Follicular Angina In Adults - Symptoms, Complications, Treatment And Antibiotics For Follicular Angina

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Video: Follicular Angina In Adults - Symptoms, Complications, Treatment And Antibiotics For Follicular Angina

Video: Follicular Angina In Adults - Symptoms, Complications, Treatment And Antibiotics For Follicular Angina
Video: Treatments for Angina 2023, March
Follicular Angina In Adults - Symptoms, Complications, Treatment And Antibiotics For Follicular Angina
Follicular Angina In Adults - Symptoms, Complications, Treatment And Antibiotics For Follicular Angina

Follicular angina in adults

Angina - inflammation (tonsillitis), mainly of the palatine tonsils, which are part of the lymphadenoid pharyngeal ring (Valdeyer-Pirogov ring).

According to the modern classification, tonsillitis is divided into:

  • Acute, by the nature of inflammation (catarrhal, lacunar, follicular):
  • Primary - acute inflammation of the tonsils, less often other formations of the pharyngeal ring, arise as an independent disease;
  • secondary - acute infectious diseases (scarlet fever, diphtheria, agranulocytosis, others), inflammation of the tonsils is secondary to an infectious disease.
  • Chronic tonsillitis, along the course of pathogenesis, are divided into:
  • compensated - there are little or no consequences for;
  • decompensated - relapse is accompanied by a violation of the cooperation of body functions.

The human lymphatic system, complements the circulatory system, consists of capillaries, vessels and nodes. One-way movement of lymph is provided by a valve system. Together with venous blood, lymph ensures the outflow of body fluids from tissues. In the vicinity of important organs, the vessels form regional lymph nodes. The lymph flowing through the nodes is enriched with lymphocytes - blood cells that are important in the body's immune defense. Violation of the physiological properties of the lymph nodes causes their inflammation.


  • Description of the disease
  • Follicular sore throat causes
  • Follicular sore throat symptoms
  • Complications of follicular sore throat
  • Follicular sore throat treatment

    • 1. Etiotropic therapy
    • 2. Pathogenetic therapy
    • 3. Symptomatic therapy
    • 4. Operation

Description of the disease

Follicular tonsillitis
Follicular tonsillitis

Follicular tonsillitis (follicular tonsillitis) is a form of acute purulent inflammation of the tonsils follicle in the throat. In adults, it proceeds as an exacerbation of chronic inflammatory processes in the tonsils, or as a continuation of catarrhal inflammation.

Various forms of tonsillitis, including follicular, often affect people between the ages of 7 and 40. Tonsillitis is much less common in people from 41 to 60 years old. People in the older age group are practically not susceptible to tonsillitis.

In some cases, pathogenesis can be localized in:

  • nasopharynx - the nasopharyngeal tonsil is affected;
  • larynx - the lymphoid tissue of the larynx is affected.

Follicular angina is a common disease. The reason is that the tonsils are vulnerable to various pathogens. Palatine tonsils, other formations of the lymphadenoid pharyngeal ring, in contrast to the subcutaneous regional lymph nodes, protected from the environment:

  • located on the surface of the mucous membrane, and not protected from the surrounding space like other lymph nodes;
  • contact with microbial or viral agents, directly, when exhaling air or when chewing and swallowing food, and not through the lymphatic and circulatory system of the body.

Palatine tonsils are paired lymph nodes located on the border of the palatine-laryngeal and palatine-lingual folds in the oral cavity. They are well accessible for inspection. The free surface of the tonsils, under magnification, consists of folds (crypts). The spaces between the crypts form gaps (invaginations). There are follicles between the crypts, through which lymphocytes move freely to the surface and participate in phagocytosis (capture and destruction) of microorganisms, viruses, and tumor cells.

The physiological significance of the lacunae and follicles of the palatine tonsils:

  • capture and absorb foreign microorganisms when ingested through the mouth;
  • participate in the process of lymphopoiesis (formation of lymphocytes) and specialization of T and B - lymphocytes (immune defense cells);

A massive microbial attack, against the background of a weakened organism, is accompanied by a decrease, cessation of the protective functions of the tonsils. As a result of pathogenesis in the tonsils, acute purulent processes develop in the follicles (follicular tonsillitis) and / or lacunae (lacunar tonsillitis). Damaged tonsils become a source of pathogenesis, spreading waste products through the lymphatic system throughout the body.

