Acute tonsillitis
Acute tonsillitis is an infectious and inflammatory disease, accompanied by damage to the palatine and / or pharyngeal tonsils with involvement of the lymphadenoid pharyngeal ring in the pathological process. Tonsillitis can act as an independent nosological form, or be a consequence (or manifestation) of infectious or somatic diseases. Most often, tonsillitis is provoked by streptococci.
In adults, during acute tonsillitis, in the vast majority of cases, the palatine tonsils become inflamed, and in children, the pharyngeal tonsils. Less commonly, acute tonsillitis is diagnosed in the age group of children under 3 years old and the elderly over 50 years old. This is due to the fact that in babies, the tissue of the tonsils is still underdeveloped. In addition, babies under the age of 3 are much less likely to encounter pathogenic flora than children attending educational institutions. In older people, on the contrary, the lymphoid tissue of the tonsils gradually begins to involution.
Residents of large cities suffer from acute tonsillitis more often, as they spend more time in crowded places. The disease does not have a clear seasonality, however, it is more often recorded during epidemics of influenza and other acute respiratory viral infections. Acute tonsillitis is often combined with acute pharyngitis, in which the back of the throat becomes inflamed.
Content:
- Forms of acute tonsillitis
- Causes of acute tonsillitis
- Acute tonsillitis symptoms
- Complications of acute tonsillitis
- Diagnostics of the acute tonsillitis
- Treatment of acute tonsillitis
- Prevention of tonsillitis
- Forecast
Forms of acute tonsillitis
It is customary to distinguish between several forms of acute tonsillitis:
- Catarrhal inflammation, in which the lining of the tonsils will be affected.
-
Lacunar inflammation, when the lacunae of the tonsils are involved in the pathological process. Lacunae are deep channels in the amygdala that are sinuous in shape. Normally, they cleanse themselves of microbes on their own, but as a result of a decrease in local immunity, the lacunae lose their ability to self-purify. They accumulate plaque and purulent masses.
- Follicular inflammation, when the disease invades the lymphoid follicles.
- Fibrous tonsillitis.
- Phlegmonous acute tonsillitis.
- Ulcerative necrotizing acute tonsillitis.
- Mixed form of the disease.
If we consider acute tonsillitis depending on the type of causative agent of the disease, then its forms are distinguished:
- Streptococcal is the most common form of the disease;
- Scarlet fever;
- Diphtheria;
- Tularemia;
- Syphilitic;
- Candidal;
- Tuberculosis, etc.
Causes of acute tonsillitis
The most common causative agent of acute tonsillitis is group A beta-hemolytic streptococcus, which is sown in more than 50% of patients. Other pathogenic microorganisms that can cause inflammation of the tonsils: streptococci of other groups, Staphylococcus aureus, Haemophilus influenzae, Enterobacter.
Sometimes bacteria enter the tonsils from the outside, and sometimes it happens that a person activates his own conditionally pathogenic flora, which is normally restrained by the body's immune forces, but is always present in it.
Risk factors for the development of acute tonsillitis are:
- General and local hypothermia.
- Decreased body defenses.
- Hypovitaminosis.
- Problems with nasal breathing.
- Dry air.
- Recently suffered acute respiratory viral infections.
Any factor that reduces local and general immunity of a person can lead to the development of tonsillitis.
As for infection with harmful bacteria that cause tonsillitis from the external environment, they are most often transmitted by airborne droplets.
Acute tonsillitis symptoms
It is impossible not to notice the symptoms of acute tonsillitis.
The clinical picture of developing inflammation is as follows:
- A sore throat that is severe. They are enhanced when a person makes swallowing movements.
- Swelling and redness of the tonsils.
- The presence of purulent contents in the channels.
- The presence of plaque on the tonsils.
- Inflamed tonsil follicles.
- Swelling and tenderness of the cervical lymph nodes.
- Increased weakness, general malaise.
- An increase in body temperature to 39-40 ° C.
- Muscle and joint pain, chills.
- If tubopharyngeal ridges are involved in the process of inflammation, then the pain during swallowing will be given to the ears.
With a severe course of the disease, a person has a pronounced intoxication of the body, persistent fever, which practically cannot be eliminated with the help of antipyretic drugs. Perhaps impaired consciousness, nausea and vomiting, abdominal pain.
Complications of acute tonsillitis
Complications of acute tonsillitis are divided into early and late.
The first of them include:
- Otitis;
- Lymphadenitis;
- Sinusitis;
- Inflammation of the lymph nodes;
- Paratonsillitis;
- Paratonsillar abscess.
These complications arise during illness and most often capture organs and tissues located in close proximity to the focus of inflammation.
Late complications of tonsillitis include:
- Glomerulonephritis;
- Rheumatism;
- Rheumatic heart disease.
These complications develop several weeks after the onset of the disease. They are triggered by the spread of bacteria to distant organs through the bloodstream.
Diagnostics of the acute tonsillitis
The local doctor or ENT doctor deals with the diagnosis of tonsillitis. The diagnosis is made based on the symptoms of the disease and pharyngoscopy.
