Angina: symptoms in adults and children, treatment and prevention
The content of the article:
- Classification
-
The reasons for the development of pathology
- Etiology of primary acute tonsillitis
- Pathogenesis of streptococcal sore throat
- Psychosomatics
- Signs of angina in adults and children
- Diagnostics
- Treatment
- Possible complications
- Prevention
- Video
Angina in both adults and children is acute, with varying degrees of severity, which depends on the etiological agent, the form of the disease and the presence of concomitant pathologies.
With angina, inflammation of the tonsils occurs
What is angina? Angina, or acute tonsillitis, is an infectious and inflammatory disease with damage to one or more components of the lymphadenoid pharyngeal ring, most often the palatine tonsils (tonsils).
Classification
The inflammatory process can be primary and secondary. Primary acute tonsillitis is divided into catarrhal, lacunar, follicular and ulcerative membranous.
Secondary inflammation of the palatine tonsils can be observed in acute infectious diseases - diphtheria, scarlet fever, measles, tularemia, typhoid fever, infectious mononucleosis. It also occurs against the background of diseases of the blood system, including with agranulocytosis, alimentary-toxic aleukia, leukemia.
Depending on the etiological agent, the bacterial, viral, fungal and syphilitic form of angina is isolated.
ICD-10 code - J03:
- J0 - with streptococcal etiology of the disease;
- J8 - with a specified other etiology of the disease;
- 9 - with an unknown pathogen.
The reasons for the development of pathology
Etiology of primary acute tonsillitis
In 70–80% of cases, the cause of the development of inflammation of the tonsils is beta-hemolytic group A streptococcus, or pyogenic streptococcus. It is a gram-positive, facultatively anaerobic microorganism that is transmitted by airborne droplets, food and contact.
Pyogenic streptococcus is most often transmitted by airborne droplets
The peak incidence occurs in the winter-spring period, when the general resistance of the body decreases. The entrance gate is the mucous membrane of the upper respiratory tract. The incubation period is on average 1–2 days.
In addition to pyogenic streptococcus, the causative agent of angina can be staphylococci, other types of streptococci, meningococcus, pneumococcus, hemophilus influenzae, Klebsiella, mycoplasma, chlamydia, adenovirus, etc.
The ulcerative filmy sore throat of Simanovsky - Plaut - Vincent is caused by a spindle-shaped bacillus and a spirochete of the oral cavity, which are conditionally pathogenic flora of the oral cavity.
Pathogenesis of streptococcal sore throat
Any conditions that violate the integrity of the protective barrier on the surface of the tonsils contribute to the development of acute tonsillitis:
- violation of the natural microflora of the oral cavity and nasopharynx;
- acute viral infections of the upper respiratory tract;
- local and general hypothermia;
- mechanical injuries of the mucous membrane of the pharynx and tonsils;
- chemical and thermal damage to the oropharyngeal mucosa;
- congenital or acquired immunodeficiencies;
- the presence of chronic diseases of the upper respiratory tract;
- smoking;
- exposure to harmful production factors.
When the pathogen enters through the upper respiratory tract or oral cavity, it interacts with the natural barriers of the tonsil mucosa and penetrates into the tissues. After that, inflammatory mediators are released and the permeability of the vascular walls increases.
Due to the spread of infection through the lymphatic vessels, a negative effect of acute tonsillitis on the heart is possible
The spread of the pathological agent occurs through the lymphatic vessels with damage to the regional cervical lymph nodes. Exotoxins emitted by beta-hemolytic streptococcus (streptolysin, leukocidin, hemolysin, etc.) have a toxic effect on the heart, nervous system, and disrupt the functions of the immune system. As a result, autoantibodies can form against the endothelium of blood vessels, heart, kidneys, synovial membrane of the joints, which leads to the development of rheumatism, endocarditis, acute post-streptococcal glomerulonephritis, vasculitis.
Psychosomatics
From the point of view of psychosomatics, the tonsils check everything that gets inside the body: food, energy, information, situation, problem. They are a sensor that gives feedback on what is going through them. Often tonsillitis develops in a person who cannot contradict society, from which it is highly dependent on the opinions of others.
It is believed that angina can occur for psychosomatic reasons - due to the pressure of the people around
So, frequent sore throats, which are difficult to distinguish from ARVI (acute respiratory viral infection), are found in people who work in corporations, where they are under pressure, as a result of which their own beliefs break.
This is especially evident in children who are brought up in a family where they are not interested in their desire, and any resistance or attempt to express their opinion is suppressed either by force or by manipulation.
Both an adult and a child can have a sore throat with frequent relapses, until it is possible to determine the true cause of the pathology.
Signs of angina in adults and children
Acute catarrhal tonsillitis is mild. The disease begins acutely. The first sign of inflammation of the tonsils may be an increase in body temperature and a sore throat.
In the catarrhal form, the pain syndrome is insignificant. There are complaints of moderate headache, weakness, malaise, and aching joints. Regional lymph nodes increase slightly in size and become moderately painful. The duration of the catarrhal form of sore throat is 2-3 days, after which it ends with recovery or passes into another type of disease.
