quinsy throat

From Big Medical Encyclopedia

QUINSY throat (angina pharyngis; lat. ango — I squeeze, I smother; synonym:the orlovy toad, acute tonsillitis, acute amigdalit) — the acute general infectious disease with the expressed local inflammatory changes in lymphadenoid tissue of a throat, is more often in palatine tonsils.

Quinsy is among the most widespread diseases and takes the third place by the number of days of disability after flu and acute respiratory diseases. Exact accounting of incidence And. presents considerable difficulties since quite often Quinsy is not differentiated from aggravations of an adenoid disease. Incidence And. the dignity depends on population density, household, production. - a gigabyte., geographical and climatic conditions. Among urban population Quinsy arises more often than among rural. Incidence is especially high And. in large industrial centers.

It is known that in the same conditions And. more often children and persons to 30 — 40-year age get sick.

By special researches it is shown that the frequency of negotiability of the population to the doctor apropos And. makes 50 — 60 cases a year on everyone 1000 zhit.

History

the Disease is known since ancient times. In Hippocrates's works (5 — 4 century BC) and Tselsa (1 century AD) there are descriptions of symptoms of A. V Ibn-Sina's works (Avicenna, 11 century) is mentioned an intubation and tracheotomy at asphyxia at patients And. Development and implementation in medical practice of bacteriological methods of a research allowed to subdivide And. on different types depending on a microbic factor. Opening of a diphtheritic stick gave the chance to otdifferentsirovat And. from diphtheria. In 1898 Plaut (N. K. of Plant) and Vincent (N. of Vincent) at the same time described a special form ulcer and filmy And., emergence a cut is caused by symbiosis of bacteria — a spindle-shaped stick (you. fusiformis) and spirochete of an oral cavity (Spirochaeta buccalis). The disease received the name of a fuzospirokhetoz. For the first time this form A. as the disease caused by the unknown activator it was described by the Russian clinical physician S. P. Botkin and then in 1890 in more detail his pupil N. P. Simanovsky. Almost at the same time Plaut and Vincent found the characteristic activator, and in a crust, time is a disease it is accepted to call Simanovsky's quinsy — Plauta — Vincent. This form A. in the years of wars can accept character of epidemics as it, e.g., was observed during World War I («a trench disease»). Epidemic disease outbreaks among children in the years of World War II are described.

With introduction to practice of hematologic researches special forms A were allocated. — agranulocytic (see. Agranulocytosis ) and monocytic (see. Mononucleosis infectious ). In 1935 I. V. Davydovsky and A. G. Kestner for the first time described the ulcer and necrotic Quinsy observed at aleukias alimentary and toxic (see). Due to the development of virology much attention is paid to studying of an etiological role of viruses (in particular, adenoviruses) in defeat of lymphadenoid fabric. In the majority of the available messages about virus And. the separate outbreaks of this disease both in children's collectives, and among adults are described.

An etiology

In an etiology And. various activators matter: cocci, sticks, spirochetes, fungi, viruses, adenoviruses etc. Main activator A. (more than in 90% of cases) it was considered to be a β-hemolitic streptococcus of group A. It was confirmed by the serological researches indicating significant increase (to 82%) in blood serum of patients And. credits of anti-streptococcal antibodies, and experimental reproduction And. during the use of the pure growth of a β-molitichesky streptococcus emitted from a stomatopharynx of patients And. In a crust, time the greatest etiological role in emergence And. attribute to staphylococcus that is confirmed by increase in blood serum of patients And. credits of anti-staphylococcal antibodies. Reduction of frequency of a vysevayemost of a β-gemoliti-chesky streptococcus at And. many authors explain with wide use of the sulfanamide drugs and antibiotics changing microbic flora of palatine tonsils. With same connect the increasing frequency (to 60%) carriages of virulent strains of a hemolitic streptococcus among healthy people. In the last decade much attention is paid to studying of an etiological role of viruses (in particular, adenoviruses) in A. Predpolagayetsya's emergence that the virus not only can play a role of the independent activator A., but also it is capable to provoke activity of a bacterial flora. By means of RSK it is proved that sometimes And., earlier treated as bacterial, actually have a virus origin. Effective treatment And. specific antiviral drugs — interferon (see) and 6 azauridine — proves the adenoviral (virus) nature And.

Epidemiology

the Source of spread of an infection are patients And., acute respiratory diseases of upper respiratory tracts (pharyngitis, laryngitis, tracheitis), scarlet fever, and also convalescents after the postponed above-stated diseases if in the period of a disease it did not make rational treatment and they remained carriers of virulent strains of microorganisms. Distinguish exogenous and endogenous factors of infection of almonds. Exogenous infection is possible in two ways: airborne and alimentary. The airborne way is more often observed at contact with the patient A. in families, collectives (kindergartens, schools, hospitals, hostels, military units and so forth).

