Angina (acute tonsillitis) - Symptoms

Symptoms of angina begin acutely: a burning sensation, dryness, irritation, then moderate pain in the throat, which intensifies when swallowing. The patient complains of malaise, fatigue, headache. Body temperature is usually subfebrile, in children it can rise to 38.0 degrees C. The tongue is usually dry, coated with a white coating. A slight increase in regional lymph nodes is possible.

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Symptoms of catarrhal tonsillitis

Symptoms of angina in children are more severe, often with high fever and intoxication. The disease can develop into another, more severe form (follicular, lacunar). Catarrhal angina differs from acute catarrh of the upper respiratory tract, flu, acute and chronic pharyngitis by the predominant localization of inflammatory changes in the tonsils and palatine arches. Although catarrhal angina, compared to other clinical forms of the disease, is characterized by a relatively mild course, it is necessary to take into account that severe complications can also develop after catarrhal angina. The duration of the disease is usually 5-7 days.

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Symptoms of follicular tonsillitis

A more severe form of inflammation, involving not only the mucous membrane, but also the follicles themselves. Symptoms of angina begin acutely, with a rise in temperature to 38-39 C. There is a pronounced pain in the throat, which sharply increases when swallowing, and irradiation to the ear is often possible. Intoxication, headache, weakness, fever, chills, and sometimes pain in the lower back and joints are expressed. In children, vomiting often occurs with an increase in temperature, meningism may appear, and clouding of consciousness is possible.

In children, the symptoms of angina usually occur with pronounced intoxication, accompanied by drowsiness, vomiting and sometimes convulsive syndrome. The disease has a pronounced course with an increase in symptoms during the first two days. The child refuses to eat, and signs of dehydration appear in infants. On the 3rd-4th day of the disease, the child's condition improves somewhat, the surface of the tonsils is cleared, but the sore throat persists for another 2-3 days.

The duration of the disease is usually 7-10 days, sometimes up to two weeks, and the end of the disease is recorded by the normalization of the main local and general indicators: pharyngoscopic picture, thermometry, blood and urine indicators, as well as the patient's well-being.

Lacunar tonsillitis is characterized by a more pronounced clinical picture with the development of a purulent-inflammatory process in the mouths of the lacunae with further spread to the surface of the tonsil. The onset of the disease and the clinical course are almost the same as with follicular tonsillitis, but lacunar tonsillitis is more severe. Intoxication phenomena come to the fore.

Along with the rise in temperature, a sore throat appears, with hyperemia, infiltration and swelling of the tonsils and with pronounced infiltration of the soft palate, speech becomes slurred, with a nasal tone. Regional lymph nodes enlarge and become painful upon palpation, which causes pain when turning the head. The tongue is coated, appetite is reduced, patients feel an unpleasant taste in the mouth, there is bad breath.

The duration of the disease is up to 10 days, with a protracted course up to two weeks, taking into account the normalization of functional and laboratory indicators.

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Symptoms of phlegmonous tonsillitis

Intratonsillar abscess is extremely rare and is an isolated abscess in the thickness of the tonsil. The cause is a trauma to the tonsil by various small foreign objects, usually of an alimentary nature. The lesion is usually unilateral. The tonsil is enlarged, its tissues are tense, the surface may be hyperemic, palpation of the tonsil is painful. Unlike a paratonsillar abscess, with an intratonsillar abscess, general symptoms are sometimes expressed insignificantly. Intratonsillar abscess should be differentiated from frequently observed small superficial retention cysts, translucent through the epithelium of the tonsils in the form of yellowish rounded formations. From the inner surface, such a cyst is lined with crypt epithelium. Even with suppuration, these cysts can be asymptomatic for a long time and are detected only during a random examination of the pharynx.

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Symptoms of atypical tonsillitis

The group of atypical tonsillitis includes relatively rare forms, which in some cases complicates their diagnosis. Pathogens are viruses, fungi, symbiosis of fusiform bacilli and spirochetes. It is important to take into account the clinical features and diagnostics of the disease, because verification of the pathogen by laboratory methods is not always possible when the patient first visits a doctor; the result can usually be obtained only after a few days. At the same time, the appointment of etiotropic therapy for these forms of tonsillitis is determined by the nature of the pathogen and its sensitivity to various drugs, so an adequate assessment of the characteristics of local and general reactions of the body in these forms of tonsillitis is especially important.