Follicular sore throat causes

Follicular sore throat causes
Follicular sore throat causes

In the etiology of follicular tonsillitis, causative agents of the disease and an individual predisposition to tonsillitis are involved:

  • infectious agents (beta hemolytic streptococcus - GABHS, staphylococci C and G, viruses, Candida spp.)
  • a general decrease in the reactivity of the body (cooling, chronic fatigue, hypovitaminosis, malnutrition).

Infection methods:

  • endogenous, the pathogen constantly asymptomatically circulates in the body, against the background of a decrease in reactivity, the disease is provoked.
  • exogenous, the pathogen comes from outside.

Pathogen transmission routes:

  • aerosol, airborne, by inhalation;
  • fecal-oral, with food, water;
  • contact and household.

Transmission factors infected:

  • water;
  • food;
  • Houseware.

Seasonal and individual predisposition of people to angina has been noticed.

Pathogenesis of follicular tonsillitis. For follicular sore throat, proceeding according to the type of acute primary inflammation, the staging of pathogenesis is characteristic. The peculiar morphological structure of the tonsils located on the surface of the mucous membrane provide direct contact with the causative agents of angina. The tonsils of a healthy person's body capture and absorb microorganisms, trigger the mechanism of cellular and humoral immunity.

Under certain conditions: - a weakened general reactivity of the body and a massive microbial attack create prerequisites for inflammation of the tonsils.

The gate of infection - the tonsils, have a loose structure and high adhesion of microbes on the walls of the mucous membrane. Microorganisms, in particular staphylococci, have a mechanism to counteract the development of immunity, including:

  • factors of the walls of microbial cells (lipoteichoic acid), has an affinity for the mucous membrane of the epithelium of the tonsils.
  • m-protein of streptococci, inhibits phagocytosis of cells of the human body.

First of all, lymphoid formations of the oropharynx and palatine tonsils are involved in the pathogenesis. If untreated, streptococci enter the bloodstream, cause a violation of thermoregulation, toxicosis of the cardiovascular, urinary, digestive, and nervous systems. Streptococcus enzymes (proteinase, streptokinase) are involved in the development of the pathogenesis of primary tonsillitis.

Follicular sore throat symptoms

Follicular sore throat symptoms
Follicular sore throat symptoms

The harbingers of follicular sore throat is inflammation of the mucous membrane of the soft palate, palatine arches, palatine tonsils:

  • the surface of the tissues of the oral cavity is hyperemic, covered with mucus;
  • the patient complains of unsharp sore throat
  • examination reveals subfebrile temperature, moderate swelling, swelling of the mucous membrane, regional lymph nodes (cervical, submandibular) are enlarged, painful on palpation.

Within 1-3 days, if untreated, the first signs appear. General clinical examination reveals the symptoms of follicular tonsillitis:

  • Pharyngoscopy reveals small bubbles (follicles) containing pus, which are visible through the mucous membrane of the tonsils.;
  • Sharp sore throat, general malaise
  • Febrile temperature, regional lymph nodes are enlarged and painful.

A characteristic symptom of follicular angina is purulent-necrotic areas that are located next to the lacunae. The division of follicular and lacunar tonsillitis is conditional. Usually, pus-filled lacunae and follicles are located nearby. Visually, the lacunar form of angina is manifested by stripes on the amygdala, filled with purulent contents.

Follicular tonsillitis without fever. In the classical view, any inflammation, including follicular tonsillitis, is accompanied by six external signs:

  • local hyperemia (redness of the tonsils),
  • hyperthermia (increased local body temperature),
  • swelling of the glands and surrounding tissue,
  • local acidosis (increased tissue acidity),
  • dysfunction of the damaged organ,
  • pain.

Related article: Fever without symptoms in an adult or a child

In recent years, an unusual course of follicular angina has been noted, in the absence of hyperthermia. In some sources, the normal temperature in inflammation is explained by errors in diagnosis. The phenomenon was noticed by patients due to the inability to get sick leave with acute angina. As a result, some of the people with angina are forced to stay at the workplace, which has serious consequences for the body.

