Angina

Angina (angina pharyngis, lat. angina, from ango - squeeze, soul; synonym: acute tonsillitis, acute amygdala) - the total acute infectious disease in which inflammation is expressed mainly in lymphadenoid tissue of the throat (often the tonsils).
Sore throat is one of the most common diseases of the upper respiratory tract, by frequency ranks second (after influenza and acute respiratory catarrh). Angina are mostly children of preschool and school age and adults up to 35-40 years. In infants and people of old age angina is rare.
Etiology. In the etiology of angina main role belongs to different types of bacteria, mainly beta-hemolytic Streptococcus group a, more rarely staphylococci, pneumococci; sometimes set and viral origin of angina (adenoviruses and others). Parasites can enter the body from the outside through droplet infection or with food (exogenous path); in other cases, the disease is the result of activation of microbes, saprophyticus in the gaps tonsils or on their surface (endogenous path). The latter, as a rule, is observed frequently in people with chronic tonsillitis, different diseases of the oral cavity and the upper respiratory tract. Acute inflammation in the area of the tonsils can occur by type of secondary infection in various diseases, drastically reducing immune response of the body, such as blood diseases. In the development of angina significant role belongs to modify the reactivity of the organism, which can be caused by many reasons, most often, General or local cooling. So soft people, as a rule, are sick with flu. Of great importance fatigue, poor nutrition, unfavorable industrial and domestic factors. A special role in the implementation of allergic reactions play tonsil. Streptococci, located on the surface and in the gaps, have sometimes expressed sensitizing properties. In certain conditions, the tonsils are formed autoallergy.
Pathological anatomy. Pathological changes in the tonsils are directly dependent on the nature of the General disease, local damage and age peculiarities. As a rule, the process in angina bilateral, inflammatory phenomenon in the amygdala can develop on its zemnoi the surface and in the deep gaps in the parenchyma. In catarrhal angina marked redness, swelling, leukocytic infiltration parenchyma tonsils. The epithelium on the surface of the tonsils and gaps in places thickens and clusively. When and lacunar tonsillitis its inflammation more pronounced. In the parenchyma of the tonsils are formed lymphohistiocytosis infiltrates areas of necrosis. In the gaps violated the integrity of the epithelium; a large number of sero-mucous discharge with admixture of leukocytes, lymphocytes, detached cells, cholesterol crystals and even colonies of bacteria. Violation of the integrity of the surface epithelium of causes plentiful allocation of leukocytes and fibrin, and therefore formed fibrinous film, the raids. Sometimes these films merge together and on the surface of the amygdala is formed "drain" plaque. In some areas-thrombosis small tonsillar veins and enlargement of the lymph vessels. Ulcero-necrotic angina is characterized by the predominance of the phenomena of tissue necrosis tonsils. Sometimes necrosis applies to palatal arch, the soft palate and uvula. Such phenomena are most often when blood diseases, including agranulocytosis, aleikia, as well as in angina Simanovsky - Plaut - Vincent.
The clinical picture and over. The incubation period for sore throat lasts from several hours to several days. In the prodromal period is marked malaise, unpleasant sensations in the throat when swallowing, sore. Then pain in throat when swallowing, deteriorating overall health. The severity of these phenomena in different forms of angina and in different reactivity of organism is very diverse. The most frequent catarrhal, lacunar and follicular, at least - necrotic lesions and other forms of angina.

angina photo

Catarrhal angina occurs most easily, characterized by a primary lesion of the tonsils and the free edge of the front of the Palatine arches (redness and swelling) (printing. table, Fig. 1). The disease begins abruptly with a slight sore throat, feeling sore, dry, foreign body in the throat. There are General malaise, fatigue, headache, sometimes chill. Soon the pain in throat when swallowing increases, often priuchayut, become painful and submandibular cervical lymph nodes. The temperature is usually low grade, rarely above 38 degrees. In children, the General condition is violated in a greater degree, the temperature sometimes rises to 39-39,5 degrees. The duration of the disease on average 3-5 days. If the temperature is long gone, remains malaise, this indicates complicated process. Catarrhal angina can move in a lacunar, follicular, phlegmonously.