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Symptoms of ulcerative-necrotic angina

Ulcerative-membranous, Simanovsky-Plaut-Vincent's angina, fusospirochetal angina is caused by the symbiosis of the spindle-shaped bacillus (Вас. fusiformis) and the oral spirochete (Spirochaeta buccalis). In normal times, the disease occurs sporadically, is characterized by a relatively favorable course and low contagiousness. However, in years of social upheaval, with insufficient nutrition and with the deterioration of hygienic living conditions of people, a significant increase in the incidence is noted and the severity of the disease increases. Among the local predisposing factors, insufficient oral care, the presence of carious teeth, mouth breathing, which contributes to the drying of the oral mucosa, are important.

Often the disease manifests itself with the only symptom of angina - a feeling of awkwardness, a foreign body when swallowing. Often the only reason for going to the doctor is a complaint about the appearance of an unpleasant putrid smell from the mouth (moderate salivation). Only in rare cases does the disease begin with an increase in temperature and chills. Usually, despite the pronounced local changes (plaques, necrosis, ulcers), the general condition of the patient suffers little, the temperature is subfebrile or normal.

Usually one tonsil is affected, a bilateral process is extremely rare. Usually pain when swallowing is insignificant or completely absent, an unpleasant putrid smell from the mouth attracts attention. Regional lymph nodes are moderately enlarged and slightly painful upon palpation.

Dissociation is noteworthy: pronounced necrotic changes and insignificance of general symptoms of angina (absence of pronounced signs of intoxication, normal or subfebrile temperature) and reaction of lymph nodes. In its relatively favorable course, this disease is an exception among other ulcerative processes of the pharynx.

However, without treatment, ulceration usually progresses and within 2-3 weeks can spread to most of the surface of the tonsil and go beyond it - to the arches, less often to other parts of the pharynx. When the process spreads deeper, erosive bleeding, perforation of the hard palate, and destruction of the gums can develop. The addition of a coccal infection can change the overall clinical picture: a general reaction characteristic of angina caused by pyogenic pathogens appears, and a local reaction - hyperemia near the ulcers, severe pain when swallowing, salivation, putrid odor from the mouth.

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Symptoms of viral sore throats

They are divided into adenoviral (the causative agent is most often adenoviruses types 3, 4, 7 in adults and 1, 2 and 5 in children), influenza (the causative agent is the influenza virus) and herpetic. The first two types of viral tonsillitis are usually combined with damage to the mucous membrane of the upper respiratory tract and are accompanied by respiratory symptoms (cough, rhinitis, hoarseness), sometimes conjunctivitis, stomatitis, diarrhea are observed.

Herpetic angina, also called vesicular (vesicular, vesicular-ulcerative), is more common than other types. The causative agents are Coxsackie virus types A9, B1-5, ECHO virus, human herpes simplex virus types 1 and 2, enteroviruses, picornavirus (the causative agent of foot-and-mouth disease). In summer and autumn, it can be epidemic, and during the rest of the year it usually manifests itself sporadically. The disease is more often observed in young children.

The disease is highly contagious, transmitted by airborne droplets, rarely by the feco-oral route. The incubation period is from 2 to 5 days, rarely 2 weeks. Symptoms of angina are characterized by acute phenomena, an increase in temperature to 39-40 C, difficulty swallowing, sore throat, headache and muscle pain, sometimes vomiting and diarrhea. In rare cases, especially in children, serous meningitis may develop. Along with the disappearance of blisters, usually by the 3rd-4th day, the temperature normalizes, the enlargement and soreness of the regional lymph nodes decreases.

Quite often, the symptoms of angina are one of the manifestations of an acute infectious disease. Changes in the throat are non-specific and can be of a diverse nature: from catarrhal to necrotic and even gangrenous, so when developing angina, you should always remember that it may be the initial symptom of some acute infectious disease.

Symptoms of sore throat in diphtheria

Diphtheria of the pharynx is observed in 70-90% of all cases of diphtheria. It is generally accepted that this disease occurs more often in children, however, the increase in diphtheria cases observed in the last two decades in Ukraine is mainly due to non-immunized adults. Children in the first years of life and adults over 40 years of age are seriously ill. The disease is caused by the diphtheria bacillus - a bacillus of the genus Corynebacterium diphtheriae, its most virulent biotypes, such as gravis and intermedius.

The source of infection is a patient with diphtheria or a carrier of toxigenic strains of the pathogen. After the disease, convalescents continue to excrete diphtheria bacilli, but most of them stop being carriers within 3 weeks. The release of convalescents from diphtheria bacteria can be hindered by the presence of chronic foci of infection in the upper respiratory tract and a decrease in the overall resistance of the body.