The symptoms of the disease are determined by its severity and form.
The follicular form of pathology is characterized by an increase in body temperature above 38 ° C, intense pain in the throat, chills, sleep and appetite disturbances, pallor of the skin, pain in muscles and joints, headache. Regional lymph nodes are enlarged and sharply painful. In children, against the background of intoxication, there may be drowsiness, convulsions, vomiting, and stool disorders. Symptoms increase for 2-3 days. The duration of the disease is on average 7–8 days.
Lacunar angina proceeds with the same symptoms as follicular. The difference is observed in the pharyngoscopic picture. The duration of this type of acute tonsillitis is 7-8 days.
The ulcerative-membranous form of pathology develops against the background of an immunodeficiency state, hypovitaminosis, cachexia or chronic intoxication. It is characterized by mild one-sided sore throat. The temperature reaction is weak, so there are no symptoms of intoxication. On the affected side, there is an increase in regional lymph nodes. Bad breath is common. The duration of the disease is from 7 to 12 days.
Diagnostics
What to do if you suspect tonsil inflammation? In order to recognize this or that form of the disease, as well as to determine the pathogen, if symptoms of angina occur in adults and children, it is necessary to contact a specialist (therapist, infectious disease specialist or otorhinolaryngologist) who will conduct an examination and, based on the results, explain in detail how to treat tonsillitis, avoiding complications …
To make a diagnosis, a number of studies may be required, including cytological and bacteriological
Diagnostics includes examination, pharyngoscopy, bacteriological, cytological or histological examination, clinical blood test, general urine analysis. According to the indications, an x-ray examination of the chest organs, electrocardiography and consultation of related specialists are carried out: an immunologist, a cardiologist, a nephrologist.
What a sore throat looks like can be seen in a photo of the throat taken during a pharyngoscopy. With catarrhal tonsillitis, hyperemia of the mucous membrane of the palatine tonsils, palatine arches and the soft palate is noted. In the clinical analysis of blood, there is a slight increase in the number of leukocytes, an increase in ESR (erythrocyte sedimentation rate).
The type of palatine tonsils with angina varies depending on the form of the disease
The catarrhal form of tonsillitis must be differentiated from viral pharyngitis, in which there is often a cough, a runny nose and there is no enlargement and tenderness of the lymph nodes.
With follicular angina during pharyngoscopy, there is a bright hyperemia and edema of the palatine arches and tonsils, on which suppurative follicles in the form of yellowish, rounded elevations. Tongue dry and coated with white coating. In the clinical analysis of blood, leukocytosis is noted with a shift of the leukocyte formula to the left due to an increase in the number of neutrophils, accelerated ESR. In the general analysis of urine, traces of protein and a small number of red blood cells appear.
With the lacunar form of tonsillitis, there is a hyperemia of the mucous membrane of the palatine arches and tonsils and their increase in size. A white-yellow plaque that covers the entire surface of the tonsils is located in the mouths of the lacunae, but does not go beyond the tonsils. The plaque is easily removed with a spatula. In this case, the process may involve the lateral ridges of the pharynx, which become edematous, hyperemic. In the clinical analysis of blood, leukocytosis with neutrophilic shift to the left and accelerated ESR.
In the ulcerative-membranous form, during pharyngoscopy, an ulcer is visualized on the affected tonsil, covered with a gray-yellow bloom, after which the clear edges of the ulcer are determined. Ulceration can be on the soft palate, the posterior wall of the pharynx, the vestibular larynx, which leads to bleeding, palatal perforation, and damage to the periosteum.
To confirm the diagnosis and further correction of treatment, a bacteriological examination of scraping from the surface of the tonsils and the oral mucosa is prescribed, including a bacteriological examination for Leffler's bacillus (to exclude diphtheria).
It is very important to timely recognize the streptococcal etiology of the disease for adequate therapy. Express diagnostics of streptococcal antigen from the surface of the tonsils is carried out using test strips. The study takes 5 minutes, the specificity and sensitivity reaches 98%.
In case of an ulcerative-membranous form of angina, in controversial cases, a biopsy of the tonsil tissue along the edge of the ulcer is performed, followed by histological and cytological studies.
In connection with the risk of complications after acute tonsillitis, the following are shown:
- control clinical study of blood and urine;
- determination of C-reactive protein;
- ECG.
Treatment
With angina, a home or stationary regimen is recommended, depending on the severity of the patient, social conditions. In severe and moderate cases, hospitalization in the infectious diseases department is indicated. This is especially true for patients with severe symptoms of intoxication against a background of febrile temperature (above 38 ° C), when infusion therapy is needed to replenish fluid in the body and detoxify.
Treatment in uncomplicated cases is carried out at home
To reduce the stress on the cardiovascular system, bed rest is recommended. The diet should be sparing, with the exception of spicy, rough foods that can irritate the mucous membranes. Preference is given to a dairy-vegetable diet rich in vitamins. A plentiful warm drink is recommended: mineral water, compotes, lingonberry and cranberry fruit drinks.
