disease plays a state of tonsils and virulence of microflora.
With the development of an acute inflammatory process, patients have swelling of the nasopharyngeal mucosa, plethora and lymph drainage. Further, the development of vascular thrombosis, which leads to the formation of microabscesses and the formation of ulcerative lesions.
Classification of angina
- Catarrhal angina (the easiest form, in which only the mucous membrane of the tonsils is involved in the inflammatory process);
- Lacunar angina (formation of inflammation in the lacunae of the tonsils);
- Follicular angina (pathological condition, accompanied by suppuration of follicles);
- Combined forms of inflammation.
Symptoms of sore throat
Symptoms of catarrhal angina
This pathology is characterized by a sharp onset, with an increase in body temperature to 38 C. Patients complain of malaise, headache, chills and other signs of general intoxication. Some time after the symptomatology there is a pain in the throat, which increases with swallowing (a distinctive feature of angina is the severe pain that occurs with an "empty" throat).
During the diagnostic examination, there is a significant reddening of the mucosa, loosening and enlargement of the tonsils, dryness and lagging of the tongue.
At palpation enlarged and painful lymph nodes are revealed. Blood indicators, as a rule, in this state are little changed or are within the norm. With adequate treatment, the duration of catarrhal angina is 3-5 days. However, sometimes there are cases when the disease passes into the next form, which is characterized by a deeper defeat of the tonsils.
Symptoms of lacunar angina
The most characteristic sign of this form of angina is the accumulation in the lacunae of fibrinous exudate. At the same time on the swollen and hyperemic mucous surface of the tonsils are formed whitish deposits, localized in the mouths of lacunae. More often they are separate entities, less often they merge and cover most of the surface of these organs. These raids do not spread beyond the tonsils, they are easily removed, but after a while they appear again.
Symptoms of follicular sore throat
This form of inflammation is characterized by the appearance on the tonsil mucosa of multiple purulent islets, reminiscent of their form and form millet grains. These indistinctly formed formations are nothing but suppurated follicles.
With the passage of time, pustules begin to increase, and often they are opened in the pharyngeal cavity. In clinical practice, cases where one of the tonsils develop lacunar, and the other - follicular angina, are not uncommon. In this case, the patient has pronounced symptoms of intoxication, headache, weakness, severe sore throat, chills and fever.
Especially severe follicular angina occurs in childhood. In ill children, increased salivation and a frequent need for swallowing. However, because of severe pain, the child tries not to swallow. As a consequence, the soft sky does not completely close the nasopharyngeal space, which causes the saliva to enter the nasal cavity and flow through the nose.
The voice in children and adults suffering from follicular angina acquires a nasal condition, because of the increase in the tonsils, a temporary decrease in hearing is noted and breathing becomes difficult. In especially severe cases, heart and joint pain develops. When palpation, soreness and a significant increase in regional lymph nodes are noted. There are also significant deviations in the clinical analysis of blood (increased ESR, leukocytosis, shift of the leukocyte formula to the left). Often in the urine, traces of protein are found.
Symptoms of follicular sore throat continue to increase within four to five days, after which, with adequate treatment, the patient begins to recover. In case of complications, the disease can drag on and go into a chronic form.
Combined tonsillitis: symptoms
Combined, or fibrinous angina is an inflammatory process that occurs with the simultaneous development of lacunar and follicular angina. In this condition, an extensive yellowish-white coating appears on the mucous membrane of the tonsils, often extending beyond the limits of this organ. The combined form of pathology begins acutely, with a high body temperature and the phenomena of general intoxication. In some cases, patients suffering from fibrinous angina, show signs of clinical meningeal syndrome, which develops in the stimulation of the meninges.
Other varieties of angina
Angina of lingual tonsil
This is a fairly rare disease, proceeding according to the type of catarrhal, phlegmonous or follicular inflammation. For this form of pathology, the same clinical manifestations are characteristic, as for other types of angina. Its distinctive feature is the severe pain that occurs when pressing on the root of the tongue, swallowing and moving the tongue. As the pathological process develops, the inflammation begins to spread to the intermuscular tissue, and, in the absence of adequate treatment, can cause the development of interstitial purulent inflammation of the tongue. With the development of phlegmonous tonsillitis, the general condition of the patient worsens, the body temperature rises, then a purulent deposit appears on the surface of the lingual tonsil, and painful pains occur in the root of the tongue, which increase with swallowing.
Acute adenoiditis (retinasal angina)
This form of pathology most often occurs in childhood at the stage of the pharyngeal tonsil. It can occur against a background of various infectious diseases, and also become a complication of inflammation of the paranasal sinuses and the nasal cavity.
Acute adenoiditis is characterized by a sharp disruption of nasal breathing, accompanied by a high body temperature and an obsessive cough. The most typical complaints include pain, localized behind a soft sky, giving back ears and nasal cavity, headaches, as well as discomfort or difficulty in swallowing and digestive disorders.
During the medical-diagnostic examination, the patient shows swelling, a strong reddening of the pharyngeal tonsil, the presence of raids and a viscous muco-purulent secret in her furrows.
