Lacunar Angina In Adults

Palatine tonsils (tonsils) are paired formations of lymphoid tissue located in the oropharynx. The surface of the tonsils is permeated with lacunae (depressions), which have extensive branching into the body of the lymphoid tissue. The total surface of the mucous membranes of the tonsils is up to 350 cm ², which is comparable to the area of the walls of the oropharynx.

The physiological feasibility of a large area of the tonsils is due to an increased likelihood of contact of microorganisms and viruses with cells of the immune system in the lacunae. Immunocompetent lymphocytes in the tonsils capture foreign pathogenic cells and neutralize them. With the weakening of the body, the tonsils cannot cope with the main function, there is an inflammation of the palatine tonsils - tonsillitis.

Lacunar tonsillitis (lacunar tonsillitis) is an acute purulent inflammation of the lacunae of the tonsils. Lacunar angina occurs in childhood and adolescence. For adults, almost always, this is an exacerbation of a smoldering infection. Lacunar angina in adults is diagnosed before the age of 50. At an older age, the likelihood of the disease decreases. The disease is diagnosed all year round, with a peak incidence from October to January.

Content:

Symptoms of lacunar sore throat

Causes of lacunar sore throat

Treatment of lacunar sore throat

Symptoms of lacunar sore throat

Lacunar angina in adults is manifested in the acute phase of inflammation. Pathogenesis develops rapidly. The clinic, in full, manifests itself during the day, accompanied by a sharp rise in temperature to febrile (38-39 ⁰ С) or pyretic (39-41 ⁰ С) values.

Symptoms of lacunar sore throat appear as:

fever, often of the hectic type (temperature fluctuations during the day up to ± 5 ⁰ C), sometimes of the remitting type (an increase in body temperature to 2 ⁰ C and its maintenance for a long time without a decrease);
intoxication syndrome (weakness, headache, fatigue, lack of appetite, insomnia);
pain syndrome (pain when swallowing, arthralgia - pain in the joints of the jaw, myalgia - pain in the muscles);
hyperemia of the cheeks, against the background of pallor of the nasolabial triangle (with secondary angina, used in differential diagnosis);
hyperemia of the mucous membranes (palatine arches, tonsils, soft palate);
purulent contents in gaps and tonsils - pathognomonic (leading) symptom;
lymphadenitis - inflammation of regional lymph nodes in the neck and jaw;
tachycardia - increased heart rate (HR), usually up to 90 beats / minute;

In bacteriological studies, various microorganisms are detected:

group A beta hemolytic streptococcus (GABHS);
Staphylococcus aureus (Staphylococcus aureus);
Staphylococcus haemolyticus (hemolytic staphylococcus aureus);

Sometimes, when sowing a smear from the throat, other microorganisms are also isolated - the causative agents of lacunar sore throat. Immunological methods, polymerase chain reaction (PCR) and others secrete viruses that can also cause sore throats. Most often, with lacunar angina, there are:

adenoviruses;
herpes virus;
cytomegalovirus.

Causes of lacunar sore throat

Lacunar sore throats are divided into primary and secondary.

The main causative agents of primary lacunar sore throat in adults:

streptococci;
staphylococci;
other microorganisms and fungi;
some types of viruses.

Secondary tonsillitis occurs with scarlet fever, tuberculosis, and other infections in which the pathological process spreads to the palatine tonsils and the surrounding tissue.

Lacunar angina is an infectious disease, infection can occur when:

inhaling air;
alimentary with food;
household contact.

In clinical practice, most often, infection is mentioned by contact with a person who is sick with angina.

Predisposing factors of the disease:

inflammation of the oropharynx and nasopharynx;
caries and periodontal disease;
hypothermia of the body;
chronic fatigue;
unfavorable ecology.

The diagnosis of lacunar angina is made on the basis of a complex of clinical and epidemiological studies, laboratory data and instrumental examination.

The clinical examination includes:

collection of anamnesis, external examination, palpation of peripheral lymph nodes, skin, subcutaneous tissue, chest auscultation;
medical history;
General analysis of blood (CBC) and urine (OAM).
Bacteriological examination includes sowing a smear (pharynx, nasopharynx, lacunae) on the microflora, according to indications, crops are made on Lefler's bacillus (in differential diagnosis, diphtheria is suspected) and conditionally pathogenic microflora.
Immunological research to identify viruses - causative agents of angina.
Instrumental studies include the definition of an electrocardiogram, pharyngoscopy and laryngoscopy.
Other studies according to indications.

Treatment of lacunar sore throat

Hospitalization depending on the severity of the pathogenesis. In any case, bed rest and limitation of the number of contacts are shown. The food is warm, pureed, not spicy. Plentiful drink is shown.

Methods of treatment, drugs are similar to the treatment of follicular sore throat. Conservative treatment is indicated, and in the absence of effect, in the case of acute enlargement of the tonsils, with difficulty in breathing, surgical removal of the tonsils is indicated.

Antibiotics for lacunar angina. Antibiotic therapy is indicated for the microbial etiology of lacunar angina. Antibiotics are used as antibacterial agents, sulfa drugs are much less common. The purpose of prescribing antibiotics is eradication (destruction of the pathogen). When prescribing antibiotics, it is important to provide adequate therapy for angina.

The correct choice of antibiotic provides:

Complete destruction of the pathogen;
Exclusion of side effects for various concomitant diseases of angina;
Balance of antibiotic effect and safety.

On the subject: The most effective antibiotic for angina

In modern conditions, the drugs of first choice for ENT infections are antibiotics of the penicillin series.

Meanwhile, they often use:

Cephalosporins (Axetin, Zinnat, Suprax, cefadroxil, cefuroxime, ceftriaxone);
Macrolides (Azithromycin, Erythromycin, Josamycin);
Fluoroquinolones (Moxifloxacin and others);

Recently, many clinicians have shown the high therapeutic efficacy of Augmentin, an antibiotic of the penicillin series in the pharmacological combination of amoxicillin and clavulanate. This antibiotic is indicated for angina complicated by many concomitant diseases.

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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)