Systemic antibiotic therapy plays a key role in the treatment of acute bacterial tonsillitis. Preparations are selected depending on the alleged pathogen, and correction of treatment, if necessary, is carried out after receiving the results of bacteriological inoculation of discharge from the surface of the tonsils.
Given the prevalence of streptococcal infection, as well as its natural sensitivity to penicillins, the drugs of choice are Phenoxymethylpenicillin or Amoxicillin. You can also use I-II generation cephalosporins: Cefadroxil, Cefuroxime Axetil.
If the patient has previously received antibiotics, Amoxiclav is preferable, which contains amoxicillin with clavulanic acid.
But before prescribing this or that antibacterial agent, the doctor must make sure that the patient does not have an allergic reaction to this group of drugs. If you are allergic to penicillins or cephalosporins, macrolides are prescribed: Azithromycin, Clarithromycin, Roxithromycin or Josamycin.
Non-steroidal anti-inflammatory drugs are used as antipyretic and pain relievers: Paracetamol, Ibuprofen, Tsefekon, Analgin, Ketonal.
Patients with a tendency to allergic reactions and with severe edema of the mucous membranes are shown antihistamines: Loratadin, Cetirizine.
Local treatment of angina consists in the targeted delivery of the active substance to the inflammation focus. It is recommended to rinse the oropharynx with an alkaline or saline solution, decoctions of calendula, sage or chamomile.
For gargling, decoctions of medicinal herbs, in particular chamomile, are often used.
Pain relievers and antiseptic drugs are actively used: Anti-angina (chlorhexidine, tetracaine, ascorbic acid), Hexalysis (biclotymol, enoxolone, lysozyme), Hexasprey (biclotymol), Cameton (camphor, menthol, eucalyptus), Pectusliptetol (menthol), eucalyptus (benzalkonium chloride, menthol, essential oils), Strepsils with lidocaine (amylmetacresol), Tantum Verde (benzydamine, menthol).
Herbal preparations have an antiseptic and analgesic effect: Tonsilgon, Tonsipret.
An important role in the treatment of angina is played by topical antimicrobial agents. The drug Grammidin is widely used in the form of lozenges or spray.
Grammidin Neo with anesthetic is recommended for patients with acute tonsillitis. It contains antibacterial and antiseptic components - gramicidin C, cetylpyridinium chloride and oxybuprocaine. Gramicidin C is an antibiotic of the tyrothricin group; it is practically not absorbed from the gastrointestinal tract and does not penetrate into the general bloodstream. The mechanism of action is to increase the permeability of the cytoplasmic membrane of the bacterial cell, which causes its death. Gramicidin C has a pronounced antimicrobial effect (bacteriostatic and bactericidal) on staphylococci, streptococci, neisseria, anaerobic agents and other microorganisms, while the development of resistance is not observed.
The drug Grammidin, in addition to its antimicrobial effect, has antiviral, antifungal and anti-inflammatory effect. As a result of the activation of interferon synthesis, local immunity is stimulated. Also, discomfort in the throat is softened, swallowing is facilitated. It is very important that the drug is characterized by low toxicity, does not affect the normal microflora and does not cause dysbiosis.
Possible complications
What is the danger of the disease in the early and late stages? The consequences of acute tonsillitis can occur both during an active inflammatory process and after the resolution of the disease.
Rheumatism can occur as a complication of angina
Potential complications include:
- paratonsillitis and paratonsillar abscess;
- purulent cervical lymphadenitis;
- mediastinitis;
- rheumatism;
- periopharyngeal (lateropharyngeal) or retropharyngeal abscess;
- acute post-streptococcal glomerulonephritis;
- tonsillogenic sepsis;
- acute sinusitis;
- acute otitis media.
The spread of the purulent process into the peri-mucous tissue leads to the formation of a paratonsillar abscess, and upon transition to the periopharyngeal space and mediastinum - mediastinitis. Often, with the development of purulent complications, emergency surgery is required. In severe cases, tonsillogenic sepsis may occur.
Prevention
To prevent the development of angina or recurrence of inflammation, it is recommended to observe the necessary preventive measures.
One of the most effective methods of preventing disease is maintaining an active lifestyle.
You need to lead a healthy, active lifestyle that will help strengthen the immune system. Hardening is also shown, which is very important to do it right. The body should be accustomed to temperature changes in stages, starting with wiping with warm water in the morning, and then lowering its temperature by one degree per day. Thus, you can gradually learn to pour cold water over yourself.
Other preventive measures:
- Observe oral hygiene: brush your teeth twice a day, use dental floss and an irrigator, rinse your mouth after each meal, visit the dentist and carry out professional hygiene once every six months.
- Wash hands thoroughly before eating.
- Monitor the quality of food: nutrition should be balanced, correct, which will provide the body with the necessary vitamins and minerals.
- Actively ventilate the premises, use a humidifier.
With the development of various diseases, you should contact specialized specialists in a timely manner. This will help avoid chronicity of the process and the development of complications.
Video
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Alina Ervasova Obstetrician-gynecologist, consultant About the author
Education: First Moscow State Medical University. THEM. Sechenov.
Work experience: 4 years of work in private practice.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