Lacunar and follicular tonsillitis is characterized by a more severe clinical picture. Some clinicians do not distinguish these forms of angina, because sometimes it is difficult and almost not necessary. Symptoms depends on the degree of intoxication. There are strong pain in throat when swallowing, malaise, fatigue, pulling sensation in the legs and lower back, headache, g degrees to 39-40 degrees. In the blood - leukocytosis (the number of leukocytes to 20 000-25 000), shift leukocyte left, ROE accelerated, sometimes up to 40-50 mm per hour. Regional lymph nodes are usually enlarged, painful. If laringoscopiei - sharp hyperemia and infiltration of the mucous membrane of the throat, swelling of the tonsils. With follicular tonsillitis on outstanding surface tonsils visible rounded yellowish-white dots - inflamed follicles; tonsil surface reminiscent of the picture of the sky (printing. table, Fig. 2). When lacunar tonsillitis in the necks of the gaps appear yellowish-white RAID, which can be merged (printing. table, Fig. 3); the disease usually lasts for 5-7 days.
Phlegmonously angina (printing. table, Fig. 4) should be considered as a process that is located in the amygdala. When the abscess, developing in the parenchyma of the tonsils,the so - called mihalikova or vnutrijeludockova, General and local inflammation less pronounced. Abscess often independently opened in the lumen of the throat through one of the tonsil crypts.
Angina Simanovsky - Plaut - Vincent (synonym ulcerative-filmy angina) often develops in people, exhausted previous illnesses, when malnutrition. A special agent of this form angina is fusospirochetal symbiosis - spindle-shaped wand (You. fusiformis) and spirochetes of the oral cavity (Spirochaeta buccalis), which are often found in the mouth in avirulent condition. Angina Simanovsky - Plaut - Vincent is a particular nosological form, often occurs simultaneously with ulcerative stomatitis similar etiology.
The disease sometimes occurs sporadically, sometimes in the form of mass outbreaks. Characteristic of the one-sidedness of the process, a slight pain in throat when swallowing, nerezko expressed regional lymphadenitis. The General condition violated a little, low-grade temperature or normal. On tonsils raids yellowish-white color (printing. table, Fig. 5)consisting of dead parts of mucous membrane; after their exclusion remains a yellowish surface ulcer with sharp edges. In rare cases, except mucosa, izyaslau underlying tissues and even periosteum, which may lead to perforation of the hard palate, the destruction of the gums, tooth loss.
The accession of the coccal flora alter the overall clinical picture; there are strong pain when swallowing, halitosis, greatly increases the temperature. In first blood neutrophilic leucocytosis (the number of leukocytes to 15 000), and in the subsequent and moderate anemia. The disease lasts 8-14 days, but may last for several weeks and even months. Bacteria fotospuredee Association are sometimes found when izyaslavsky cancer of the tonsils, which often leads to diagnostic error.
The so-called herpes angina is characterized by eruption of vesicles on the mucous membrane of the mouth, rarely on tonsils, so to speak of herpes mediaengine. The disease is caused by viruses. Recently began to allocate adenovirus sore throat; to confirm the diagnosis, a number of special laboratory tests (see Adenovirus infections).
In a special group include the so-called secondary sore throat diseases of the blood (agranulozitos, Alenia alimentary toxic, leukemia, listeriosis, infectious mononucleosis).


Angina lingual tonsils often occurs simultaneously with the defeat of other tonsils, but sometimes it is a separate disease. In addition to the General phenomena characterized by pain in the depth of the throat and tongue, in the middle. Local changes are detected only at laryngoscopy: lingual tonsil hyperemic, infiltrated, sometimes covered with a point or drain yellowish-white bloom. In some cases there is an acute inflammation of lymphadenoid tissue localized in the nasopharynx, as well as on the sides and on the back of the throat, - angina nasopharyngeal tonsils, sore throat side rollers (printing. table, Fig.6) and angina granules back of the throat.
A special place is occupied by diseases akromegaliei fiber essentially non angina, but which for many years retained the name "angina". To them in the first place is the so-called flegmona A., or, more correctly, acute paratonsillar, as in the inflammatory process involves mainly okoloserdecna fiber and other extraordinaria tissue. Suppurative microbes penetrate here from the crypts of the tonsils, in most cases, during or shortly after the end of A. true
There are three forms, or stage, acute paratonsillitis: swollen, infiltrative and abstemious (B. S. Preobrazhenskaya). Localization can be the following akromegaliei (peritonsillar, peritonsillar) abscesses.
1. Front or front-upper (supracondiliana) is the most common; the process develops mainly in Najmiddinova space.
2. Rear - rare; develops in the tissue between the amygdala and rear handle, and sometimes in the thick of this arch. 3. The bottom - there is a particularly rare, formed behind the lower section of the front arm outwards from the lower pole of the tonsils or pominalnoj tissue. 4. Outside, or side, there is rare, but the prognosis for most heavy. Develops outer abscess in the tissue performing tonsillar niche outwards from the amygdala. Therefore, at the break of the abscess is a pus is not poured into the cavity, pharynx, but can penetrate the cervical tissue, and therefore there is a risk of serious complications.