Epidemic flashes can be an example of an alimentary way of infection And. in collectives at consumption of raw milk from the cows suffering from streptococcal defeat of an udder. However modern hygienic actions (pasteurization of milk, etc.) the similar phenomena can warn. Endogenous infection (autoinfection) takes place more often in the presence of an adenoid disease. At the same time are usually observed repeated or recurrent And. At the heart of emergence And. in these cases disturbance of balance between micro and a macroorganism under the influence of the adverse external or internal factors reducing reactivity of an organism lies. Recurrent And. quite often develops in the allergized organism, and it is considered as an aggravation of an adenoid disease.

Connection of incidence is established And. at adults with scarlet fever at children. In the years of rise in incidence of scarlet fever the increased A. Imeyutsya's incidence the expressed seasonal rises in incidence is noted And. during the autumn and winter period.

Pathological anatomy

Allocate the following forms A., having a characteristic gistomorfologichesky picture.

At catarral And. the acute inflammation of a mucous membrane of pharyngeal almonds and palatal handles develops. The mucous membrane hyperemic, edematous, cyanotic, dim, is covered with mucous exudate. All other forms acute begin with catarral changes And.

At lacunary And. process begins with a mucous membrane of lacunas. In expanded lacunas serous and mucous exudate with impurity of leukocytes, cells of a desquamated epithelium, sometimes fibrin accumulates. Exudate acts from mouths of lacunas in the form of whitish-yellowish pro-barrels on a surface of brightly hyperemic and increased almond. Sometimes exudate covers a surface of an almond and spreads out of its limits. Microscopically the ulceration of an epithelium of lacunas, infiltration of a mucous membrane leukocytes, thrombosis of small vessels and the centers of purulent fusion in follicles is found. Process comes to an end with release of exudate from lacunas; at repeated And. in lacunas traffic jams are formed of the condensed exudate.

Follicular And. it is characterized by preferential defeat of follicles. Almonds are increased, their mucous membrane is hyperemic, on a surface illuminate the suppurated follicles in the form of yellow prosovidny points. Microscopically follicles with purulent fusion, and also giperplazirovanny follicles with the light centers are found. At merge it is purulent - the melted follicles in a parenchyma of almonds there can be small abscesses.

Fibrinous And. it is characterized by increase in almonds with education at their surfaces, a mucous membrane of a soft palate and adjacent parts of a throat of grayish-white plaques in the form of a characteristic film. The inflammation can have croupous or diphtheritic character. At a deep necrosis the diphtheritic inflammation develops — almonds are increased, hyperemic, covered with densely sitting films after which department there are ulcers. Limf, nodes of a neck at the same time are increased, cellulose is edematous. The fibrinous inflammation is most characteristic of diphtheria.

Necrotic And. it is characterized by a superficial Or deep necrosis of a mucous membrane. Almonds are hyperemic, covered with the whitish-gray plaque consisting of nekrotizirovanny fabric, leukocytes, a large number of bacteria, fibrin. Plaques are softened and torn away further, forming deckle-edged ulcers. Distribution of necrotic process on a surface and in the depth of fabrics can lead to destruction of a soft palate and walls of a throat with the subsequent scarring of defect. Are involved in process cervical limf. nodes. Necrotic And. it is most often observed at an acute leukosis and other diseases of system of blood, before quite often met at scarlet fever, diphtheria, a tularemia, etc. It can be complicated by hemorrhages or gangrene (gangrenous And.). The superficial ulcerations covered with a dirty-green plaque with a putrefactive smell are characteristic of A. Simanovsky — Plauta — Vincent.

At phlegmonous And. sharply expressed infiltration by kruglokletochny elements of fabric of a mindalik p okolompndalikovy cellulose takes place; sometimes comes to the abstsedirovayena.

A pathogeny

In a pathogeny And. an important role is played by both exogenous, and internal causes. Among exogenous factors the infection getting through an epithelium of a free surface of almonds and its crypts has paramount value. Also hematogenous genesis of emergence is not denied And., however it concedes to local infection.

Great value in a pathogeny And. it is given to overcooling as to the general, and local. Disturbance of a hemodynamics in almonds during the cooling provokes activity of microbic flora with the subsequent development And. Also adaptation ability of an organism to a factor of cooling has a certain value. The people who are not tempered, as a rule, easier get sick And.

