Angina (acute tonsillitis) - Information Overview

Angina (acute tonsillitis) is an acute infectious disease caused by streptococci or staphylococci, less often by other microorganisms, characterized by inflammatory changes in the lymphoid tissue of the pharynx, most often in the palatine tonsils, manifested by a sore throat and moderate general intoxication.

What is angina, or acute tonsillitis?

Inflammatory diseases of the pharynx have been known since ancient times. They received the general name "tonsillitis". In essence, as B.S. Preobrazhensky (1956) believes, the name "throat tonsillitis" unites a group of heterogeneous diseases of the pharynx and not only inflammation of the lymphadenoid formations themselves, but also of the cellular tissue, the clinical manifestations of which are characterized, along with signs of acute inflammation, by the syndrome of compression of the pharyngeal space.

Judging by the fact that Hippocrates (5th-4th centuries BC) repeatedly cited information related to a throat disease very similar to angina, it can be assumed that this disease was the subject of close attention of ancient doctors. Removal of tonsils in connection with their disease was described by Celsus. The introduction of the bacteriological method into medicine gave reason to classify the disease by the type of pathogen (streptococcal, staphylococcal, pneumococcal). The discovery of the diphtheria corynebacterium made it possible to differentiate common tonsillitis from a angina-like disease - diphtheria of the pharynx, and scarlet fever manifestations in the throat, due to the presence of a rash characteristic of scarlet fever, were identified as an independent symptom characteristic of this disease even earlier, in the 17th century.

At the end of the 19th century, a special form of ulcerative-necrotic angina was described, the occurrence of which is caused by the fusospirochetal symbiosis of Plaut-Vincent, and with the introduction of hematological studies into clinical practice, special forms of pharyngeal lesions were identified, called agranulocytic and monocytic angina. Somewhat later, a special form of the disease was described, arising with alimentary-toxic aleukia, similar in its manifestations to agranulocytic angina.

It is possible that not only the palatine tonsils but also the lingual, pharyngeal, and laryngeal tonsils may be affected. However, the inflammatory process is most often localized in the palatine tonsils, which is why the term "tonsillitis" is commonly used to mean acute inflammation of the palatine tonsils. This is an independent nosological form, but in the modern understanding, it is essentially not one, but a whole group of diseases that differ in etiology and pathogenesis.

ICD-10 code

J03 Acute tonsillitis (quinsy).

In everyday medical practice, a combination of tonsillitis and pharyngitis is often observed, especially in children. Therefore, the unifying term "tonsillopharyngitis" is widely used in the literature, but tonsillitis and pharyngitis are included separately in ICD-10. Given the exceptional importance of the streptococcal etiology of the disease, streptococcal tonsillitis (J03.0) is distinguished, as well as acute tonsillitis caused by other specified pathogens (J03.8). If it is necessary to identify the infectious agent, an additional code (B95-B97) is used.

Epidemiology of angina

In terms of the number of days of incapacity for work, angina ranks third after influenza and acute respiratory diseases. Children and people under 30-40 years of age are most often affected. The frequency of visits to a doctor per year is 50-60 cases per 1000 population. The incidence depends on the population density, living conditions, sanitary and hygienic, geographical and climatic conditions. It should be noted that the disease is more common among the urban population than among the rural population. According to literature, 3% of those who have had the disease develop rheumatism, and in patients with rheumatism, after the disease, heart disease develops in 20-30% of cases. In patients with chronic tonsillitis, angina is observed 10 times more often than in practically healthy people. It should be noted that approximately every fifth person who has had angina subsequently suffers from chronic tonsillitis.

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Causes of angina

The anatomical position of the pharynx, which determines wide access to it of pathogenic factors of the external environment, as well as the abundance of vascular plexuses and lymphadenoid tissue, turn it into a wide entry gate for various types of pathogenic microorganisms. The elements that primarily react to microorganisms are solitary accumulations of lymphadenoid tissue: palatine tonsils, pharyngeal tonsils, lingual tonsil, tubal tonsils, lateral ridges, as well as numerous follicles scattered in the area of the back wall of the pharynx.