Some substances of the body take part in thermoregulation, with a lack or absence of them, the thermoregulation mechanism is disrupted, accompanied by the phenomenon of loss of an important diagnostic sign. If inflammation was preceded by pathologies accompanied by suppression of hormones: hypopituitarism, hypothyroidism, parkinsonism, impaired synthesis of inflammatory mediators - histamine and serotonin, then inflammation, including follicular tonsillitis, can proceed without fever.

Pathologies that alter the homeostasis of the body:

  • metabolic imbalance, infections, autoimmune diseases
  • decreased immunity
  • heart failure
  • taking antibiotics
  • the initial stage of the disease
  • exhaustion and alcohol intoxication
  • pharmacological vasodilators (drugs that cause the expansion of the walls of blood vessels).

In some cases, the normal temperature for follicular angina can be with:

  • chronic course of inflammation;
  • monthly bleeding;

Some patients pay attention only to sore throat, in the absence of other signs of inflammation. An important diagnostic sign is determined by examining the throat - purulent follicles on the tonsils.

Complications of follicular sore throat

Complications of follicular sore throat
Complications of follicular sore throat

Angina is a focal infection localized in the oropharynx that has a significant effect on the state of human health in general. The influence of chronic tonsillitis on the function of distant organs and body systems has been proven. Diseases developing as a result of the influence of tonsillitis in medical practice are usually called metatonsillar diseases (i.e. developing as a result of tonsillitis).

More than a hundred metatonsillar diseases are currently known. Doctors do not always find an obvious connection with angina and other pathologies. Inflamed palatine tonsils - focus:

  • increased sensitivity of the body to the effects of streptococcal and staphylococcal infections;
  • violations of the body's immunological defense;
  • permanent (permanent) bacteremia;
  • disorders of neurodynamic processes in the body.

The influence of chronic follicular tonsillitis in the pathogenesis is widely known:

  • of cardio-vascular system;
  • arthritis, arthrosis;
  • kidneys and other elements of the urinary system.

In addition, the negative role of chronic tonsillitis in various diseases has been determined. The relationship between chronic tonsillitis and:

  • dermatitis, in particular with psoriasis, debridement of the focus or tonsillectomy (removal of tonsils) in some cases is an important factor in the normalization of skin pathology;
  • collagen diseases (systemic lupus erythematosus, hemorrhagic vasculitis, polyarthritis and others);
  • respiratory tract diseases (chronic pneumonia, peribronchitis and others);
  • liver diseases, a direct relationship has been established to the severity of the course of viral hepatitis;
  • peripheral angioneuroses (Raynaud's disease), cerebral angioedema (Meniere's syndrome).

Some scientific sources describe the dependence of chronic tonsillitis with disorders:

  • menstrual cycle and reproductive disorders in women of fertile age;
  • obesity;
  • increased fatigue, weather dependence;
  • decreased sexual potency
  • depletion of the hormonal functions of the adrenal cortex, pancreas, thyroid glands.

Follicular sore throat treatment

Follicular sore throat treatment
Follicular sore throat treatment

Otolaryngologist - a specialist in diagnostics, therapeutic or surgical treatment and prevention of diseases of the nasal cavity, larynx, pharynx, ears.

For consultation with an otolaryngologist, if you suspect a throat disease, you should contact if you have sensations:

  • pain (perspiration) in the throat;
  • swelling of the throat and shortness of breath;
  • increase in local (in the throat) and general temperature;

The diagnosis is made on the basis of a survey, examination of the pharynx (pharyngoscopy) and larynx (laryngoscopy). The clinical picture of tonsillitis is typical, the percentage of diagnostic errors is not great. To determine the causative agent of tonsillitis (tonsillitis), laboratory research methods are often used (bacteriological culture, PCR method, test for beta hemolytic streptococcus group A - GABHS, express method, and others).

Differential laboratory diagnosis of bacterial and viral tonsillitis is necessary to determine the treatment strategy. With a viral etiology of the disease, antibacterial treatment is not effective. One of the outside laboratory criteria for the diagnosis of bacterial and viral tonsillitis is the assessment of the therapeutic effect on the use of antibiotics in the first 48 hours; antibiotics do not work on viruses.

The next step before the treatment of bacterial tonsillitis is to determine the sensitivity of microflora to antibiotics and the choice of an effective drug. There is no fundamental difference in the treatment of various types of tonsillitis.