The known value is allocated for a factor of food (uniform food, a hypovitaminosis and so forth). Elimination of a hypovitaminosis in a nek-swarm of degree reduces a possibility of a disease And. Some authors consider that the excess use of animal protein contributing to allergic reactions promotes increase in frequency of a disease And.

In some cases in emergence And. the injury of an almond (a foreign body — a fish or meat bone, the pallet — can play a role at rough expression of contents of lacunas, metal and rubber tubes — at bronkho-and ezofagoskopiya, intubations of a trachea etc.).

Contributing to emergence And. pathological changes in an oral cavity, a nose and a throat can be factors. E.g., breath through a mouth at difficulty of nasal breath can cause And., especially in cold season.

From internal causes an important role is played by age. And. almost it is not observed at chest age when the lymphadenoid device of a throat is not developed yet; it is more often noted at children of preschool and school age, and also at adults to 35 — 40 years. At advanced age And. arises less often and quite often proceeds it is erased. It is explained by the age involute changes of lymphadenoid tissue of throat happening under the influence of a number of nsyrogumoralny factors, in particular adrenal hormones. A certain role in a pathogeny And. has a condition of c. N of page, vegetative functions, disturbance of exchange processes in an organism. There are instructions on constitutional predisposition to And.

In a pathogeny recurrent And. (an aggravation of an adenoid disease) an important role is played by an allergic factor. Development And. is considered as allergic-giperergichesky process. Adenoviral character And. it is confirmed with virologic, serological and cytologic data. From the lymphadenoid tissue of the person removed at operation in 91% of cases it is possible to cultivate types of adenoviruses 1, 2, 5, 3, 4, 6 is more rare. Types 1 and 2 often find in giperplazirovanny almonds of healthy children.

Immunity

Disease And. does not create immunity. On the contrary, repetition of a disease is often noted. It is explained by a sensitization of an organism and the fact that activators are different types of microbes. After the postponed adenoviral disease there is a type-specific immunity which does not guarantee against the similar disease caused by other type of adenovirus.

Clinical picture

Classification

Classification And. presents considerable difficulties in connection with a variety of types of a disease. Lack of the uniform standard classification is explained by it. The existing classifications take only any one criterion as a principle: clinical, pathoanatomical, etiological; as a result polymorphism of this disease completely is not reflected. On the nature of the local manifestations defined at faringoskopiya (see), in clinic conditionally distinguish And. catarral, follicular, lacunary, fibrinous and phlegmonous. On character of the activator — streptococcal, staphylococcal, pneumococcal, virus (adenoviral) etc.; on localization — And. palatine tonsil, And. nasopharyngeal almond, And. lingual almond, And. tubarny almond, And. guttural.

Current and symptoms

Prodromal stage short — from several hours to several days. And. usually begins sharply, with a fever, high temperature (to 40 °), however temperature can be and subfebrile. There is a dryness, irritation, a sadneniye and feeling of a prelum in a throat. The phenomena of the general intoxication are noted: weakness, weakness, feeling of a nagging pain in muscles of extremities, a joint pain, a waist, a headache. Along with temperature increase the pharyngalgia during the swallowing appears. In some cases the phenomena of intoxication act into the forefront, and during the first hours diseases the pharyngalgia does not disturb the patient (more often at an adenoid disease); it appears by the end of the first or during second day. At patients with a hypertrophy of almonds at infiltration of a soft palate in time And. the speech becomes muffled — with a nasal shade. Increase and become painful at a palpation regional limf, nodes, however extent of their reaction happens various that connect with virulence of the activator, a functional condition of almonds and all organism. At sharply expressed inflammatory changes regional limf, nodes morbidity at turn of the head is noted that causes its forced situation. As a result of reflex influences and painful swallowing the sialosis raises. Language is laid over, appetite is lowered, patients feel off-flavor in a mouth, began to smell from a mouth. Quite often also other disturbances from a digestive tract take place: the diffuse abdominal pain, is more rare in the field of a caecum, ponosa, locks. In some cases And. can be followed by increase in a spleen and emergence of protein in urine. At height of a disease pulse according to fervescence becomes frequent, the respiration rate increases, pain in heart is quite often noted. Such tonzillo-cardial syndrome is explained by reflex influence from peripheral nervous receptors of almonds on the nervous device of heart. Systolic and diastolic arterial pressure during the first hours of a disease falls, and then comes to norm. In blood the leukocytosis is, as a rule, observed (sometimes to 20000, a deviation to the left with young forms, toxic granularity of leukocytes). ROE usually accelerates on 2 — the 3rd day of a disease and reaches sometimes considerable figures (to 50 mm an hour).