It is an inflammation that affects the lymphoid tissue of the morganic ventricles of the larynx, pear-shaped sinuses and cherpalodnagortan folds. Often, the pathological process can spread into the submucosa. Most often, infectious agents that provoke the development of laryngeal tonsillitis penetrate the larynx due to trauma, thermal or chemical burn, as well as foreign matter. At the same time, hypothermia, an abscess or paratonzillitis can provoke the development of this pathological condition.
Larynx angina is a fairly serious disease that occurs with a significant disruption of the general condition, increased body temperature to high marks, severe pain when turning the neck and swallowing, shortness of breath and hoarseness of the voice. With a favorable course in a week, recovery comes. In the case of complications, phlegmonous laryngitis, suppurative inflammation of the submucosal layer, perichondrium and intermuscular tissue can be formed. This pathological condition can lead to a purulent abscess and the development of asphyxia.
Angina of the bottom of the mouth
Angina of the bottom of the mouth, also called Ludwig's angina, is an inflammatory process that affects the submandibular salivary glands, the cellulose of the neck and the bottom of the mouth. In the early stages of the pathological process, the patient develops tension and discomfort when swallowing and talking in the area of the mandibular angle. Then the body temperature rises, and the symptoms of general intoxication increase. As the inflammation develops, a painful infiltrate develops, gradually filling all the sub-chambers and descending to the lateral or middle part of the neck. The skin in the area of inflammation is highly hyperemic and swollen. Also, the patient develops edema of the oral cavity. Speech becomes vague, there are limitations and soreness when opening the mouth. In the event that the infiltrate begins to squeeze the cervical vessels and trachea, the patient develops dyspnea and there is a cyanosis of the face. Ludwig's angina is a serious enough disease that can lead to such dangerous complications as sepsis, mediastinitis, meningitis and choking.
Inflammation of lymphoid tissue of the posterior pharynx
This pathology, which in medical terminology is also called acute pharyngitis, affects patients of any age. As a rule, inflammation occurs in persons with reduced immunity, in the presence of concomitant diseases of the nasal cavity, as well as in sudden fluctuations in ambient temperature. The pathological process begins with acute catarrhal inflammation of the mucous membranes of the nose and throat with a gradual spread to its middle part. Thus patients complain of dryness and pershenie in a throat, an obsessive cough and pains at swallowing. Sometimes the disease can lead to the development of purulent mediastinitis or an abscessed abscess.
Ulcerative taping angina
This is a rare enough pathology, which in the war years was called trench trick. This disease can occur sporadically, most often at a young age, in individuals with reduced resistance to the body, with general exhaustion or with avitaminosis.
As a rule, the inflammatory process covers one side, bilateral lesions are much less common. In this case, against the background of normal or subfebrile temperature, there are gradually increasing pains in the pharynx. Further on the surface of the tonsils appear yellowish-white or grayish films of a soft consistency, surrounded by an inflammatory rim and resembling stearin spots. These films are easily removed with a cotton swab, leaving behind a bleeding ulcerated surface with clearly defined edges. Initially, the ulcerative defect is superficial, however, as the pathological process progresses, it deepens, spreads beyond the tonsil and takes the form of a volcanic crater. Often, inflammation can penetrate deeper layers, affect the mucous membrane of the gums, tongue and periosteum. The disease occurs with a characteristic putrefactive odor from the mouth. With a favorable course after 1-2 weeks, recovery comes, but often relapses occur, and sometimes the pathological process can drag on for months.
In especially severe cases, patients with angina may develop paratonzillar or parafariengial abscesses. At the same time, otitis media, laryngitis , pyelonephritis, laryngeal edema, neck phlegmon, rheumatic carditis, tonsillitis sepsis, articular rheumatism, metastatic processes in various organs and tissues, mediastinitis and meningitis are often a complication.
Diagnosis of sore throat
When the diagnosis is made, the clinical picture of the disease, the history of the disease, and the patient are assigned pharyngoscopy and culture bacterial examination. Differential diagnosis of angina with acute respiratory viral infection, acute pharyngitis and diphtheria of the pharynx is mandatory.
Treatment of angina
Treatment of angina is carried out in a complex that includes symptomatic, antibacterial and pathogenetic therapy. The patient is recommended bed rest, sparing milk and vegetable diet and abundant warm drink.
As etiotropic treatment, the patient is given sulfonamide, antibacterial and anti-inflammatory drugs of local and systemic action. Regular rinsing of the throat with a solution of baking soda, hydrogen peroxide (2 tablespoons per 200 ml of water), herbal decoctions (sage, chamomile, calendula), a solution of boric acid or furacilin.
As a symptomatic treatment used antipyretic, analgesic and antirheumatic drugs. Also, the dry warm compresses on the region of regional lymph nodes, UHF and microwave therapy are well recommended in the treatment of angina.
After recovery, the patient is assigned a control laboratory test, and, in case of detection of signs of complications development, it is strongly recommended that the specialist be consulted and treated subsequently.
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