Acute tonsillitis: treatment, symptoms, complications
The content of the article:
- The reasons for the development of pathology
- Acute tonsillitis symptoms
-
Diagnostics
Differential diagnosis
-
Treatment of acute tonsillitis
- Medical care standard
- Features of therapy
- Complications
- Video
Acute tonsillitis, or tonsillitis, is a widespread acute infectious and inflammatory disease in which the lymphoid formations of the pharyngeal ring, mainly the palatine tonsils, are affected. The problem of treating the disease is still relevant, since the frequency of complications in angina is increasing every year.
The importance of prescribing adequate therapy for angina is associated with a high likelihood of complications.
The following forms of tonsillitis are distinguished:
- catarrhal;
- lacunar;
- follicular;
- combined.
Also, angina can be primary and secondary.
Acute tonsillitis code according to ICD-10 (International classification of diseases 10 revision):
- J0 Streptococcal tonsillitis;
- J8 Acute tonsillitis due to other specified pathogens.
The reasons for the development of pathology
The development of inflammation in the tonsils is most often associated with the ingestion of viruses or bacteria.
The most common causative agent of the disease is viruses
Typically, viruses are the causative agents, causing up to 40% of cases of angina:
- adenovirus;
- parainfluenza virus;
- respiratory syncytial virus;
- rhinovirus;
- enteroviruses (Coxsackie B virus);
- Epstein-Barr virus.
Beta-hemolytic group A streptococcus is especially dangerous among bacteria.
Among bacteria, beta-hemolytic streptococcus of group A is of paramount importance. This pathogen is associated with up to 20% of cases of angina in adults and up to 30% in children. Other bacteria can also be the cause of acute inflammation of the tonsils:
- pneumococci;
- streptococci of other groups;
- anaerobes;
- mycoplasma;
- chlamydia;
- spirochetes.
An important role in the development of acute inflammation in the tonsils and oropharynx is played by a decrease in general and local immunity. At the same time, saprophytic flora, which is normally present in the oral cavity, for example, mycotic lesion by yeast-like fungi of the genus Candida, can also become pathogenic.
Acute tonsillitis symptoms
Clinical manifestations of angina:
- sore throat;
- weakness;
- headache;
- increased body temperature;
- chills;
- decreased appetite.
Catarrhal sore throat is characterized by:
- a burning, dry, or sore throat;
- moderate pain in the throat, aggravated by swallowing;
- subfebrile body temperature (37.1–38.0 ° C);
- malaise, weakness;
- headache.
With follicular angina, the symptoms are more pronounced:
- severe sore throat, sharply worse when swallowing;
- irradiation of pain in the ear;
- an increase in body temperature above 38.0 ° C;
- difficulty swallowing;
- headache;
- weakness, chills;
- back pain, joints.
Lacunar angina is characterized by the same symptoms, but in a more severe form. There may be purulent plugs in the gaps.
With acute tonsillitis, the child's appetite disappears against the background of fever. He may also refuse to eat due to pain when swallowing. Angina in children can be accompanied by such disorders of the digestive system as nausea, vomiting, abdominal pain.
Diagnostics
The doctor makes a diagnosis based on complaints, medical history data, examination, results of laboratory and instrumental research methods.
To make a diagnosis, a pharyngoscopy is performed, if necessary, the doctor takes a photo of the throat
Angina is characterized by a sharp onset of the disease. The severity of symptoms of intoxication does not depend on the pathogen. So, streptococcal tonsillitis can proceed with normal body temperature, and with a viral infection, it can reach 40 ° C.
In most cases, angina is accompanied by the phenomena of regional lymphadenitis: the submandibular, anterior and posterior cervical lymph nodes increase in size, become dense and painful.
Pharyngoscopy reveals hyperemia and edema of the tonsils, palatine arches, posterior pharyngeal wall, as well as the soft palate and uvula. There is a plaque on the palatine tonsils. It can also be on the back of the pharynx. The plaque is loose, porous, easily removed with a spatula from the surface of the mucous membrane without a bleeding defect.
With streptococcal angina, a rash in the form of petechial hemorrhage may appear on the soft palate and uvula.
During a pharyngoscopy, a specialist can take a photo, take a smear for bacteriological culture and determine the sensitivity to antibacterial drugs.
To clarify the diagnosis, a clinical blood test is prescribed
In the clinical analysis of blood, an increased number of leukocytes, an increase in the erythrocyte sedimentation rate (ESR) are determined.