The symptoms of a disease described above are more often observed at severe forms And. (with plaques on almonds) are also less expressed at catarral And. Clinical picture A. in many respects can change at sharply lowered general reactivity of an organism. In such cases the ostrovospalitelny phenomena seen at a faringoskopiya (infiltration, plaques, ulcers) proceed at the general satisfactory condition, low or even standard temperature and at very insignificant pains during the swallowing, and sometimes at their total absence.

Sharply use of streptocides and antibiotics changes a clinical picture. First of all the phenomena of intoxication are removed though inflammatory process remains active and morphological changes in a stomatopharynx are sharply expressed. Sometimes it leads to premature cancellation of drug treatment and change of the mode. In typical cases the disease lasts 5 — 7 days.

Clinical forms

Among clinical forms A. most often distinguish catarral, lacunary, follicular, fibrinous, and also intratonzillyarny abscess (phlegmonous And.). However division of these forms is especially conditional. In essence it is uniform pathological process which can quickly progress or stop at one of stages of the development. Process at And., as a rule, bilateral. Lacunary And. meets more often than follicular; catarral And. as the independent disease meets infrequently. Sometimes catarral And. it appears the first phase, for a cut more severe form follows or there is other disease.

Fig. 1. Catarral quinsy

Catarral quinsy it is characterized by the expressed diffuse hyperemia of almonds, frequent puffiness of palatal handles. Almonds moderately, and sometimes considerably increase in volume, on their surface and in lacunas accumulation of the exudate containing leukocytes and a desquamated epithelium of a mucous membrane, the covering almond (fig. 1) is observed. Regional limf, nodes are not always increased and painful at a palpation. Catarral And. in comparison with other clinical forms of a disease differs in rather easy current, however it shall not reduce attention of the doctor and the patient to a disease since it is known, as after catarral And. there can be complications.

Fig. 3. Lacunary quinsy

Lacunary quinsy it is characterized by more expressed clinical picture. Against the background of the hyperemic and bulked-up almonds in mouths of lacunas plaques or exudate appear. In the beginning small plaques which merge further are visible a various form of yellow-white color and form films, sometimes extending to all almond, but do not go beyond its limits; this plaque rather easily is removed, without leaving the bleeding surface (fig. 3).

Fig. 2. Angina follicularis

Angina follicularis. Against the background of the hyperemic and bulked-up almonds there is a significant amount of the yellow-white small abscesses representing the suppurated follicles (fig. 2) which then are opened, leaving on a surface of almonds quickly healing sores. Follicular And. can arise as an independent disease, to join to lacunary And. or to proceed along with it. The nature of defeat of almonds at the time of survey can be sometimes not identical: on one party can be catarral And., and on another — follicular or lacunary And., but further, as a rule, process becomes symmetric.

Fibrinous quinsy can develop from follicular or lacunary. In the first case a basis of film formation are the opened suppurated follicles, in the second — nekrotiziruyushchiysya an epithelium at an entrance to lacunas with distribution of process on a surface of an almond. Separate small plaques merge in the form of islands or entirely cover all almond, accepting fibrinous character. Fibrinous plaques have whitish-yellow color, the almond is increased, inflamed. For similarity of character of plaques on almonds at diphtherias (see) a fibrinous form A. in literature received the name of diphtheroid. However, unlike diphtheria, a plaque at fibrinous And. acts rather easily, leaving behind a little bleeding erosion. The general phenomena are expressed usually unsharply, temperature is increased slightly.

Fig. 4. Phlegmonous quinsy (paratonzilyarny abscess)

Intratonzillyarny abscess (phlegmonous And.) — the isolated abscess in the thickness of an almond. Results from injuries a foreign body (a fish, meat bone and so forth) with the subsequent suppuration of a parenchyma of an almond (fig. 4). Meets seldom. Defeat, as a rule, unilateral. The almond is increased in volume, is hyperemic, painful at a palpation. The general and local phenomena are expressed unsharply. The ripened abscess can be opened in an oral cavity or in peritonsillar (peritonsillar) fat with development in the latter case of paratonsillar (peritonsillar) abscess.

Special forms of quinsy depending on character of the activator

Simanovsky's quinsy — Plauta — Vincent — ulcer and filmy And., represents an independent disease and is caused by symbiosis spindle-shaped bacterium (see) with a usual spirochete of an oral cavity why is called fuzospirokhetozy.

