Acute common infectious disease, mainly affecting the tonsils. The inflammatory process may be localized in other clusters limfadenoidnoy tissues of the pharynx and larynx - in lingual, laryngeal, nasopharyngeal tonsils. Then accordingly suggest lingual, laryngeal or retronazalnoy angina. Infection can be exogenous (more often) or endogenous (self-infection). There are two modes of transmission: airborne and alimentary. Endogenous infection occurs in the mouth or throat (chronic inflammation of the tonsils, carious teeth, etc.). The source of infection can also be purulent diseases of the nose and paranasal sinuses.
Etiology. The most common infectious agents are staphylococci, streptococci (particularly hemolytic), pneumococcus. There is information about the possibility of viral sore throats. Predisposing factors: local and general cooling, reduced reactivity. Angina usually affects children of preschool and school age and adults 35 - 40 years, especially in autumn and spring.
Symptoms within. Pain on swallowing, malaise, fever. Frequent complaints of joint pain, headaches, intermittent fever. Disease duration, and local changes in the tonsils are dependent on the form of angina. For rational treatment and adherence angina lasts on average 5-7 days. Distinguish bluetongue, follicular and lacunary form of angina. Essentially these are different manifestations of the same inflammatory process in the tonsils.
Catarrhal angina. Usually starts suddenly and tickling, diffuse pain in the throat, general malaise, subfebrile temperature. Changes in blood mild expressed or absent. On examination of the pharynx (pharyngoscope) indicated moderate swelling, redness of the tonsils and surrounding areas of the palatine arches, the soft palate and the posterior pharyngeal wall is not changed. Regional lymph nodes may be enlarged and painful on palpation. Catarrhal angina may be the initial stage of the other forms of angina, and sometimes a manifestation of a contagious disease.
Lacunar and follicular angina characterized by more severe clinical picture. Headache, sore throat, nausea, general weakness. Changes in the blood greater than catarrhal angina. Often, the disease begins chills, fever up to 38-39 ° C and above, especially in children. The high leukocytosis-20 10 (in the ninth degree) / n and a shift to the left of white blood count and a high erythrocyte sedimentation rate (40-50 mm / h). Regional lymph nodes are enlarged and painful on palpation. When pharyngoscope a marked congestion and swelling of the tonsils and surrounding areas of the soft palate and palatine arches. When tonsillitis seen festering follicles shining through the mucous membrane in the form of small yellow-white bubbles. When lacunar angina also formed a yellowish-white attacks, but they are located at the mouths of gaps. These attacks can later merge with each other, covering all or almost all of the free surface of the tonsils, and are easily removed with a spatula.
Division for follicular tonsillitis and lacunary conditional, as one and the same patient can be both a follicular and lacunar tonsillitis.
Sore throat abscess. Acute purulent inflammation okolomindalikovoy fiber. Often a complication of one of the above forms of angina and develops after 1 -2 days after it ended angina. The process usually unilateral, characterized by sharp pain in the throat when swallowing, headache, chills, feeling of weakness, malaise, nasal, trismus masticatory muscles, increase body temperature to 38-39 grams. C, bad breath, profuse salivation. Changes in the blood correspond acute inflammation. Regional lymph nodes are greatly enlarged and painful on palpation. When pharyngoscope dramatically on congestion and swelling of tissues of the soft palate on one side. Tonsils on this side shifted to the median line and the bottom. Due to swelling of the soft palate often see the amygdala can not. The mobility of the affected half of the soft palate is significantly restricted, which can lead to leakage of liquid food from the nose.
If the first 2 days of vigorous treatment of quinsy is not started, then the 5-6-day limited abscess may form in okolomindalikovoy tissue - peritonsillar (paratonsillar) abscess. With high and low virulence microorganisms reactivity abscess may form, despite active treatment, earlier than usual (3-4th day of the disease). When the formed peritonsillar abscess can be seen thinned portion of the mucous membrane white-yellow color - translucent abscess. After self or abscess incision is rapid regression of the disease. In recent years there has healed up to 1-2 months form quinsy with periodic abscess formation, which is associated with inappropriate use of antibiotics. Inflammation of throat ring limfadenoidnom not always indicate a sore throat.
Differential diagnosis should be made with scarlet fever, diphtheria, measles, influenza, acute inflammation of the upper respiratory tract, including acute pharyngitis, with acute blood diseases - mononucleosis, etc. (see Diseases of the blood). In addition to the clinical symptoms of angina is of great importance and the nature of local changes detected on examination of the pharynx and larynx (pharyngitis and laryngoscopy, pharyngorrhinoscopy). Important role played by data from laboratory studies (study tonsils raids on sticks diphtheria, complete blood count). For example, the detection of specific mononuclear cells in the blood indicates infectious mononucleosis.