The main cause of tonsillitis is due to the epidemic factor - infection from a sick person. The greatest risk of infection exists in the first days of the disease, but a person who has had the disease can be a source of infection (albeit to a lesser extent) during the first 10 days after tonsillitis, and sometimes longer.

In 30-40% of cases in the autumn-winter period, pathogens are viruses (adenoviruses types 1-9, coronaviruses, rhinovirus, influenza and parainfluenza viruses, respiratory syncytial virus, etc.). The virus can not only act as an independent pathogen, but can also provoke the activity of bacterial flora.

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Symptoms of angina

The symptoms of angina are typical - a sharp pain in the throat, an increase in body temperature. Among the various clinical forms, banal angina is most common, and among them - catarrhal, follicular, lacunar. The division of these forms is purely conditional, in essence, this is a single pathological process that can quickly progress or stop at one of the stages of its development. Sometimes catarrhal angina is the first stage of the process, after which a more severe form follows or another disease occurs.

Classification of angina

During the foreseeable historical period, numerous attempts have been made to create a more or less scientific classification of sore throats, but each proposal in this direction had certain shortcomings, not due to the "fault" of the authors, but due to the fact that the creation of such a classification is practically impossible for a number of objective reasons. These reasons include, in particular, the similarity of clinical manifestations not only with different banal microbiota, but also with some specific sore throats, the similarity of some general manifestations with different etiological factors, frequent discrepancies between bacteriological data and the clinical picture, etc. Therefore, most authors, guided by practical needs in diagnostics and treatment, often simplified the classifications they proposed, which sometimes boiled down to classical concepts.

These classifications had and still have a clearly expressed clinical content and, of course, have great practical significance, however, these classifications do not reach a truly scientific level due to the extreme multifactorial nature of the etiology, clinical forms and complications. Therefore, from a practical point of view, it is advisable to divide tonsillitis into non-specific acute and chronic and specific acute and chronic.

The classification presents certain difficulties due to the diversity of disease types. The classifications of V.Y. Voyachek, A.Kh. Minkovsky, V.F. Undritz and S.Z. Romm, L.A. Lukozsky, I.B. Soldatov and others are based on one of the criteria: clinical, morphological, pathophysiological, etiological. As a result, none of them fully reflects the polymorphism of this disease.

The most widely used classification of the disease among practitioners was developed by B.S. Preobrazhensky and subsequently supplemented by V.T. Palchun. This classification is based on pharyngoscopic signs, supplemented by data obtained during laboratory studies, sometimes with etiological or pathogenetic information. According to origin, the following main forms are distinguished (according to Preobrazhensky Palchun):

• an episodic form associated with autoinfection, which is activated under unfavorable environmental conditions, most often after local or general cooling;
• an epidemic form that occurs as a result of infection from a patient with tonsillitis or a carrier of a virulent infection; the infection is usually transmitted by contact or airborne droplets;
• tonsillitis as another exacerbation of chronic tonsillitis, in this case, the violation of local and general immune reactions is a consequence of chronic inflammation in the tonsils.

The classification includes the following forms.

• Trivial:
  • catarrhal;
  • follicular;
  • lacunar;
  • mixed;
  • phlegmonous (intratonsillar abscess).
• Special forms (atypical):
  • ulcerative necrotic (Simanovsky-Plaut-Vincent);
  • viral;
  • fungal.
• For infectious diseases:
  • for diphtheria of the pharynx;
  • with scarlet fever;
  • root;
  • syphilitic;
  • in case of HIV infection;
  • pharyngeal lesions in typhoid fever;
  • in tularemia.
• For blood diseases:
  • monocytic;
  • in leukemia:
  • agranulocytic.
• Some forms according to localization:
  • tonsil (adenoiditis);
  • lingual tonsil;
  • laryngeal;
  • lateral ridges of the pharynx;
  • tubular tonsil.