Fig. 6. Quinsy of Simanovskogo-Plauta-Vensana

Defeat of almonds can come at hit of activators from the outside or at their movement from the centers of an oral cavity (stomatitis, caries, periodontosis). It is assumed that also the fuzospirokhetozny symbiosis which was earlier existing in deepenings of a mucous membrane can become more active. An important condition for developing of a disease are dystrophic changes and disturbances of an integrity of fabrics (necroses, erosion, ulcers) at the general weakening of an organism (e.g., at a nutritional dystrophy, the cachexia caused by a malignant tumor at leukoses, a radial illness etc.). At this look ulcer and filmy And. pases of a surface of palatine tonsils appear easily dischargeable plaques with a gray or yellow shade (fig. 6). After removal or independent rejection of plaques there are superficial ulcers.

In typical cases, despite the expressed local changes (plaques, necroses, ulcers), the general condition of the patient suffers a little, temperature subfebrile or normal. Without treatment the ulceration usually progresses and within 2 — 3 weeks can capture the most part of a surface of an almond and even to go beyond its limits (on a handle, is more rare on other sites of a throat). Accession in these cases of a coccal infection can change the overall clinical picture: there is a general reaction inherent And., caused by pyogenic activators, and local reaction — a hyperemia near ulcers, severe pains during the swallowing, a sialosis, a putrefactive smell from a mouth, swelling and morbidity at a palpation regional limf, nodes. In the absence of any unfavorable conditions the disease comes to an end with recovery within 8 — 14 days.

Viral quinsies divide on And., caused by an influenza virus, Koksaki's virus and adenoviruses.

Influenzal And. is caused by an influenza virus. At the same time the mucous membrane of upper respiratory tracts (rhinitis, pharyngitis, laryngitis, tracheitis) is surprised. In some cases preferential defeat of palatine tonsils is observed. A characteristic sign is the bright hyperemia of a mucous membrane and longer period of temperature increase.

Herpetic And. is caused by Koksaki's virus. Arises at children of younger age more often. The beginning of a disease acute, with the expressed general phenomena (temperature to 39 — 40 °, a headache, vomiting and a diarrhea), the pharyngalgias amplifying during the swallowing. Against the background of diffuzno hyperemic mucous membrane of a uvula, palatal handles, a soft palate, almonds and a back wall of a throat reddish bubbles in number of 5 — 20 of the size of lentil are defined. These bubbles burst with formation of quickly healing erosion or spontaneously are exposed to involution. Almonds are slightly edematous. The disease proceeds favorably, however can sometimes be complicated by serous meningitis. Herpetic And. in the summer and in the fall has character of epidemics more often, in other time meets sporadic.

Adenoviral And. is caused by adenoviruses (at children more often 1, 2, 5, at adults 3, 4, 6 types) with characteristic faringokonjyunktivalny fever. The disease begins sharply, with disturbance of the general state, pains in muscles of a body. Along with the expressed changes on a back wall of a throat (a hyperemia, infiltration) almonds and palatal handles are involved in process, nakotory the whitish plaque can appear. The last has a dot or drain appearance and can go beyond an almond. Regional limf. nodes are increased and painful at a palpation. In some cases adenoviral diseases can have a clinical picture banal A. Zabolevaniye arises epidemic more often and differs in big contageousness.

Special forms of quinsy depending on localization

Quinsy of a lingual almond meets less often usual And. also can proceed as a catarral, follicular or phlegmonous inflammation. Arises more often at persons of middle and advanced age. Can meet along with defeat of other almonds or independently. The injury can be a cause of illness at meal or operations in the neighboring areas. The general symptoms in the form of temperature increase and intoxication same, as well as at banal And. Local symptoms differ in the expressed oxycinesia in language. Swallowing is complicated, the speech is violated. At the same time the lockjaw of chewing muscles is quite often noted. Survey of a throat and a root of language is complicated because of pains at an otdavlivaniye of language by the pallet or at protrusion and procrastination of language by production of a laringoskopiya. If process extends deep into, the purulent inflammation of language can develop (glossitis) or abscess of a root of language, and also phlegmon of a mouth floor.

Fig. 5. Quinsy of side rollers

Quinsy of side rollers of a throat and quinsy of granules of a back wall of a throat. Differentiation of these And. it is not always easy to carry out in practice since lymph nodes of a side and back wall of a throat usually are at the same time involved in process. The beginning of a disease acute is also expressed by emergence of whitish points with the subsequent their suppuration and formation of superficial multiple dot necroses under an epithelial cover in the field of granules or side rollers (fig. 5). These types And. often arise at the persons who earlier transferred a tonsilectomy, after a cut quite often there is a hyperplasia of side rollers and granules on a back wall of a throat.