Bacteriological examination of mucous discharge from the tonsils is a highly desirable diagnostic procedure. It allows you to determine the type of bacteria that triggered the inflammation. It is also necessary to conduct a clinical blood test, which provides general information about the patient's condition.
The differential diagnosis of acute tonsillitis should be carried out with diseases that have similar symptoms. First of all, it is infectious mononucleosis and enterovirus infection.
Treatment of acute tonsillitis
If the patient feels satisfactory, then the treatment of acute tonsillitis is carried out at home. In case of severe intoxication, the patient is hospitalized in the infectious diseases department of the hospital.
The first 3-4 days you should adhere to bed rest so that the body has enough strength to recover.
It is necessary to follow a diet with an emphasis on dairy products and plant foods. All dishes until the inflammation subsides should be served to the patient in liquid or puree form. The temperature of the dishes matters: they should not be hot or cold. It is important to eat fresh fruits and vegetables rich in vitamins. Drinking plenty of fluids is a prerequisite for a speedy recovery.
An antibiotic should be prescribed by a doctor, based on a bacterial culture of mucus.
Basic principles of prescribing antibacterial drugs for acute tonsillitis:
- Treatment should be course and last at least 10 days.
- The sooner antibiotic therapy is started, the faster it will be possible to achieve recovery and the lower the risk of complications in the patient.
- Family members of a patient with acute tonsillitis do not need prophylactic antibiotic therapy.
The drugs of choice for acute tonsillitis are unprotected penicillins such as Amoxicillin. These drugs are highly active against streptococci, are well tolerated by patients and do not require high doses. Moreover, they have minimal impact on the human digestive system.
If the patient is diagnosed with recurrent acute tonsillitis, then the appointment of unprotected penicillins will be unjustified. Re-emergence of inflammation indicates the persistence of bacteria and the release of the enzyme beta-lactamase. In this case, the drug of choice is Flemoxin Solutab, which belongs to the group of protected penicillins. Dosage of the medicinal product: 625 mg 3 times a day, or 875 mg 2 times a day.
Antibiotics from the cephalosporin group are also resistant to beta-lactamase. Preference should be given to medicines of the 3rd generation, for example, Suprax Solutab. In case of intolerance to penicillins, antibiotics from the macrolide group, for example, Josamycin, can be used.
Against the background of severe intoxication, drugs are administered parenterally. If a person has a high body temperature and severe sore throat, then it is necessary to take drugs from the NSAID group, for example, Nurofen.
If the patient receives adequate treatment, then recovery occurs within 7-10 days.
The following criteria indicate the effectiveness of therapy:
- Improving overall well-being.
- Decreased body temperature.
- Fading away of pain and discomfort in the throat.
- Reducing the severity of inflammation of the tonsils.
- Cleansing lacunae from pus and mucus.
- Reduction in the size of the lymph nodes, elimination of their soreness.
When, after 2-3 days from the start of treatment, there are no signs of improvement in well-being, this indicates that the antibacterial drug was chosen incorrectly and its replacement is required. It can be a broader-spectrum drug, or a protected penicillin (subject to treatment with unprotected penicillins).
For the duration of treatment, smoking cessation is a prerequisite.
It is also possible to carry out the following auxiliary activities:
- Gargle with antiseptic solutions such as Miramistin, Norsulfazole, Streptocide, or Chlorhexidine. A good effect is given by decoctions of medicinal herbs: chamomile or sage.
- Taking warm foot baths, provided there is no temperature.
- Inhalation with saline or alkaline mineral water.
Mechanical removal of plaque from the tonsils and "rubbing" them with drugs is an unacceptable measure in the treatment of tonsillitis. These manipulations can lead to injury to the mucous membrane of the tonsils and aggravation of the patient's condition. Therefore, local treatment is reduced to resorption of tablets with an antiseptic effect, for example, Lizobact or Hexoral, irrigation of the tonsils with aerosols and sprays.
Surgical treatment. The tonsils are part of the immune system and have an important protective function in the body. Therefore, they are removed only as a last resort.
Indications for surgery can be:
- The ineffectiveness of conservative therapy.
- Recurrent tonsillitis with severe course and recurring 3 or more times a year.
- Complications from other organs.
- Formation of a paratonsillar abscess.
The operation is performed under general anesthesia and lasts an average of half an hour.
Prevention of tonsillitis
To minimize the risk of developing inflammation of the tonsils, the following preventive measures must be observed:
- Compliance with oral hygiene, timely treatment of caries.
- Compliance with cleanliness in the room, frequent wet cleaning of the room, provision of fresh air.
- Timely and high-quality treatment of all diseases of the respiratory system.
- Leading a healthy lifestyle, balanced diet.
- Hardening.
- Taking immunostimulating drugs during outbreaks of infectious and viral diseases.
- Limiting contact with people with tonsillitis.
Forecast
The prognosis for acute tonsillitis primarily depends on the state of the patient's immune system, as well as on how timely therapy is started. Correctly conducted treatment leads to a complete recovery of the patient and the absence of recurrence of tonsillitis. Complications develop more often in those people who delay contacting a specialist and self-medicate.
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)