When treating sore throat, there are two main methods of treatment:

  • medication;
  • surgical.

Medicines are used in the overwhelming majority of clinical cases for the treatment of angina.

1. Methods of etiotropic therapy

drugs are used to suppress the cause of the disease, in this case microbes (staphylococci, streptococci).

Antibiotics for follicular angina. In the case of GABHS tonsillitis, it is advisable to use penicillin antibiotics (benzylpenicillin, amoxicillin, phenoxymethylpenicillin and similar drugs) tablets inside. In case of intolerance to antibiotics of the penicillin series, antibiotics are prescribed - macrolides (summamed, chemomycin and others).

As a rule, they usually appoint:

  • Sumamed
  • Zetamax Retard
  • Azitro Sandoz
  • Amoxiclav
  • Augmentin

The effect of antibiotic therapy should be expected in the first 48 hours. Lack of treatment is the reason for correcting the treatment strategy. When using antibiotics, you should pay attention to:

  • Individual sensitivity of the patient to them;
  • The possibility of using antibiotics at certain times (pregnancy, concomitant diseases, and others);
  • Compatibility with other medicinal products.

On the subject: The most effective antibiotic for angina

Etiotropic methods for angina also include therapeutic methods (washing, rinsing, throat, suction of pus from the follicles, lubrication of the tonsils, introduction of drugs into the follicles). The methods are considered etiotropic when antimicrobial drugs are used to treat the tonsils.

  • Rinsing the follicles of the tonsils. Rinse with a syringe, antiseptic solutions. Reduces tonsil swelling, inflammation,
  • Suction of the purulent contents of the follicles. Vacuum suction is used while the follicles are washed.
  • Injection of medicinal substances into the tonsils.
  • Lubrication of the tonsils with a solution of wound-healing oil solutions.
  • Rinsing the oropharynx with decoctions of herbs, ready-made rinsing solutions.

Video: how to quickly cure a sore throat at home? 5 easy steps:

2. Methods of pathogenetic therapy

They use drugs aimed at correcting the pathogenesis mechanism (immunocorrection, vitamin therapy, antihistamines, novocaine blockades, physiotherapeutic manipulations).

  • Immunocorrection. It is widely used in the case of tonsillitis of viral etiology.
  • Vitamin therapy. It is used in combination with a diet, the correct daily regimen, and is often prescribed for follicular angina.
  • Antihistamines. Sore throats cause sensitization of the body, the use of antiallergic drugs is justified in case of complications from allergies.
  • Novocaine blockade. In some cases, it is used as a means of pathogenetic therapy.
  • Physiotherapy manipulations. For follicular tonsillitis, it is prescribed (irradiation of the tonsils with UFO, microwave, UHF, application of drugs using electrophoresis, magnetotherapy, inhalation)

3. Methods of symptomatic therapy

Follicular tonsillitis is characterized by an increase in body temperature, pain of varying intensity. If necessary, the doctor prescribes drugs that eliminate unpleasant symptoms.

Surgical treatments. Surgical removal of tonsils is a widely used manipulation. Tonsillectomy (removal of tonsils) is performed under local, sometimes under general anesthesia. Manipulation is not shown to everyone. There are absolute and relative contraindications. Absolute contraindications: hemophilia, renal and heart failure, severe metabolic disorders, and so on. Relative contraindications: pregnancy, exacerbation of infectious diseases, and others.

The operation is shown when:

  • enlarged tonsils, making it difficult to swallow, breathing (apnea), especially at night;
  • unpromising drug treatment of chronic forms of tonsillitis;
  • involvement of surrounding tissues in the purulent process.

In modern ENT surgery, the following methods are used:

  • excision (scissors, electrically, ultrasonic scalpel, infrared scalpel, shaver technology, guided removal technology)
  • radiofrequency ablation (controlled reduction in the size of the tonsils), carbon dioxide (carbon) laser (`` evaporation '' of the tonsils)

Methods of surgical removal of tonsils depends on the equipment of the clinic and the qualifications of the doctors.


The author of the article: Lazarev Oleg Vladimirovich | ENT

Education: In 2009, he received a diploma in the specialty "General Medicine" at the Petrozavodsk State University. After completing an internship at the Murmansk Regional Clinical Hospital, he received a diploma in Otorhinolaryngology (2010)

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