Angina (acute tonsillitis): overview of information

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

What is angina, or acute tonsillitis?

Inflammatory diseases of the pharynx are known since ancient times. They have received the general name "angina". In fact, according to B.S. Preobrazhensky (1956), the name "throat angina" unites a group of heterogeneous diseases of the pharynx and not only inflammation of the lymphadenoidal formations proper, but also cellular tissues, the clinical manifestations of which are characterized, along with the signs of acute inflammation, by the pharyngeal compression syndrome space.

Judging by the fact that Hippocrates (V-IV centuries BC) repeatedly cited information pertaining to the disease of the pharynx, very similar to angina, it can be considered that this disease was the subject of close attention of ancient doctors. The removal of tonsils due to their disease is described by Celsus. The introduction of a bacteriological method into medicine gave rise to the classification of the disease according to the type of pathogen (streptococcal, staphylococcal, pneumococcal). The discovery of the corynebacterium of diphtheria made it possible to differentiate banal angina from an angina-like disease-diphtheria of throat, and scarlet fever manifestations in the pharynx due to the presence of a characteristic scarlet fever were identified as an independent symptom characteristic for this disease, even earlier, in the 17th century.

At the end of XIX century. Described a special form of ulcerative necrotic tonsillitis, the emergence of which is due to Fuso spirochaete symbiosis of Plaut-Vincent, and when introducing into the clinical practice of hematological studies, special forms of the pharyngeal lesions, called agranulocyte and monocytic angina, were isolated. Somewhat later, a special form of the disease that occurs with alimentary-toxic aleukia, similar in its manifestations to agranulocyte angina, was described.

It is possible to defeat not only the palatine, but also the lingual, pharyngeal, guttural tonsils. However, most often the inflammatory process is localized in the palatine tonsils, therefore it is commonly called angina, which means acute inflammation of the palatine tonsils. This is an independent nosological form, but in the modern sense it is essentially not one, but a whole group of diseases, different in etiology and pathogenesis.

ICD-10 code

J03 Acute tonsillitis (tonsillitis).

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

Epidemiology of sore throat

In terms of the number of days of incapacity for work, angina ranks third after the flu and acute respiratory diseases. Most often, children and persons get sick before the age of 30-40. The frequency of access to a doctor per year is 50 -60 cases per 1000 population. The incidence depends on the population density, household, sanitary and hygienic, geographical and climatic conditions. It should be noted that among the urban population, the disease is cleaner than in rural areas. According to the literature, rheumatism develops in 3% of patients, and in patients with rheumatic disease, after 20-30% of cases, heart disease is formed. In patients with chronic tonsillitis, angina is observed 10 times more often than in practically healthy people. It should be noted that about one in five, who suffered a sore throat, subsequently suffers from chronic tonsillitis.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Causes of sore throat

The anatomical position of the pharynx, which determines the wide access to it of pathogenic environmental factors, as well as the abundance of vascular plexuses and lymphadenoid tissue, transform it into wide entrance gates for various pathogenic microorganisms. Elements, primarily reacting to microorganisms, are solitary clusters of lymphadenoid tissue: palatine tonsils, pharyngeal tonsils, lingual tonsil, tubal tonsils, lateral ridges, and numerous follicles scattered in the region of the posterior pharyngeal wall.

The main cause of angina is caused by an epidemic factor - infection from the patient. The greatest danger of infection exists in the first days of the disease, but the person who has transferred the disease is the source of infection (although to a lesser extent) during the first 10 days after the angina and sometimes longer.

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

[10], [11], [12], [13], [14], [15]

Symptoms of angina

Symptoms of angina are typical - a sharp pain in the throat, an increase in body temperature. Among the various clinical forms most common are common angina, and among them - catarrhal, follicular, lacunar. The division of these forms is purely conditional, in essence it 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, followed by a more severe form or another disease.

Classification of angina

During the foreseeable historical period, numerous attempts have been made to create some sort of scientific classification of throat angina, but each proposal in this direction was fraught with certain shortcomings and not due to the "fault" of the authors, but because the creation of such a classification for a number of objective reasons is impossible. These reasons, in particular, include the similarity of clinical manifestations not only with different banal microbiota, but also with certain specific anginas, the similarity of some common manifestations with different etiologic factors, the frequent differences between bacteriological data and the clinical picture, etc., therefore, most authors, guided by practical needs in diagnosis and treatment, often simplified the proposed classifications, which, at times, were reduced to classical ideas.

These classifications have been and still have a pronounced clinical content and, of course, are of great practical importance, however, these classifications do not reach a truly scientific level due to the extreme multifactority of etiology, clinical forms and complications. Therefore, from the practical point of view, angina can be divided into nonspecific acute and chronic and specific acute and chronic.

Classification presents certain difficulties due to the variety of disease types. In the basis of classifications V.Y. Voyachek, A.Kh. Minkovsky, V.F. Undrytsa and S.Z. Romma, L.A. Lukozsky, I.B. Soldatova et al. Lies one of the criteria: clinical, morphological, pathophysiological, etiological. As a result, none of them fully reflects the polymorphism of this disease.