In clinical practice it is often necessary to differentiate from angina lacunary localized diphtheria throat. Angina in diphtheria is the most dangerous in the epidemiological and because of possible complications. Suspected diphtheria should have been an overall survey of the patient. Angina in diphtheria causes severe intoxication: the patient lethargic, pale, adinamichen, but at the same temperature reaction may be poorly expressed (within subfebrile). On palpation of the cervical lymph node involvement increased, and edema fat neck. Faringoskopicheski with lacunar angina attacks show a yellowish-white color, localized within the tonsils in diphtheria they go beyond the tonsils and have a dirty gray color. When lacunar angina plaque removed easily by coating the surface of the tonsils is not changed, with diphtheria raids are removed from the difficulty in removing plaque found eroded area of the mucosa.
When lacunar angina - always sided symptoms, with diphtheria - often localized changes can be one-way (especially in mild to moderate forms of the course). For suspected diphtheria should urgently take smear attacks tonsils for bacteriological examination for the presence of diphtheria bacilli. The patient should be hospitalized immediately in box office infectious hospital.
Diagnosis of peritonsillar abscess is easy. The typical clinical picture, which developed after a seemingly ending sore throat, congestion and unilateral sudden swelling of tissues of the soft palate, protrusion of the amygdala to the median line, a significant increase in body temperature indicate inflammation okolomindalikovoy fiber.
Complications: rheumatism, cholecystitis, orchitis, meningitis, nephritis, etc. From the local complications, except for the above quinsy, the most frequent acute otitis media, acute laryngitis, laryngeal edema, parafaringealny abscess, acute cervical lymphadenitis, abscess neck.
Treatment. In the early days of the disease before the normalization temperature is prescribed bed rest. The food should be rich in vitamins, non-acute, unheated and not cold. It is useful to drink plenty of liquids: fresh fruit juice, lemon tea, milk, alkaline mineral water. Necessary to monitor the function of the intestine. Medications should be used strictly individually, depending on the nature of angina, the status of other organs and systems. In mild angina without the expressed intoxication appoint indications sulfa drugs inside, adults, 1 g four times a day. In severe cases, with significant toxicity, prescribed antibiotics. Increasingly using penicillin V / m to 200 000 IU 4-6 times a day. If the patient can not tolerate penicillin, erythromycin is prescribed to 200 000 units in during meals 4 times a day for 10 days, or oletetrin 250 000 IU orally 4 times a day for 10 days, or tetracycline into the 250 000 units 4 times a day for 10 days.
Rheumatic patients, and those with pathological changes in the kidney to prevent the exacerbation of the disease prescribe antibiotics regardless of the form of angina. Inside appointed as acetylsalicylic acid, 0.5 g 3-4 times a day, ascorbic acid, 0.1 g 4 times a day.
Etiology. The most common infectious agents are staphylococci, streptococci (particularly hemolytic), pneumococcus. There is information about the possibility of viral sore throats. Predisposing factors: local and general cooling, reduced reactivity. Angina usually affects children of preschool and school age and adults 35 - 40 years, especially in autumn and spring.
Symptoms within. Pain on swallowing, malaise, fever. Frequent complaints of joint pain, headaches, intermittent fever. Disease duration, and local changes in the tonsils are dependent on the form of angina. For rational treatment and adherence angina lasts on average 5-7 days. Distinguish bluetongue, follicular and lacunary form of angina. Essentially these are different manifestations of the same inflammatory process in the tonsils.
Catarrhal angina. Usually starts suddenly and tickling, diffuse pain in the throat, general malaise, subfebrile temperature. Changes in blood mild expressed or absent. On examination of the pharynx (pharyngoscope) indicated moderate swelling, redness of the tonsils and surrounding areas of the palatine arches, the soft palate and the posterior pharyngeal wall is not changed. Regional lymph nodes may be enlarged and painful on palpation. Catarrhal angina may be the initial stage of the other forms of angina, and sometimes a manifestation of a contagious disease.
Lacunar and follicular angina characterized by more severe clinical picture. Headache, sore throat, nausea, general weakness. Changes in the blood greater than catarrhal angina. Often, the disease begins chills, fever up to 38-39 ° C and above, especially in children. The high leukocytosis-20 10 (in the ninth degree) / n and a shift to the left of white blood count and a high erythrocyte sedimentation rate (40-50 mm / h). Regional lymph nodes are enlarged and painful on palpation. When pharyngoscope a marked congestion and swelling of the tonsils and surrounding areas of the soft palate and palatine arches. When tonsillitis seen festering follicles shining through the mucous membrane in the form of small yellow-white bubbles. When lacunar angina also formed a yellowish-white attacks, but they are located at the mouths of gaps. These attacks can later merge with each other, covering all or almost all of the free surface of the tonsils, and are easily removed with a spatula.
Division for follicular tonsillitis and lacunary conditional, as one and the same patient can be both a follicular and lacunar tonsillitis.