According to the prevalence of the pathological process, localized and widespread forms of diphtheria are distinguished; according to the nature of local changes in the pharynx, catarrhal, insular, membranous and hemorrhagic forms are distinguished; depending on the severity of the course - toxic and hypertoxic.

The incubation period lasts from 2 to 7, rarely up to 10 days. In mild forms of diphtheria, local symptoms predominate, the disease proceeds like a sore throat. In severe forms, along with local symptoms of a sore throat, signs of intoxication quickly develop due to the formation of a significant amount of toxin and its massive entry into the blood and lymph. Mild forms of diphtheria are usually observed in vaccinated people, severe ones - in people who have no immune protection.

In the catarrhal form, local symptoms of angina are manifested by a mild hyperemia with a cyanotic tint, moderate swelling of the tonsils and palatine arches. Symptoms of intoxication in this form of diphtheria of the pharynx are absent, the body temperature is normal or subfebrile. The reaction of regional lymph nodes is not expressed. Diagnosis of the catarrhal form of diphtheria is difficult, since there is no characteristic sign of diphtheria - fibrinous plaque. Recognition of this form is possible only through bacteriological examination. In the catarrhal form, recovery may occur on its own, but after 2-3 weeks isolated paresis appears, usually of the soft palate, mild cardiovascular disorders. Such patients are dangerous in epidemiological terms.

The islet form of diphtheria is characterized by the appearance of single or multiple islets of fibrinous deposits of a grayish-white color on the surface of the tonsils outside the lacunae.

The plaques with characteristic hyperemia of the mucous membrane around them persist for 2-5 days. Subjective sensations in the throat are weakly expressed, regional lymph nodes are slightly painful. The gel temperature is up to 37-38 C, headache, weakness, and malaise may be noted.

The membranous form is accompanied by a deeper lesion of the tonsil tissue. The palatine tonsils are enlarged, hyperemic, moderately edematous. On their surface, continuous plaques are formed in the form of films with a characteristic bordering zone of hyperemia around them. At first, the plaque may look like a translucent pink film or a web-like mesh. Gradually, the delicate film is impregnated with fibrin and by the end of the first (beginning of the second) day it becomes dense, whitish-gray in color with a pearlescent sheen. At first, the film comes off easily, then the necrosis becomes deeper and deeper, the plaque is tightly fused with the epithelium by fibrin threads, is removed with difficulty, leaving an ulcerative defect and a bleeding surface.

Toxic form of diphtheria of the pharynx is quite a severe lesion. The onset of the disease is usually acute, the patient can name the hour when it occurred.

Characteristic symptoms of angina allow identifying the toxic form of diphtheria even before the appearance of characteristic swelling of the subcutaneous fat of the neck: severe intoxication, swelling of the pharynx, reaction of regional lymph nodes, pain syndrome.

Severe intoxication is manifested by an increase in body temperature to 39-48 C and maintaining it at this level for more than 5 days, headache, chills, severe weakness, anorexia, pale skin, adynamia. The patient notes pain when swallowing, salivation, difficulty breathing, a sickly sweet smell from the mouth, open nasal tone. The pulse is frequent, weak, arrhythmic.

The pharyngeal edema begins with the tonsils and spreads to the arches, uvula, soft and hard palate, and paratonsillar space. The edema is diffuse, without sharp boundaries or protrusions. The mucous membrane above the edema is intensely hyperemic, with a cyanotic tint. A grayish web or jelly-like translucent film can be seen on the surface of the enlarged tonsils and edematous palate. The plaque spreads to the palate, root of the tongue, and mucous membrane of the cheeks. The regional lymph nodes are enlarged, dense, and painful. If they reach the size of a chicken egg, this indicates a hypertoxic form. Hypertoxic fulminant diphtheria is the most severe form, usually developing in patients over 40 years of age. representatives of the "non-immune" contingent. It is characterized by a violent onset with a rapid increase in severe signs of intoxication: high temperature, repeated vomiting, impaired consciousness, delirium, hemodynamic disorders such as collapse. At the same time, significant swelling of the soft tissues of the pharynx and neck develops with the development of pharyngeal stenosis. There is a forced body position, trismus, rapidly increasing gelatinous swelling of the mucous membrane of the pharynx with a clear demarcation zone separating it from the surrounding tissues.

