Angina

   Angina - common infectious disease with local manifestations in the form of an acute inflammation of one or more components of lymphadenoid pharyngeal ring, usually of the tonsils. The term "angina" is known since ancient medicine, to date associated with it many of the pathological changes in the oropharynx, with common symptoms, but differ in the etiology and course. 


Classification

Generally accepted that the three types of angina.

• Primary angina (normal, ordinary, banal).

• Acute inflammatory disease with clinical signs of defeat only lymphadenoid ring throat.

• Secondary (symptomatic) angina.

• The defeat of the tonsils of acute infectious diseases (scarlet fever, diphtheria, infectious mononucleosis, etc.).

• The defeat of the tonsils in diseases of the blood (agranulocytosis, septic angina, leukemia).

• Specific angina - an etiological factor is the specific infection (for example, Vincent's angina, a fungal angina).

Primary angina

 Aetiology

 Most often (in 85% of cases) the primary cause of angina ß-hemolytic streptococcus group A, at least - Staphylococcus aureus, Streptococcus pneumoniae, or mixed microflora. 

Epidemiology.

    Primary angina - one of the most common diseases of the upper respiratory tract, the frequency second only to SARS. Incidence has a pronounced seasonal (spring, autumn). Ill mostly children and young persons (under 35 years). The source of infection - patients with angina, as well as carriers of streptococci, releasing into the environment a large number of pathogens in speaking and coughing. The main route of infection - airborne, it is also possible contamination of contact-household and nutritional ways. Susceptibility to Streptococcus high, especially among children. Equally important is an endogenous infection (in the presence of the oral cavity and pharynx foci of chronic infection, such as tooth decay, gum disease, etc.). 

Pathogenesis

    Atrium - oropharyngeal lymphoid tissue, where a primary site of inflammation. Predispose to the development of angina general and local hypothermia, dusty or polluted atmosphere, increased dryness of the air, impaired nasal breathing, hypovitaminosis, decreased immunity, etc. Most often develop angina after suffering SARS. Pathogens SARS reduce the protective functions of epithelium and contribute to the invasion of streptococci. Fixing ß-hemolytic streptococci on the surface of the tonsils and other lymphoid tissue accumulations caused some affinity antigenic structures of the microbe, including lipoteichoic acid to the epithelium of lymphoid apparatus oropharynx. Streptococcus M protein reduces phagocytic activity of leukocytes in place the entrance gate and thereby enhances the susceptibility to the disease child. Pathogenic action of streptococci is not limited to local damage, leading to development of angina. The waste products of streptococci (especially toxins), getting into the blood, causing disturbances in thermoregulation, toxic damage to the nervous and cardiovascular systems, and can also run the immunopathological processes leading to the development of metatonsillar diseases (rheumatic fever, glomerulonephritis). Especially high risk of developing diseases in metatonsillar often recurrent streptococcal tonsillitis. 

Classification

    Depending on the nature and depth of the lesion is isolated tonsil bluetongue, follicular, lacunary and necrotic angina. According to the severity of isolated mild, moderate and severe forms of the disease. The severity of angina was determined taking into account the severity of global and local changes, the crucial common manifestations.

   Typically, the clinical picture is consistent with pharyngoscope, but absolute correspondence between morphological forms of the disease and the severity of the forms on there. The most readily proceeds catarrhal angina, the most difficult - necrotic. 

The clinical picture.

    The incubation period ranges from 10-12 hours to 2-3 days. The disease begins acutely. Increased body temperature, there is a chill, pain on swallowing. Grow and become painful lymph nodes. The severity of fever, intoxication and faringoskopicheskaya pattern depend on the form of the disease.

• Catarrhal angina. Characteristically mostly superficial damage tonsils. Signs of intoxication expressed moderately. The body temperature is low-grade. Changes in the blood are absent or negligible. When pharyngoscope find a bright diffuse flushing, exciting soft and hard palate, the back of the throat. Less often limited to congestion and palatine tonsils bows. Tonsils are increasing mainly due to infiltration and edema. The disease lasts 1-2 days, after which the inflammation subsides in the throat, or develop another form of angina (lacunar or follicular).