Quinsy of a tubarny almond there is usually along with retronasal A. Harakter of an inflammation same, as at banal And. From local complications the inflammation of an acoustical (eustachian) pipe, acute average otitis can be observed.

Quinsy retronasal (And. a nasopharyngeal almond) — see. Adenoiditis .

Quinsy guttural — see. Laryngitis .

The special group is made And., which are not independent diseases, and represent changes in a pharynx at the corresponding diseases of blood (see. Agranulocytosis , Aleukia alimentary and toxic , Leukoses , Listeriosis , Mononucleosis infectious ). For designation of ostrovospalitelny changes in a pharynx at to scarlet fever (see) and diphtherias (see) the terms «scarlatinal quinsy», «diphtheritic quinsy» were applied earlier. As such changes in a throat are only display of the specified diseases, refused these terms.

At secondary syphilis (see) erythematic and papular rashes in a stomatopharynx are quite often noted that served as the reason for emergence of the term «syphilitic erythematic or papular quinsy», however this term does not correspond to a concept about And. as to certain nosological unit.

Complications of quinsy

Complications of quinsy are very various. Distinguish local and general complications. Complications in close located bodies belong to local: acute average otitis, acute laryngitis, hypostasis of a throat, acute paratonsillar or retropharyngeal abscesses, acute cervical lymphadenitis, phlegmon of a neck. Carry rheumatism, myocarditis, infectious polyarthritis, pyelonephritis, cholecystitis, appendicitis, an orchitis to the general complications, osteomyelitis, tonzillogenny sepsis, meningitis, etc. is more rare. Regarding cases And. proceeds with allergic manifestations in the form of a small tortoiseshell, a mnogoformny erythema, a scarlatiniform and korevidny erythema and so forth.

Peritonsillitis. The term «phlegmonous quinsy» applied earlier to designation of an inflammation of a peritonsillar fat and the fabrics surrounding it in a crust. time is almost not used since in essence is wrong. It is replaced with the term «okolomindalikovy, or paratonsillar, abscess» or it is more correct — «peritonsillitis» as inflammatory process develops hl. obr. not in the fabric of an almond, and in the peritonsillar fat surrounding it. It is reasonable to leave the term «phlegmonous quinsy» for designation an intratonzillyarna of abscess.

The infection gets into okolomindalikovy cellulose in most cases in the tonzillogenny way to time or right after the termination usual And. Most often the acute peritonsillitis develops at the patients suffering from chronic tonsillitis (see). Distinguish three forms (stages) of a peritonsillitis: edematous, infiltrative and abscessing. The characteristic clinical picture of a disease is observed only when process passes through all stages and comes to an end with formation of paratonsillar abscess (tsvetn. tab.). However the disease can atypically proceed (at reception of streptocides and antibiotics), being limited to edematous or infiltrative stages; in these cases the general and local displays of a disease proceed easier and quicker.

The peritonsillitis more often happens unilateral. It begins with emergence and increase of the throbbing pain in a throat irradiating quite often in an ear. Swallowing and expectoration become sharply painful. Not swallowed saliva accumulates in a mouth that leads to hypersalivation. The tonic spasm of chewing muscles limits disclosure of a mouth sometimes to a narrow crack that complicates survey of a throat. Language and lips become covered by a whitish plaque. There is a pungent smell from a mouth. The speech becomes muffled and nasal because of puffiness of a soft palate. In attempt of swallowing liquid or food often gets into a nose or a throat, causing a poperkhivaniye and cough. The movements of the head and a neck are painful. Position of the head forced. Regional limf, nodes are increased and painful at a palpation. In hard cases cervical lymphadenitis develops. Temperature always high — to 40 °. ROE accelerates and the leukocytosis with shift develops to the left. The patient has an emaciated appearance that is promoted by forced starvation and sleeplessness because of pharyngalgias. At a faringoskopiya sharp infiltration of fabrics of a stomatopharynx is noted. Palatal handles on the struck party are stuck out sometimes to such an extent that an almond and a handle pass a midline and push aside a uvula (sometimes sharply edematous) to the opposite side. Sometimes at the ripened abscess the yellowish site of a softening — the place of the subsequent break of pus is visible. The break happens sometimes through one of crypts (lacunas). The spontaneous break of abscess outside (on 5 — the 6th day at a favorable current) or opening by his doctor gives sharp relief to the patient at once, and process within several days regresses. However a recurrence is possible. Depending on localization of an abscess in relation to an almond distinguish front or anterosuperior (supratonsillar), back, lower, outside or side (lateral) paratonsillar abscesses. Sometimes a picture, similar to the ripened paratonsillar abscess, is observed at an aggravation of an adenoid disease of an adenoviral etiology. In these cases a bigger hypostasis of a mucous membrane, its cyanosis and existence of bubbles is noted. During the opening of such paratonsillar abscess there is no pus, there is moderate bleeding. The disease has a wavy current and lasts up to 20 days.