Complications of diphtheria are associated with the specific action of the toxin. The most dangerous are complications from the cardiovascular system, which can occur with all forms of diphtheria, but more often with toxic, especially grades II and III. The second most common are peripheral paralysis, which usually has the character of polyneuritis. They can also occur in abortive cases of diphtheria, their frequency is 8-10%. The most common is paralysis of the soft palate, associated with damage to the pharyngeal branches of the vagus and glossopharyngeal nerves. In this case, speech takes on a nasal, nasal tone, liquid food gets into the nose. The soft palate hangs sluggishly, motionless during phonation. Less common are paralysis of the muscles of the extremities (lower - 2 times more often), even less common - paralysis of the abducens nerves, causing convergent strabismus. Lost functions are usually fully restored in 2-3 months, less often - after longer periods. In young children, and in severe cases in adults, a severe complication may be the development of laryngeal stenosis and asphyxia in diphtheritic (true) croup.

Symptoms of sore throat in scarlet fever

It occurs as one of the manifestations of this acute infectious disease and is characterized by a feverish state, general intoxication, fine-point rash and changes in the pharynx, which can vary from catarrhal to necrotic tonsillitis. Scarlet fever is caused by toxigenic hemolytic streptococcus group A. Transmission of the infection from a patient or carrier of the bacilli occurs mainly by airborne droplets, children aged 2 to 7 years are most susceptible. The incubation period is 1-12 days, more often 2-7. The disease begins acutely with a rise in temperature, malaise, headache and sore throat when swallowing. With severe intoxication, repeated vomiting occurs.

Symptoms of angina usually develop even before the rash appears, often simultaneously with vomiting. Angina in scarlet fever is a constant and typical symptom. It is characterized by bright hyperemia of the mucous membrane of the pharynx ("flaming pharynx"), spreading to the hard palate, where a clear border of the inflammation zone is sometimes observed against the background of the pale mucous membrane of the palate.

By the end of the first day (less often on the second day) of the disease, a bright pink or red small-point rash appears on the skin on a hyperemic background, accompanied by itching. It is especially abundant in the lower abdomen, on the buttocks, in the groin area, on the inner surface of the limbs. The skin of the nose, lips, chin remains pale, forming the so-called nasolabial triangle of Filatov. Depending on the severity of the disease, the rash lasts from 2-3 to 3-4 days or longer. By the 3-4th day, the tongue becomes bright red, with papillae protruding on the surface - the so-called raspberry tongue. The palatine tonsils are swollen, covered with a grayish-dirty coating, which, unlike that in diphtheria, is not continuous and is easily removed. The coating can spread to the palatine arches, soft palate, uvula, and floor of the oral cavity.

In rare cases, mainly in young children, the larynx is involved in the process. The developed edema of the epiglottis and the outer ring of the larynx can lead to stenosis and require urgent tracheotomy. The necrotic process can lead to perforation of the soft palate, a defect of the uvula. As a consequence of the necrotic process in the pharynx, bilateral necrotic otitis and mastoiditis can be observed, especially in young children.

Recognition of scarlet fever in its typical course is not difficult: acute onset, significant increase in temperature, rash with its characteristic appearance and location, typical pharyngeal lesions with lymph node reaction. In latent and atypical forms, the epidemic anamnesis is of great importance.

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Symptoms of sore throat with measles

Measles is an acute, highly contagious infectious disease of viral etiology, accompanied by intoxication, inflammation of the mucous membrane of the respiratory tract and the lymphadenoid pharyngeal ring, conjunctivitis, and a maculopapular rash on the skin.

The spread of the infectious agent, the measles virus, occurs through airborne droplets. The patient is most dangerous to others during the catarrhal period of the disease and on the first day of the rash. On the 3rd day of the rash, contagiousness decreases sharply, and after the 4th, the patient is considered non-contagious. Measles is classified as a childhood infection, most often affecting children aged 1 to 5 years; however, people of any age can get sick. The incubation period is 6-17 days (usually 10 days). Three periods are distinguished during the course of measles: catarrhal (prodromal), periods of rashes and pigmentation. According to the severity of the symptoms of the disease, primarily intoxication, mild, moderate and severe measles are distinguished.

In the prodromal period, against the background of moderate fever, catarrhal symptoms develop in the upper respiratory tract (acute rhinitis, pharyngitis, laryngitis, tracheitis), as well as signs of acute conjunctivitis. However, symptoms of angina often manifest themselves in the form of a lacunar form.

