Follicular Tonsillitis - Symptoms, Treatment

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Follicular tonsillitis

The content of the article:

1. Causes and risk factors
2. Forms of the disease
3. Follicular sore throat symptoms
4. Diagnostics
5. Follicular sore throat treatment
6. Possible complications and consequences
7. Forecast
8. Prevention

Angina is an acute local infectious and inflammatory disease in which the tissue of the tonsils that form the pharyngeal lymphoid ring (most often - palatine, much less often - pharyngeal, lingual and tubal) is affected.

Yellowish-white dots on the tonsils - a characteristic symptom of follicular sore throat

Follicular sore throat is a type of disease in which purulent inflammation (suppuration) of individual tonsil follicles develops, which creates a specific picture of the "starry sky".

Follicular tonsillitis is ubiquitous, affecting both men and women equally. It is more common in childhood and adolescence (which is due to the imperfection of the immune system), with the exception of children of the first year of life, in whom this disease is recorded extremely rarely due to the antitoxic and antimicrobial streptococcal immunity acquired from the mother during breastfeeding. In the structure of morbidity, the share of persons under 30 years old accounts for ¾ of all cases of follicular tonsillitis, after 50 years the probability of developing follicular tonsillitis is much lower.

Follicular tonsillitis can act as an independent disease, but in some cases it can also be an ENT symptom of common acute infectious diseases.

Causes and risk factors

The main cause of follicular sore throat is infection with pathogenic bacteria, viruses or fungi, or autoinfection with its own opportunistic microflora, which is activated when the local immunity tension decreases.

The bacterial agents most commonly associated with follicular sore throat include:

• β-hemolytic streptococcus group A, GABHS (is the cause in more than 50-70% of cases);
• streptococci of groups C and G (along with GABHS, cause 30-40% of all cases of angina in pediatric practice);
• arcanobacteria (most often found in the age group up to 25-30 years old);
• neisseria;
• pneumococci;
• meningococci;
• coli influenza;
• klebsiella; and etc.

Viruses provoke the development of the disease much less often, the main cause of follicular sore throat is the following:

• adenovirus;
• rhinovirus;
• coronavirus;
• influenza and parainfluenza viruses;
• Epstein-Barr virus;
• Coxsackie virus A.

In some cases, the disease can be caused by the pathogenic effect of fungi of the genus Candida, usually in association with viruses or bacteria.

Infection of the tissue of the tonsils with pathogenic microflora usually occurs by airborne droplets or alimentary, but it is not excluded with direct contact. In addition to infection from the outside, endogenous infection is possible in the presence of a chronic inflammatory process in the ENT zone, especially often in chronic tonsillitis (in this case, group A β-hemolytic streptococcus can persist for a long time in the internal structures of the tonsils).

Sometimes follicular sore throat may be due to exposure to Candida in the body

The intensity and severity of the inflammatory process depends on several factors:

• the number of microorganisms that have penetrated the mucous membrane of the tonsils;
• the degree of pathogenicity (virulence) of the infectious agent;
• the presence of risk factors.

Risk factors for developing follicular sore throat:

• general hypothermia or local exposure to extremely low temperatures;
• acute psycho-emotional overstrain or prolonged chronic stress;
• previous acute infectious and inflammatory diseases (especially with the involvement of ENT organs);
• burdened allergic anamnesis;
• hypo- and vitamin deficiency;
• unfavorable environmental conditions (smoke, high levels of gas pollution, the presence of toxic substances in the inhaled air, etc.);
• unfavorable climatic conditions (cold, damp weather or excessively high air temperature along with low humidity, lack of sunlight);
• previous mechanical damage to the tonsils;
• autonomic maladjustment;
• chronic inflammatory diseases of the ENT-zone organs;
• immunodeficiency states;
• severe chronic diseases (decompensated diabetes mellitus, tuberculosis, malignant neoplasms, etc.);
• young age (maximum functional activity of lymphoid tissue);
• stay in places where a large number of people congregate (kindergartens and educational organizations, offices, health camps, public transport, shopping centers, markets, etc.).

Follicular tonsillitis develops as a violent, rapid allergic inflammation: decay products in the focus of inflammation play the role of sensitizing agents that can provoke the involvement of other organs and tissues in the pathological process (myocardium, joints, kidneys, etc.).

Forms of the disease

Depending on the clinical picture of the disease, the following forms of follicular sore throat are distinguished:

• vulgar (characterized by a set of typical signs: obvious manifestations of intoxication syndrome, relief of manifestations of the disease within 7 days, viral or bacterial nature, involvement of both palatine tonsils in the pathological process);
• atypical, or atypical.