Sore throat abscess. Acute purulent inflammation okolomindalikovoy fiber. Often a complication of one of the above forms of angina and develops after 1 -2 days after it ended angina. The process usually unilateral, characterized by sharp pain in the throat when swallowing, headache, chills, feeling of weakness, malaise, nasal, trismus masticatory muscles, increase body temperature to 38-39 grams. C, bad breath, profuse salivation. Changes in the blood correspond acute inflammation. Regional lymph nodes are greatly enlarged and painful on palpation. When pharyngoscope dramatically on congestion and swelling of tissues of the soft palate on one side. Tonsils on this side shifted to the median line and the bottom. Due to swelling of the soft palate often see the amygdala can not. The mobility of the affected half of the soft palate is significantly restricted, which can lead to leakage of liquid food from the nose.
If the first 2 days of vigorous treatment of quinsy is not started, then the 5-6-day limited abscess may form in okolomindalikovoy tissue - peritonsillar (paratonsillar) abscess. With high and low virulence microorganisms reactivity abscess may form, despite active treatment, earlier than usual (3-4th day of the disease). When the formed peritonsillar abscess can be seen thinned portion of the mucous membrane white-yellow color - translucent abscess. After self or abscess incision is rapid regression of the disease. In recent years there has healed up to 1-2 months form quinsy with periodic abscess formation, which is associated with inappropriate use of antibiotics. Inflammation of throat ring limfadenoidnom not always indicate a sore throat.
Differential diagnosis should be made with scarlet fever, diphtheria, measles, influenza, acute inflammation of the upper respiratory tract, including acute pharyngitis, with acute blood diseases - mononucleosis, etc. (see Diseases of the blood). In addition to the clinical symptoms of angina is of great importance and the nature of local changes detected on examination of the pharynx and larynx (pharyngitis and laryngoscopy, pharyngorrhinoscopy). Important role played by data from laboratory studies (study tonsils raids on sticks diphtheria, complete blood count). For example, the detection of specific mononuclear cells in the blood indicates infectious mononucleosis.
In clinical practice it is often necessary to differentiate from angina lacunary localized diphtheria throat. Angina in diphtheria is the most dangerous in the epidemiological and because of possible complications. Suspected diphtheria should have been an overall survey of the patient. Angina in diphtheria causes severe intoxication: the patient lethargic, pale, adinamichen, but at the same temperature reaction may be poorly expressed (within subfebrile). On palpation of the cervical lymph node involvement increased, and edema fat neck. Faringoskopicheski with lacunar angina attacks show a yellowish-white color, localized within the tonsils in diphtheria they go beyond the tonsils and have a dirty gray color. When lacunar angina plaque removed easily by coating the surface of the tonsils is not changed, with diphtheria raids are removed from the difficulty in removing plaque found eroded area of the mucosa.
When lacunar angina - always sided symptoms, with diphtheria - often localized changes can be one-way (especially in mild to moderate forms of the course). For suspected diphtheria should urgently take smear attacks tonsils for bacteriological examination for the presence of diphtheria bacilli. The patient should be hospitalized immediately in box office infectious hospital.
Diagnosis of peritonsillar abscess is easy. The typical clinical picture, which developed after a seemingly ending sore throat, congestion and unilateral sudden swelling of tissues of the soft palate, protrusion of the amygdala to the median line, a significant increase in body temperature indicate inflammation okolomindalikovoy fiber.
Complications: rheumatism, cholecystitis, orchitis, meningitis, nephritis, etc. From the local complications, except for the above quinsy, the most frequent acute otitis media, acute laryngitis, laryngeal edema, parafaringealny abscess, acute cervical lymphadenitis, abscess neck.
Treatment. In the early days of the disease before the normalization temperature is prescribed bed rest. The food should be rich in vitamins, non-acute, unheated and not cold. It is useful to drink plenty of liquids: fresh fruit juice, lemon tea, milk, alkaline mineral water. Necessary to monitor the function of the intestine. Medications should be used strictly individually, depending on the nature of angina, the status of other organs and systems. In mild angina without the expressed intoxication appoint indications sulfa drugs inside, adults, 1 g four times a day. In severe cases, with significant toxicity, prescribed antibiotics. Increasingly using penicillin V / m to 200 000 IU 4-6 times a day. If the patient can not tolerate penicillin, erythromycin is prescribed to 200 000 units in during meals 4 times a day for 10 days, or oletetrin 250 000 IU orally 4 times a day for 10 days, or tetracycline into the 250 000 units 4 times a day for 10 days.
Rheumatic patients, and those with pathological changes in the kidney to prevent the exacerbation of the disease prescribe antibiotics regardless of the form of angina. Inside appointed as acetylsalicylic acid, 0.5 g 3-4 times a day, ascorbic acid, 0.1 g 4 times a day.
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