“Tonsillitis” refers to a group of inflammatory diseases of the pharynx and their complications, which are based on damage to the anatomical formations of the pharynx and adjacent structures.

J. Portman simplified the classification of angina and presented it in the following form:

1. Catarrhal (banal) non-specific (catarrhal, follicular), which after localization of inflammation are defined as palatine and lingual tonsillitis, retronasal (adenoiditis), uvulitis. These inflammatory processes in the pharynx are called "red tonsillitis".
2. Membranous (diphtheritic, pseudomembranous non-diphtheritic). These inflammatory processes are called "white tonsillitis". To clarify the diagnosis, it is necessary to conduct a bacteriological study.
3. Tonsillitis accompanied by loss of structure (ulcerative-necrotic): herpetic, including Herpes zoster, aphthous, Vincent's ulcer, scurvy and impetigo, post-traumatic, toxic, gangrenous, etc.

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Screening

When identifying the disease, complaints of a sore throat, as well as characteristic local and general symptoms are used. It should be taken into account that in the first days of the disease, with many general and infectious diseases, there may be similar changes in the oropharynx. To clarify the diagnosis, dynamic observation of the patient and sometimes laboratory tests (bacteriological, virological, serological, cytological, etc.) are necessary.

Diagnosis of angina

The anamnesis should be collected with special care. Great importance is attached to the study of the general condition of the patient and some "pharyngeal" symptoms: body temperature, pulse rate, dysphagia, pain syndrome (unilateral, bilateral, with or without irradiation to the ear, the so-called pharyngeal cough, a feeling of dryness, irritation, burning, hypersalivation - sialorrhea, etc.).

Attention is also paid to the timbre of the voice, which changes dramatically during abscessing and phlegmonous processes in the pharynx.

Endoscopy of the pharynx in most inflammatory diseases allows for an accurate diagnosis, however, the unusual clinical course and endoscopic picture force us to resort to additional methods of laboratory, bacteriological and, if indicated, histological examination.

To clarify the diagnosis, laboratory tests are required: bacteriological, virological, serological, cytological, etc.

In particular, microbiological diagnostics of streptococcal tonsillitis is of great importance, which includes a bacterial examination of a smear from the surface of the tonsil or the back wall of the pharynx. The results of the culture largely depend on the quality of the material obtained. The smear is taken using a sterile swab; the material is delivered to the laboratory within 1 hour (for longer periods, special media must be used). Before collecting the material, do not rinse your mouth or use deodorants for at least 6 hours. With the correct technique for collecting material, the sensitivity of the method reaches 90%, specificity - 95-96%.

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Treatment of angina

The basis of drug treatment of angina is systemic antibacterial therapy. In outpatient settings, antibiotics are usually prescribed empirically, so information about the most common pathogens and their sensitivity to antibiotics is taken into account.

Preference is given to drugs of the penicillin series, since beta-hemolytic streptococcus has the greatest sensitivity to penicillins. In outpatient settings, drugs for oral administration should be prescribed.

Prevention of angina

Disease prevention measures are based on the principles developed for infections transmitted by airborne droplets or food, since tonsillitis is an infectious disease.

Preventive measures should be aimed at improving the external environment, eliminating factors that reduce the body's defenses against pathogens (dust, smoke, excessive crowding, etc.). Individual preventive measures include hardening the body, physical exercise, establishing a reasonable work and rest schedule, spending time in the fresh air, eating food with sufficient vitamin content, etc. Of utmost importance are treatment and preventive measures such as oral hygiene, timely treatment (surgical if necessary) of chronic tonsillitis, restoration of normal nasal breathing (adenotomy if necessary, treatment of paranasal sinus diseases, septoplasty, etc.).

Forecast

The prognosis is favorable if the treatment is started in a timely manner and carried out in full. Otherwise, local or general complications may develop, and chronic tonsillitis may develop. The average period of incapacity for work is 10-12 days.

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