Follicular sore throat symptoms

The main symptoms of follicular sore throat:

• sudden, rapid onset of the disease;
• acute pain in the pharynx, especially pronounced in the projection of the tonsils, aggravated by swallowing;
• discomfort, scratching sensation, sore throat;
• deterioration in general well-being, decreased performance, drowsiness, intolerance to habitual physical activity, apathy, decreased or complete lack of appetite;
• an increase in body temperature up to 38-39 ºС, accompanied by severe chills, sweating, headache, dizziness;
• unpleasant, putrid odor from the mouth;
• when the inflammation resolves, a wet cough often occurs with the separation of purulent plugs;
• increase and soreness on palpation of regional lymph nodes (submandibular, anterior and posterior cervical, parotid).

The main symptom of follicular sore throat is a sharp sore throat, aggravated by swallowing

An objective examination of the patient reveals a pronounced hyperemia of the mucous membrane of the posterior pharyngeal wall, soft palate, hypertrophy and swelling of the tonsils. Against the background of enlarged, hyperemic tonsils, chaotically scattered yellowish-white dots are noted, resembling a picture of the starry sky (festering follicles located under the mucous membrane).

Diagnostics

The basis for the diagnosis of follicular angina is the assessment of the clinical picture of the disease and the results of laboratory research methods:

• complete blood count (leukocytosis with neutrophilic shift to the left, accelerated ESR);
• biochemical blood test (acute phase indicators);
• microscopy of a smear from the oropharynx and inoculation of the material on a nutrient medium in order to clarify the type of pathogen and differential diagnosis of follicular tonsillitis and diphtheria;
• determination of streptococcal antigen in smears by agglutination;
• immunodiagnosis of increased titers of anti-streptococcal antibodies.

With follicular angina, a blood test shows leukocytosis and accelerated ESR

The detection of a β-hemolytic group A streptococcus in the materials of a smear from the pharyngeal cavity is carried out in order to determine the tactics of treatment, since this type of microorganism is the most pathogenic of the group of streptococci, it can cause serious infectious and inflammatory diseases, therefore its timely detection and eradication are necessary for preventing the development of secondary complications.

Follicular sore throat treatment

Treatment of follicular sore throat, accompanied by intense symptoms of intoxication and active manifestations with the involvement of the cardiovascular, urinary systems, articular apparatus in the pathological process, is carried out in stationary conditions after the patient is hospitalized.

Follicular tonsillitis without systemic manifestations with moderate symptoms is not an indication for inpatient treatment, the patient is observed at home.

The basis of the pharmacotherapy of the disease is the intake of antibacterial drugs for a course of at least 10 days. In this case, the drugs of choice are β-lactam antibiotics: protected semi-synthetic penicillins and cephalosporins.

With follicular angina, antibiotic therapy with penicillins and cephalosporins is indicated

Treatment with drugs of the macrolide group is inappropriate, since immunity to these drugs in the Russian Federation reaches, according to the most conservative estimates, 17-20% (according to some data - up to 40%). Also, sulfa drugs and tetracyclines are not used for the treatment of the disease, since the absence of a positive response to their therapy for follicular angina is noted in 6 out of 10 patients.

In case of allergy to penicillins or cephalosporin drugs, pharmacotherapy with lincosamides is performed.

In addition to antibiotic therapy, treatment of follicular sore throat includes the following measures:

• bed rest;
• a diet based on the principles of mechanical, thermal and chemical sparing;
• abundant fortified drink;
• desensitizing therapy;
• antipyretic drugs on demand;
• local anesthetics, antiseptics (sprays, aerosols, rinses, lozenges, etc.);
• warming compresses on the submandibular region;
• vitamin and mineral complexes.

Possible complications and consequences

Complications most common in follicular angina:

• peritonsillitis;
• paratonsillar abscess;
• epiglottitis;
• inflammation of the middle ear;
• eustachitis;
• mediastinitis;
• myocarditis;
• polyarthritis;
• glomerulonephritis;
• reactive inflammation of the organs of the hepatobiliary zone;
• reactive pancreatitis.

Forecast

The prognosis is favorable with timely diagnosis and rational antibiotic therapy. A worsening prognosis for complications is characteristic of a severe course, resistance to therapy, incorrect treatment, the presence of severe concomitant diseases, in immunocompromised patients.

Prevention

1. Refusal to visit places where a large number of people gather during the period of maximum incidence of respiratory infections.
2. Compliance with personal hygiene measures (washing hands, using individual cutlery and household items).
3. Carrying out hardening, fortifying activities.
4. Timely treatment of ENT diseases.

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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author

Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".

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!