Acute paratonsillar begins with a sore throat, usually on one side. The pain is growing rapidly, often cruel, radiating to the ear or lower jaw. It gradually becomes slurred, nasal tone, mouth opening is difficult because of the pain and trism chewing muscles; you receive abundant salivation. Patients refuse food and drink in connection with severe pain when swallowing. On the affected side pronounced reaction of regional lymph nodes. The temperature is raised, sometimes up to 39-40 degrees fever is often relapsing nature when expressed General malaise. In the peripheral blood - leucocytosis (increase in the number of leukocytes sometimes up to 25 000 - 30 000), shift leukocyte left, acceleration ROHE. In urine traces of protein. If laringoscopiei - sharp hyperemia and infiltration of tissues side of the oropharynx, often on the one hand; especially pronounced protrusion in Najmiddinova the field in a result of a sharp infiltration of surrounding tissue soft palate and akromegaliei fiber; the amygdala is shifted to the middle line of the throat. In the area of maximum protrusion (Najmiddinova region) sometimes visible yellowish plot softening - place subsequent breakthrough pus; in some cases breakthrough occurs through one of the crypts upper pole of the tonsils. Spontaneous breakthrough, or opening, abscess leads to a considerable improvement of the patient. Acute paratonsillar often develops during exacerbations of chronic tonsillitis and may recur.
Complications of angina can be divided into two groups. The first group consists of complications from nearby organs; acute laryngitis, laryngeal edema, abscess or cellulitis parapharyngeal space, cellulitis neck, acute cervical lymphadenitis, mediastinum, acute otitis average, mumps and others; second, common complications with damage to distant organs and systems: tonirovannye sepsis, endo - and pericarditis, rheumatism, arthritis, pielit, jade, meningitis, etc.
Diagnosis of angina put on the basis of the anamnesis, clinical picture of the disease, pharyngo - and laryngoscopies paintings and bacteriological studies swab from the throat. The differential diagnosis should be aware that acute inflammatory changes of the mucous membrane of the pharynx are often symptoms of flu, acute respiratory catarrh, acute pharyngitis, diphtheria, scarlet fever, measles, and other
Forecast for uncomplicated flu in most cases favourable, in 5-8 days is full clinical recovery. After A. persistent immunity is not produced; this is probably due to the fact that the body is often already sensitised to the re-introduction of microbes.
Treatment. Bed rest, gentle, non-irritating, rich in vitamins, mainly dairy and vegetable diet and drink plenty of water. Inside sulfanilamidnye preparations (streptocide, sulfadimezin, norsulfazol), adults or 4 times a day, 1 g, for children according to age. Hard place sore throat with pronounced symptoms of intoxication - antibiotics (such as penicillin). Symptomatic treatment depending on indications: acetylsalicylic acid (aspirin), amidopyrine (pyramidonum), analgin, heart drugs, hypnotics. In order to remove allergic phenomena, in particular when oedematous forms A. and A. recurrent, along with the usual treatment is prescribed antisense funds (calcium chloride, diphenhydramine, pipolfen and others ). Local - rinse knitting, softening, disinfectants (see Rinsing), compresses on the neck.
In acute paratonsillitis first by the same treatment as in angina. If signs of abstsedirovaniya shown surgery - lancing of abscess (primary disease) or tonsillectomy (see Tonsillitis). Last expedient if the disease recurrent nature and develops on the background of chronic tonsillitis.
In angina Simanovsky - Plaut - Vincent - rinsing solutions of hydrogen peroxide, potassium permanganate, or boric acid, intramuscularly - large doses of antibiotics. When necrosis - intravenous infusion solution orally as tablets (0.3-0.4 g per injection, only two injections at intervals in one day) or dusting powder orally as tablets affected areas mucous membrane; you can lubricate them with a solution of orally as tablets (Novarsenoli 0,45; Aq. destillatae 10,0). Also shown are Marsena 0.01 g per 1 kg of body weight 2-4 times at intervals of 2-3 days. Sometimes used lubrication tonsils (several times a day) newsalary-glycerine (0,15 : 15).
Prevention. Measures on destruction of microbes and viruses in the environment in the home and at work, and strengthening of the body, activates its protective forces: hardening, physical education, sports, the proper work and life. Of great importance for the prevention of angina recovery has free nasal breathing: elimination of nasal septum deviation, the removal of polyps of nose cavity, adenoids, hypertrophic turbinates, etc. In the presence of caries necessary readjustment of the oral cavity. Sickly A. subject to medical examination.