At first, measles enanthem appears as red spots of various sizes on the mucous membrane of the hard palate, and then quickly spreads to the soft palate, arches, tonsils and the back wall of the pharynx. Merging, these red spots cause diffuse hyperemia of the mucous membrane of the mouth and pharynx, reminiscent of the picture of banal tonsillopharynxitis.

The pathognomonic early sign of measles, observed 2-4 days before the onset of the rash, is represented by Filatov-Koplik spots on the inner surface of the cheeks, in the area of the parotid gland duct. These whitish spots 1-2 mm in size, surrounded by a red rim, appear in the amount of 10-20 pieces on the sharply hyperemic mucous membrane. They do not merge with each other (the mucous membrane appears as if splashed with drops of lime) and disappear after 2-3 days.

During the period of rashes, along with the intensification of catarrhal phenomena from the upper respiratory tract, general hyperplasia of lymphadenoid tissue is observed: the palatine and pharyngeal tonsils swell, and an increase in cervical lymph nodes is noted. In some cases, mucopurulent plugs appear in the lacunae, which is accompanied by a new rise in temperature.

The pigmentation period is characterized by a change in the color of the rash: it begins to darken, acquires a brown tint. First, pigmentation occurs on the face, then on the trunk and limbs. The pigmented rash usually lasts 1-1.5 weeks, sometimes longer, then small bran-like peeling is possible. Complications of measles are mainly associated with the addition of secondary microbial flora. Laryngitis, laryngotracheitis, pneumonia, otitis are most often observed. Otitis is the most common complication of measles, it occurs, as a rule, during the pigmentation period. Catarrhal otitis is usually observed, purulent otitis is relatively rare, but there is a high probability of developing bone and soft tissue necrotic damage to the middle ear and the transition of the process to chronic.

Symptoms of angina in blood diseases

Inflammatory changes in the tonsils and mucous membrane of the oral cavity and pharynx (acute tonsillitis, symptoms of angina, stomatitis, gingivitis, periodontitis) develop in 30-40% of hematological patients already at the early stages of the disease. In some patients, oropharyngeal lesions are the first signs of a blood system disease and their timely recognition is important. The inflammatory process in the pharynx in blood diseases can proceed in a variety of ways - from catarrhal changes to ulcerative-necrotic. In any case, infection of the oral cavity and pharynx can significantly worsen the well-being and condition of hematological patients.

Symptoms of monocytic angina

Infectious mononucleosis, Filatov's disease, benign lymphoblastosis is an acute infectious disease observed mainly in children and young people, occurring with tonsil damage, polyadenitis, hepatosplenomegaly and characteristic blood changes. Most researchers currently recognize the Epstein-Barr virus as the causative agent of mononucleosis.

The source of infection is a sick person. Infection occurs through airborne droplets, the entry point is the mucous membrane of the upper respiratory tract. The disease is considered low-contagious, the pathogen is transmitted only through close contact. Sporadic cases are more common, family and group outbreaks are very rare. Mononucleosis is extremely rare in people over 35-40 years old.

The incubation period is 4-28 days (usually 7-10 days). The disease usually begins acutely, although sometimes in the prodromal period there is malaise, sleep disturbance, loss of appetite. Mononucleosis is characterized by a clinical triad of symptoms: fever, symptoms of angina, adenoplenomegaly and hematological changes, such as leukocytosis with an increase in the number of atypical mononuclears (monocytes and lymphocytes). The temperature is usually about 38 C, rarely high, accompanied by moderate intoxication; an increase in temperature is usually observed for 6-10 days. The temperature curve can be wavy and recurrent.

Early enlargement of regional (occipital, cervical, submandibular) and then distant (axillary, inguinal, abdominal) lymph nodes is typical. They are usually of a plastic consistency upon palpation, moderately painful, not fused; reddening of the skin and other symptoms of periadenitis, as well as suppuration of the lymph nodes, are never noted. Simultaneously with the enlargement of the lymph nodes on the 2-4th day of the disease, an enlargement of the spleen and liver is observed. The reverse development of enlarged lymph nodes of the liver and spleen usually occurs on the 12-14th day, by the end of the febrile period.