Diagnosis

Diagnosis banal And. is established on the basis of the local and general symptoms described above. It is necessary to consider that in the first days at many general and infectious diseases there can be similar changes in a stomatopharynx. For the purpose of specification of the diagnosis clinical observation and sometimes carrying out laboratory researches is necessary (bacteriological, virologic, serological, cytologic, etc.).

At the differential diagnosis it is necessary to exclude diphtheria (see), measles (see), scarlet fever (see), acute Qatar of upper respiratory tracts, flu (see), secondary And. at diseases of blood. The anginous phenomena can be observed at a rubella, belly and a typhus, chicken and natural pox, plague. The hard ulcer of almonds or their tubercular defeat can also remind on the current And. In some cases it is necessary to exclude a new growth of an almond. The most frequent diagnostic mistake of therapists and pediatricians is diagnosis catarral And. when there are phenomena acute pharyngitis (see).

The forecast

the Forecast at usual And., proceeding without complications, in most cases favorable. The disease comes to an end at catarral And. within 3 — 5 days, at expressed lacunary and follicular And. — within 6 — 8 days. And still it is necessary to be careful concerning the forecast since sometimes even at easily proceeding catarral And. heavy complications can be observed (damage of heart, kidneys and so forth).

Treatment

the Indispensable condition of acceleration of process of recovery and prevention of complications, and also preventions of spread of a disease among people around is a high bed rest and possible isolation of sick A. Neobkhodimo to allocate separate ware, a towel and so forth. Plentiful drink (tea with a lemon, fruit juice, borzhy and so forth), the sparing, unirritating, preferential milk and vegetable diet, vitamin-rich is recommended (especially redoxon). Overseeing by regular departure of intestines and if necessary — purpose of enemas or purgatives is required.

Topical treatment. Apply rinsing, spraying of medicinal powders on a surface of almonds, and also a tushirovaniye of granules and side rollers medicinal substances by means of a cotton plug on the probe. For rinsing alkaline and emollient means are used: soda, borax, sodium chloride, infusions of a camomile, sage and so forth. Apply also disinfecting solutions of potassium permanganate, hydrogen peroxide. These means have also the deodorizing properties and therefore are especially shown at fibrinous, ulcer, necrotic forms A. It is necessary to apply to rinsing solutions of antibiotics (penicillin, tetracycline, etc.) with care because of the cases of fungal infections of a throat, stomatitises which became frequent in recent years and so forth. An effective method of treatment of adenoviral tonsillitis in the period of an aggravation is irrigation of a stomatopharynx interferon (on 2 ml on a session 3 — 4 times a day within 3 — 4 days). Locally also apply dry heat, the warming compresses (water, spirit, semi-spirit), hot-water bottles on area of a neck, especially regional limf, nodes.

General treatment provides influence on the activator (for the purpose of elimination of a source of a virulent infection) and prevention of complications. Many means for treatment are offered And.: streptocides, antibiotics, salicylates. From sulfanamide drugs inside appoint white streptocide, Sulfadimezinum, Norsulfazolum, etc. (adult from 0,5 to 1 g on reception, 3 — 5 times a day; to children the dose decreases according to age and weight). During the use of sulfanamide drugs it is impossible to appoint the means containing sulfur (bitter, glauber salt, etc.), and also pyramidon. Plentiful drink (soda solution, alkaline mineral waters) is recommended. Sulfanamide drugs can cause by-effects of toxic and allergic character therefore it is necessary to watch carefully a condition of the patient, to make researches of urine and blood. At the first signs of a complication to stop administration of drug. From antibiotics apply inside biomycin, oxytetracycline, tetracycline, phenoxymethylpenicillin, erythromycin (the adult on 100000 PIECES of 4 — 6 times a day; to children — depending on age and weight). It is recommended not to swallow of tablets, and slowly to suck to provide absorption through a mucous membrane of an oral cavity since in a stomach antibiotics partially collapse. Contraindications to use of the specified antibiotics are: a leukopenia, the increased individual sensitivity to them. By-effects are sometimes observed: liquid chair, stomatitis, loss of appetite, nausea and even vomiting. In these cases it is necessary to reduce a dose, to take a break or to stop treatment by this drug and to appoint vitamins of a complex B, ascorbic to - that. At severe forms of Ampere-second of the first days of a disease appoint injections of benzylpenicillin (sodium and potassium salt), Bicillinum-3, Bicillinum-5. At purpose of dyurantny drugs it is necessary to inspect especially carefully the patient (the anamnesis, skin tests). Use of the desensibilizing means — ascorbic to - you, a gluconate of calcium, 5 — 10% of solution of calcium chloride, Dimedrol, Pipolphenum, Suprastinum and so forth is shown.

