Tonsillitis: symptoms, causes, treatment
The content of the article:
- Tonsillitis causes
- Classification
- Tonsillitis symptoms
-
Diagnostics
Differential diagnosis
- Treatment
- Prevention
- Complications
- Video
Tonsillitis is a common disease. Children are most susceptible to it (approximately 60–65% of all acute respiratory infections), especially at the age of 5–10 years. Symptoms of pathology in adults and children depend on the course of the inflammatory process, the presence of concomitant diseases.
Tonsillitis is characterized by inflammation of the tonsils
What is tonsillitis? Tonsillitis (from Latin tonsillae - tonsils) is an infectious disease, the leading symptom of which is an acute or chronic inflammatory process in the tonsils.
Chronic inflammation often contributes to the development of various complications. Acute tonsillitis, or tonsillitis, is a common disease characterized by rises in incidence in the spring and autumn. In adults, pathology occurs in 5–20% of cases of acute respiratory infections.
Tonsillitis causes
The disease develops when pathogenic bacteria or viruses enter the body. The most common pathogens among viruses are:
- adenovirus;
- parainfluenza virus;
- respiratory syncytial virus;
- rhinovirus;
- enteroviruses;
- Epstein-Barr virus.
Pyogenic streptococcus is one of the most common pathogens among bacteria
Among bacterial pathogens, beta-hemolytic group A streptococcus, or pyogenic streptococcus, plays an important role. About 15% of cases of angina are associated with it. Streptococcus is transmitted by airborne droplets, contact and food.
Also, the disease can be caused by:
- streptococci of groups C and G;
- pneumococci;
- anaerobes;
- mycoplasma;
- chlamydia;
- spirochetes;
- gonococci.
The pathogen enters the mucous membrane of the tonsils exogenously with inhaled air or food, as well as endogenously - from chronic foci of infections or with an increase in the pathogenicity of saprophytic microflora against the background of a decrease in general or local immunity.
Candida fungi lead to the development of pathology, usually against a background of reduced local immunity
In conditions of local immunodeficiency, the causative agent can be yeast-like fungi of the genus Candida, which are part of the normal flora of the oropharynx.
The development of the inflammatory process is facilitated by:
- injury to the tonsils;
- chronic inflammatory diseases of the mouth, nose and paranasal sinuses;
- violation of nasal breathing;
- concomitant somatic diseases of various organs and systems, which affect the general reactivity of the body.
Morphologically, with inflammation of the tonsils in the parenchyma, there is an expansion of blood and lymphatic vessels, infiltration of the mucous membrane with leukocytes.
In the pathogenesis of chronic inflammation, the main role is played by the violation of the protective and adaptive mechanisms of the tonsils, sensitization of the body. The pathogenic microflora in the gaps in chronic angina can become a triggering factor in the development of autoimmune processes.
Classification
Tonsillitis code according to ICD-10 (International Classification of Diseases 10 revision):
- J03.0 - streptococcal;
- J03.8 - acute, caused by other specified pathogens;
- J03.9 - acute, unspecified;
- J35.0 Chronic
Tonsillitis, depending on the course of inflammation, is divided into acute and chronic. Acute, in turn, can be primary or secondary.
Primary acute tonsillitis has the following forms:
- catarrhal;
- lacunar;
- follicular;
- ulcerative membranous, or necrotic.
In children, secondary acute tonsillitis often occurs with scarlet fever
Secondary acute tonsillitis can occur in acute infectious diseases, such as:
- diphtheria;
- scarlet fever;
- tularemia;
- typhoid fever;
- Infectious mononucleosis.
Also, the secondary inflammatory process develops against the background of hematological diseases (with agranulocytosis, leukemia, alimentary-toxic aleukia).
Chronic tonsillitis are divided into nonspecific and specific. Nonspecific chronic tonsillitis has a compensated and decompensated form. Specific inflammation of the tonsils develops with infectious granulomas - tuberculosis, syphilis, scleroma.