Thus, it is erroneous to make assumptions about the causative agent of acute inflammation based on symptoms and pharyngoscopic picture. It is especially important not to miss the sore throat caused by pyogenic streptococcus, since it is the beta-hemolytic streptococcus of group A that leads to various complications from the heart, kidneys, lungs, joints.
If you suspect the presence of group A beta-hemolytic streptococcus, an express test is performed
The rapid test for the qualitative detection of group A beta-hemolytic streptococcus is widely used. What is it? This is an express diagnostic method based on enzyme immunoassay, which allows you to determine the presence of pyogenic streptococcus without a special laboratory.
The examination takes 5-10 minutes, its accuracy is up to 98%. The test helps to timely diagnose streptococcal sore throat and avoid many complications.
Differential diagnosis
We must not forget that the acute form of tonsillitis can be a symptom of diphtheria, gonorrhea, scarlet fever and measles. Also, secondary tonsillitis can occur with infectious mononucleosis, tularemia, typhoid fever, leukemia.
Treatment of acute tonsillitis
Only the doctor decides how to treat this or that form of sore throat. For this, clinical guidelines are used.
Medical care standard
In most cases, treatment is carried out on an outpatient basis.
Most often, angina is treated at home.
In a serious condition of the patient, the presence of purulent complications or concomitant diseases with the likelihood of decompensation, hospitalization is required.
With bacterial angina, systemic antibiotic therapy is prescribed.
Symptomatic systemic treatment is indicated for the relief of fever or pain.
Local therapy is used to reduce the severity of inflammation.
Features of therapy
Angina of viral etiology does not require the use of antibiotics. In this case, the doctor prescribes antiviral drugs, immunomodulatory agents and local treatment.
Rational antibacterial therapy of angina caused by group A beta-hemolytic streptococcus is completely justified, since the number of complications of this pathology is increasing every year.
The drugs of choice for the treatment of acute tonsillitis are penicillins, cephalosporins of the 1st generation.
Antibiotics of the penicillin group:
- Amoxicillin + clavulanic acid;
- Benzathine Penicillin;
- Phenoxymethylpenicillin.
Among cephalosporins, Cefadroxil is often prescribed. With an exacerbation of a chronic process, cephalosporins of the second generation (Cefuroxime) are used.
With intolerance to these groups of antibiotics (beta-lactam), macrolides are shown:
- Spiramycin;
- Azithromycin;
- Roxithromycin;
- Clarithromycin;
- Josamycin.
Reserve drugs in the treatment of streptococcal angina are lincosamides (Lincomycin, Clindamycin).
The required dosage and duration of treatment with antibacterial agents is determined by the attending physician. Penicillins and cephalosporins are prescribed for an average of 10 days.
You should not stop taking the antibiotic ahead of time when the condition improves and the symptoms stop. Also, a spontaneous increase in the duration of treatment is not recommended. This can lead to the development of resistance of pathogenic flora to antibacterial agents.
To lower body temperature and relieve sore throat, non-steroidal anti-inflammatory drugs are recommended:
- Paracetamol;
- Ibuprofen.
For topical treatment, a nebulizer or steam inhaler can be used
Local therapy in the form of rinses, inhalations, tablets and lozenges has anti-inflammatory and analgesic effects.
The most widely used antiseptics and topical non-steroidal anti-inflammatory drugs are:
- benzalkonium chloride (Benatex);
- hexetidine (Hexoral);
- dichlorobenzyl alcohol + amylmetacresol (Strepsils, Suprima-ENT);
- chlorhexidine bigluconate (chlorhexidine);
- iodine preparations;
- octenidine + phenoxyethanol (MestaMidin-sense);
- miramistin (Miramistin);
- biclotymol (Hexasprey);
- flurbiprofen (Strepsils Intensive);
- benzydamine hydrochloride (Tantum Verde).
The lacunae of the tonsils are washed with an antiseptic solution and lubricated with 1% Lugol's solution.
Complications
Acute inflammation of the tonsils of viral or bacterial etiology can lead to purulent complications, namely:
- paratonsillar abscess;
- retropharyngeal abscess;
- purulent lymphadenitis.
Streptococcal tonsillitis can lead to non-suppurative complications:
- acute rheumatic fever (occurs 2–3 weeks after the onset of the disease);
- post-streptococcal glomerulonephritis (usually develops 8-10 days after the onset of the disease);
- streptococcal toxic shock syndrome (occurs 8-10 days after the onset of the disease);
- post-streptococcal reactive arthritis.
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.
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