At peritonsillites the mode shall be analogous described above. At the beginning of a disease the same general treatment is applied, but if abscessing already came, the positive effect is reached seldom, and during the maturing of an abscess its opening is made. At paratonsillar abscesses of recurrent character, and also at a prolonged peritonsillitis some apply a tonsilectomy (see. Tonsillitis ) in the acute period, the majority does this operation in the cold period. Patients with a bilateral peritonsillitis need treatment in stationary conditions. At other forms A. the issue of hospitalization is resolved depending on a condition of the patient, living conditions and so forth.

From physiotherapeutic methods of treatment at prolonged cervical lymphadenites apply sollyuks, currents of UVCh, microwave therapy and so forth.

At Simanovsky's quinsy — Plauta — Vincent is appointed by injections of penicillin, intravenous injection of solution of Novarsenolum, intramuscular injections of Myarsenolum, nicotinic to - you; rinsing is made penozone (1 — 2 table. l. on a glass of water), potassium permanganate (1: 2000), Rivanolum (1: 1000), salicylic to - you (15 — 20 drops of 10% of spirit for a glass of water); greasing of ulcer surfaces (1 — 2 time a day) is carried out by 10% solution of Novarsenolum in glycerin, 15 — 20% solution of potassium chloride, 5% spirit of iodine, 50% solution of sugar (at children); tushirovany ulcers of 5 — 10% solution chromic to - you, lyapisy; dusting of an ulcer (by means of a poroshkovduvatel) powder of Novarsenolum, penicillin - sulfanamide powder, icing sugar.

Much attention should be paid to care of an oral cavity, the hygienic maintenance of ware, the room.

Prevention

owing to variety of the etiological and pathogenetic moments, with to-rymi is connected And., measures of prevention are diverse too. Concerning epidemic And. prevention is based on those bases which are developed for the infections transmitted in the airborne way (see. Infection ). In prevention And. the important place is taken by treatment of an adenoid disease since. And. often is the next exacerbation of this disease. For the purpose of decrease in incidence And. preventive actions shall be directed to improvement of external environment, elimination of the factors reducing protective properties of an organism to activators A. (dust content, smoke etc.). In individual prevention the large role is played by a hardening of an organism, exercises and sport, establishment of the regular and correct mode of work and life. In increase in protective properties of an organism the general uv radiations, the general stimulating therapy are of great importance (an aloe, a vitreous and so forth). Treatment-and-prophylactic actions have essential value: sanitation of an oral cavity, almonds of a throat, nose and its adnexal bosoms. In prevention of complications And. an important role is played by the correct regime, rational treatment of the patient during a disease, and also the correct solution of a question of terms of recovery of working capacity. It is necessary that each patient who transferred And., it was in details inspected (an ECG, blood test, urine).

In the presence of pathology the corresponding observation, sometimes in a hospital is required. Both adults, and the children who are often ill And., at medical examination shall be taken on the special account.

Bibliography

Davydovsky I. V. and Kestner A. G. O to so-called «septic quinsy», Arkh. stalemate. annate. and stalemate. fiziol., t. 1, century 3, page 11, 1935; Lopotko I. A. and Lakotkina O. Yu. Quinsies, Mnogotomn. the management on otorinolaringol., under the editorship of A. G. Likhachev, t. 3, page 296, M., 1963, bibliogr.; Minkovsky A. H. Angina, M., 1951, bibliogr.; Preobrazhensky B. S. Angina, Mnogotomn. the management on mikr., wedge, and epidemiol. infectious diseases, under the editorship of N. N. Zhukov-Verezhnikov, t. 6, page 503, M., 1964. bibliogr.; Preobrazhensky B. S. and Popova G. N. Quinsy, an adenoid disease and diseases interfaced to it, M., 1970, bibliogr.; Kiviranta U. K. and. M̈kitalo R. Tonsillitis acuta, Basel — N. Y., 1964; Vincent P. Les engines, Cah. med. Lyon, t. 48, p. 1773, 1972.

N. A. Preobrazhensky; I. M. Kodolova (stalemate. An.)

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