There is also a clinical classification of forms of pathology:
- catarrhal;
- follicular;
- lacunar;
- necrotic;
- phlegmonous;
- fibrinous;
- herpetic;
- mixed.
Tonsillitis symptoms
The main signs of tonsillitis are:
- discomfort or sore throat, aggravated by swallowing, may radiate pain to the ear;
- increased body temperature (tonsillitis can occur without temperature);
- putrid odor from the mouth;
- dry cough;
- deterioration of well-being: general weakness, pain in muscles and joints, headaches, decreased performance.
If severe swelling of the tonsils occurs, a feeling of tightness in the neck, difficulty breathing may appear.
Diagnostics
In order to establish a diagnosis and carry out differential diagnostics, it is necessary:
- collection of complaints and anamnesis;
- inspection;
- instrumental examination, including pharyngoscopy;
- microscopic, cytological, bacteriological examination of the discharge from the mucous membrane of the tonsils, oropharynx;
- clinical blood test.
From the photo of the throat taken during pharyngoscopy, changes in angina are clearly visible. There are several types of pharyngoscopy that allow you to visually examine the oropharynx and assess the condition of the mucous membrane.
Pharyngoscopy allows you to determine changes in the palatine tonsils
In the catarrhal form, there is hyperemia of the tonsils, they look swollen, the epithelium is loosened and saturated with serous secretion. There are no purulent deposits.
The follicular form is characterized by transillumination of the follicles through the mucous membrane in the form of yellow dots.
With a lacunar form, an accumulation of serous-mucous and purulent discharge occurs in the lacunae. Pus is composed of leukocytes, lymphocytes, epithelium, and fibrin. Wide drainage deposits can form.
The phlegmonous form is characterized by a violation of the drainage of lacunae, edema of the parenchyma of the tonsils, necrotic changes in the follicles, which, merging, can form an abscess. Such an abscess is located close to the surface of the amygdala and is emptied into the oral cavity.
The disease is characterized by an increase, induration and tenderness of regional lymph nodes: submandibular, anterior and posterior cervical.
When examining the oral cavity or during pharyngoscopy, the doctor takes material from the surface of the tonsils, the back wall of the pharynx for bacteriological inoculation, followed by determining the sensitivity to antibacterial drugs.
There is a rapid test to determine the presence of group A beta-hemolytic streptococcus in a scraping from the mucous membrane of the oropharynx. It is performed within 5–15 minutes and is an immunochromatographic method for express diagnostics of a qualitative assessment of the presence of the antigen of group A beta-hemolytic streptococcus. The analysis is performed by a doctor and does not require a special laboratory. The test sensitivity is 97%.
If it is necessary to clarify the diagnosis, a clinical blood test is prescribed
According to a clinical blood test, leukocyte shifts are assessed. In addition to general changes in the form of an increase in the number of leukocytes and an acceleration of ESR (erythrocyte sedimentation rate), with bacteriological damage, the number of neutrophils increases, a large number of stab (young) leukocytes appear. With a viral infection, lymphocytes increase. Thus, the analysis helps in diagnosis and differential diagnosis. For example, with infectious mononucleosis, the number of monocytes increases.
Differential diagnosis
Follicular angina must be differentiated from oropharyngeal diphtheria. Both diseases occur with high fever and intoxication, sore throat, congestion and enlargement of the tonsils, but there are distinctive signs that help the doctor correctly diagnose.
Differential diagnosis is carried out by an ENT doctor
With follicular angina, yellow plaque on the tonsils is easily removed, and bleeding is not noted. With diphtheria, islands of a shiny, dense fibrinous film are formed, which is removed with difficulty, after which a bleeding surface remains.
Also, with follicular angina, the relief of the lacunae is clearly visible, swelling of the tonsils is not noted, regional lymph nodes are painful on palpation. With diphtheria of the oropharynx, the relief of the tonsils is smoothed, they are edematous, the regional lymph nodes are painless.
For candidal sore throat is characterized by moderate hyperemia of the tonsils, the presence of a cheesy plaque of white or yellow. As a rule, the fungal infection is preceded by long-term antibiotic therapy.