   Lacunar and follicular tonsillitis present with more severe symptoms. The body temperature rises to 39-40 "C. Expressed symptoms of intoxication (general weakness, headache, pain in the heart, joints and muscles.) In the blood count reveals leukocytosis with neutrophilic left shift, increased erythrocyte sedimentation rate of 40-50 mm / h The urine sometimes find traces of protein, red blood cells.

•  Lacunar angina is characterized by lesions in the lacunae of tonsils with the spread of purulent plaque on the free surface of the tonsils. When pharyngoscope show marked congestion, edema, and infiltration of the tonsils, the expansion gaps. Yellowish-white fibropurulent contents of gaps formed on the surface of the tonsils loose plaque in the form of small lesions or film. Plaque is within the tonsils, can be easily removed without leaving a bleeding defect.

• Tonsillitis is characterized by a primary lesion of the follicular apparatus of the tonsils. Faringoskopicheskaya picture: hypertrophic tonsils, swollen dramatically, through the epithelium of follicles shine festering in the form of a whitish-yellowish formations the size of a pin head (picture of "the sky"). Festering follicles opened, forming purulent plaque, which does not apply outside the tonsils.

•  Necrotic angina. Characterized by a more pronounced global and local manifestations than the above forms (pronounced persistent fever, repeated vomiting, confusion, etc.). At a blood show marked leukocytosis, neutrophilia, a sharp shift to the left leukocyte counts, a significant increase in ESR. Faringoskopicheskaya picture: the affected areas of the tonsils are covered with fabric extending deep into the mucous membrane coating with a rough, pitted, dull surface greenish-yellow or gray. Most affected areas are impregnated with fibrin and become dense, with their removal remains a bleeding surface. After the rejection of necrotic tissue is formed deep defect of 1-2 cm in diameter, often oddly shaped, with uneven bumpy bottom. Necrosis may spread beyond the tonsil on the bow, the tongue, the back of the throat.

Complications.  

Distinguish early and late complications of angina.

•     Early complications arise during the illness and are usually caused by inflammation spread to nearby organs and tissues (peritonzillit, paratonsillar abscess, purulent lymphadenitis of regional lymph nodes, sinusitis, otitis, tonzillogennoy mediastinitis).

•     Late complications occur in 3-4 weeks, and usually have an infectious-allergic etiology (articular rheumatism, rheumatic heart disease, post-streptococcal glomerulonephritis).

Diagnosis and differential diagnosis

    The diagnosis of strep throat is mainly based on data from clinical and pharyngoscope. From laboratory studies used bacteriological (detection in crops of mucus from the oropharynx ß-hemolytic streptococcus group A) and serum (rising titers of antibodies to antigens of Streptococcus) study. 

Treatment

    Treatment usually on an outpatient basis. In severe hospitalization is shown in the infectious disease clinic. Needed light diet, rich in vitamins C and B complex, drinking plenty of fluids. The basis of treatment is antibiotic therapy. Applied penicillin, amoxycillin with clavulanic acid (e.g., augmentin, amoxiclav), cephalosporins (cefaclor, cefuroxime, Zinat), macrolides (erythromycin, azithromycin), sulfonamides (kotrimaksozol). The duration of treatment - 5-7 days. For topical treatment using fuzafunzhin (bioparoks) (contraindicated in children up to 2.5 years), ambazone (Faringosept), gramicidin (gramicidin C), irrigation tonsils (kameton, ingalipt, sebidin, etc.), rinse decoction of herbs (chamomile, calendula etc.), and antiseptic solutions, such nitrofuralom (furatsilin).   

   In marked regional lymphadenitis warmly recommend to the neck (cotton-gauze bandage and hot compress) spend UHF or microwave therapy. 

Prophylaxis

    Specific prophylaxis has not been developed. To prevent the spread of infection is of great importance timely isolation of patients with angina. Individual prevention is to improve the general resistance of the organism (tempering), removal of irritants (dust, smoke, excessive dryness of the air), timely readjustment of foci of chronic infection (sinusitis, dental caries), the elimination of the causes that make it difficult to breathe freely through the nose (curvature of the nasal septum , adenoids).