The most common among practical doctors was the classification of the disease, developed by B.S. Preobrazhensky and later supplemented by V.T. Palchoun. This classification is based on pharyngoscopic signs, supplemented by data obtained in laboratory studies, sometimes with data of an etiological or pathogenetic nature. By origin, the following basic forms are distinguished (according to Preobrazhensky Palchoun):

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

The classification includes the following forms.

• Banal:
  • catarrhal;
  • follicular;
  • lacunar;
  • mixed;
  • phlegmonous (intratonsillar abscess).
• Special forms (atypical):
  • ulcerative-necrotic (Simanovsky-Plauta-Vincent);
  • virus;
  • fungal.
• For infectious diseases:
  • with diphtheria of the pharynx;
  • with scarlet fever;
  • measles;
  • syphilitic;
  •  with HIV infection;
  • defeat of pharynx with typhoid fever;
  • with tularemia.
• With blood diseases:
  • monocytic;
  • with leukemia:
  • agranulocyte.
• Some forms of localization, respectively:
  • lachrymal tonsils (adenoiditis);
  • lingual tonsil;
  • guttural;
  • lateral ridges of pharynx;
  • tubal tonsils.

By "angina" is understood a group of inflammatory diseases of the pharynx and their complications, which are based on the 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) nonspecific (catarrhal, follicular), which after localization of inflammation is defined as palatine and lingual amygdalitis, retro-nasal (adenoiditis), uvulitis. These inflammatory processes in the throat were called "red angina."
2. Membrane (diphtheria, pseudomembranous nondiptheria). These inflammatory processes were called "white angina." To clarify the diagnosis, it is necessary to carry out a bacteriological study.
3. Angina accompanied by loss of structure (ulcerative-necrotic): herpetic, including Herpes zoster, aphthous, ulcerous Vincent, with scurvy and impetigo, post-traumatic, toxic, gangrenous, etc.

[16], [17], [18], [19], [20], [21], [22], [23], [24], [25]

Screening

When a disease is detected, complaints of pain and throat, as well as characteristic local and general symptoms, are guided. It should be borne in mind that in the first days of the disease, with many common and infectious diseases, there may be similar changes in the oropharynx. To clarify the diagnosis, it is necessary to observe the patient dynamically and sometimes carry out laboratory tests (bacteriological, virologic, serological, cytological, etc.).

Diagnosis of angina

Anamnesis should be collected with great care. Great importance is attached to the study of the general condition of the patient and to certain "pharyngeal" symptoms: body temperature, pulse rate, dysphagia, pain syndrome (one-sided, bilateral, with or without irradiation in the ear, so-called pharyngeal cough, dryness, perspiration, burning, hypersalivation - sialoree, etc.).

Pay attention also to the timbre of the voice, which changes abruptly with abscessed and phlegmonous processes in the pharynx.

Endoscopy of the pharynx in most inflammatory diseases makes it possible to establish an accurate diagnosis, but the unusual clinical flow and the endoscopic pattern makes it necessary to resort to additional methods of laboratory, bacteriological and, according to indications, histological examination.

To clarify the diagnosis it is necessary to conduct laboratory tests: bacteriological, virologic, serological, cytological, etc.

In particular, microbiological diagnostics of streptococcal nature of angina is of great importance, which includes a bacteriological examination of the smear from the surface of the amygdala or the posterior pharyngeal wall. The results of sowing largely depend on the quality of the material obtained. The smear is taken with a sterile swab; the material is delivered to the laboratory within 1 hour (for longer periods it is necessary to use special media). Before taking the material, do not rinse your mouth or use deodorizing agents for at least 6 hours. With the correct technique of sampling, the sensitivity of the method reaches 90%, the specificity is 95-96%.

[26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36]

Treatment of sore throats

The basis of drug treatment of angina is systemic antibacterial therapy. On an outpatient basis, antibiotic prescribing is usually done empirically, so information about the most common pathogens and their sensitivity to antibiotics is taken into account.

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

Prophylaxis of angina

Measures to prevent the disease are based on those principles that are developed for infections transmitted by airborne or alimentary tract, since angina is an infectious disease.

Preventative measures should be aimed at improving the external environment, eliminating factors that reduce the protective properties of the organism in relation to pathogens (dustiness, smoke, excessive accumulation, etc.). Among the measures of individual prevention - tempering the body, exercise, establishing a reasonable regime of work and rest, staying in the fresh air, food with sufficient vitamins, etc. The most important are therapeutic and prophylactic measures, such as sanation of the oral cavity, timely treatment (if necessary surgical) of chronic tonsillitis, restoration of normal nasal breathing (if necessary, adenotomy, treatment of paranasal sinuses, septoplasty, etc.).

Forecast

The prognosis is favorable with the timely begun and carried out in full volume of treatment. Otherwise, possibly developed local or general complications, the formation of chronic tonsillitis. The average incapacity for work of the patient is 10-12 days.

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