With tuberculosis on the palatine arches, tonsils, ulcers of a pale pink color with uneven edges, covered with a purulent bloom, can form. The correct diagnosis is established through microscopic and bacteriological analysis.
Under the guise of sore throat, a tumor lesion of the tonsils, oropharynx can occur, which manifests itself in the form of tissue decay. The diagnosis is established on the basis of the results of a histological examination of a biopsy of the tonsils.
The development of secondary tonsillitis is possible with blood diseases, for example, with acute leukemia. Follicles can fuse and disintegrate. The disease is characterized by the rapid spread of necrotic changes in the tonsils. In establishing the diagnosis, the typical blood changes characteristic of leukemia play an important role.
Treatment
With bacterial lesions, systemic antibiotic therapy is prescribed. Its purpose is to destroy the pathogen, limit the focus of infection, and prevent purulent and autoimmune complications. First, drugs of the group of penicillins or cephalosporins of the third generation are prescribed. The drugs of choice for the treatment of acute streptococcal tonsillitis are phenoxymethylpenicillin, aminopenicillins. The antibiotic is prescribed for 10 days.
Drug therapy is prescribed by a doctor depending on the causative agent of the disease, general condition and age of the patient
In case of allergic reactions to penicillins (Amoxicillin) and cephalosporins (Cefixime), macrolides are prescribed. The duration of treatment with Azithromycin is 5 days.
In chronic angina, antibiotics are used during an exacerbation.
In the absence of positive dynamics (in the form of a decrease in body temperature and a decrease in the severity of pain in the throat within 72 hours from the start of therapy), the doctor may change the antibiotic.
You should not select or replace the drug on your own, as this can lead not only to complications, but also contribute to the formation of resistance of microorganisms to the antibiotic. If any adverse reactions occur, you should immediately consult a doctor.
In case of viral infection, prophylactic antibiotics are not recommended.
With candidiasis, systemic antifungal therapy is performed.
To lower body temperature and reduce pain, symptomatic treatment with non-steroidal anti-inflammatory drugs (Paracetamol, Ibuprofen) is indicated.
As part of a complex treatment, inhalation and rinsing is indicated.
It is very important to carry out local treatment in the form of rinsing, inhalation, the use of tablets and lozenges for resorption. Thanks to this, the severity of the pain syndrome decreases. It does not rule out systemic antibiotic therapy.
Local antiseptics are recommended:
- chlorhexidine;
- iodine preparations;
- sulfonamides;
- biclotymol;
- lysozyme.
Tonsils are lubricated with 1% Lugol's solution, 2% collargol solution, 40% propolis solution or interferon ointment.
After washing, antiseptic pastes are injected intralacunar: etonium, gramicidin. They have a wide range of effects, providing a bacteriostatic effect on pathogenic microflora.
According to the indications, general strengthening and immunostimulating agents are prescribed.
With chronic angina, physiotherapy is additionally carried out.
Prevention
Preventive measures to prevent the development of angina include:
- compliance with the rules of personal hygiene;
- taking complex vitamin preparations in the autumn and spring;
- limiting contact with patients with acute tonsillitis to prevent airborne transmission of infection;
- treatment of chronic upper respiratory tract infections.
Complications
Why is the inflammatory process in the tonsils dangerous? Angina can cause severe complications, leading to diseases of the cardiovascular system.
Otitis media is one of the possible complications of tonsillitis
In case of untimely diagnosis or inadequate treatment, the transition of an acute process to a chronic one is possible.
Streptococcal sore throat can cause purulent complications:
- otitis;
- sinusitis;
- mastoiditis;
- paratonsillar abscess;
- cervical lymphadenitis;
- meningitis;
- endocarditis;
- pneumonia.
Late non-purulent consequences are also possible:
- post-streptococcal glomerulonephritis;
- toxic shock;
- acute rheumatic fever.
Video
We offer for viewing a video on the topic of the article.
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!