An important and constant symptom of mononucleosis, which is usually used as a diagnostic guide, is the occurrence of acute inflammatory changes in the pharynx, mainly in the palatine tonsils. Slight hyperemia of the mucous membrane of the pharynx and enlargement of the tonsils are observed in many patients from the first days of the disease. Monocytic angina can occur in the form of lacunar membranous, follicular, necrotic. The tonsils increase sharply and are large, uneven, bumpy formations protruding into the cavity of the pharynx and, together with the enlarged lingual tonsil, making breathing through the mouth difficult. Dirty-gray plaque remains on the tonsils for several weeks or even months. They can be located only on the palatine tonsils, but sometimes they spread to the arches, the back wall of the pharynx, the root of the tongue, the epiglottis, thus resembling the picture of diphtheria.

The most characteristic symptoms of infectious mononucleosis are changes in the peripheral blood. At the height of the disease, moderate leukocytosis and significant changes in the blood count are observed (pronounced mononucleosis and neutropenia with a nuclear shift to the left). The number of monocytes and lymphocytes increases (sometimes up to 90%), plasma cells and atypical mononuclear cells appear, which are distinguished by high polymorphism in size, shape and structure. These changes reach their maximum by the 6th-10th day of the disease. During the recovery period, the content of atypical mononuclear cells gradually decreases, their polymorphism becomes less pronounced, plasma cells disappear; however, this process is very slow and sometimes drags on for months and even years.

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Symptoms of angina in leukemia

Leukemia is a tumor disease of the blood with obligatory damage to the bone marrow and displacement of normal hematopoietic sprouts. The disease can be acute or chronic. In acute leukemia, the bulk of tumor cells are poorly differentiated blasts; in chronic leukemia, they consist mainly of mature forms of granulocytes or erythrocytes, lymphocytes or plasma cells. Acute leukemia is observed approximately 2-3 times more often than chronic leukemia.

Acute leukemia occurs under the guise of a severe infectious disease, affecting mainly children and young people. Clinically, it is characterized by necrotic and septic complications due to impaired phagocytic function of leukocytes, severe hemorrhagic diathesis, severe progressive anemia. The disease occurs acutely, with high temperature.

Changes in the tonsils may occur both at the onset of the disease and at later stages. In the initial period, simple hyperplasia of the tonsils is observed against the background of catarrhal changes and swelling of the mucous membrane of the pharynx. At later stages, the disease acquires a septic character, symptoms of angina develop, first lacunar, then ulcerative-necrotic. The surrounding tissues are involved in the process, necrosis can spread to the palatine arches, the back wall of the pharynx, and sometimes to the larynx. The frequency of pharyngeal lesions in acute leukemia ranges from 35 to 100% of patients. Hemorrhagic diathesis, also characteristic of acute leukemia, can also manifest itself in the form of petechial rashes on the skin, subcutaneous hemorrhages, and gastric bleeding. In the terminal phase of leukemia, necrosis often develops at the site of hemorrhages.

Changes in the blood are characterized by a high content of leukocytes (up to 100-200x10 ⁹ /l). However, leukopenic forms of leukemia are also observed, when the number of leukocytes decreases to 1.0-3.0x10 ⁹ /l. The most characteristic sign of leukemia is the predominance of undifferentiated cells in the peripheral blood - various types of blasts (hemohistioblasts, myeloblasts, lymphoblasts), making up to 95% of all cells. Changes in the red blood are also noted: the number of erythrocytes progressively decreases to 1.0-2.0x10 ¹² /l and the concentration of hemoglobin; the number of platelets also decreases.

Chronic leukemia, unlike acute leukemia, is a slowly progressing disease prone to remission. The damage to the tonsils, oral mucosa and pharynx is not so pronounced. It usually occurs in older people, men are more often affected than women. The diagnosis of chronic leukemia is based on the detection of high leukocytosis with a predominance of immature forms of leukocytes, a significant increase in the spleen in chronic myeloleukemia and a generalized increase in the lymph nodes in chronic lymphocytic leukemia.

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Symptoms of angina in agranulocytosis

Agranulocytosis (agranulocytic angina, granulocytopenia, idiopathic or malignant leukopenia) is a systemic blood disease characterized by a sharp decrease in the number of leukocytes with the disappearance of granulocytes (neutrophils, basophils, eosinophils) and ulcerative-necrotic lesions of the pharynx and tonsils. The disease occurs mainly in adulthood; women get agranulocytosis more often than men. The agranulocytic reaction of hematopoiesis can be caused by various adverse effects (toxic, radiation, infectious, systemic damage to the hematopoietic apparatus).

Symptoms of angina are initially erythematous-erosive, then quickly become ulcerative-necrotic. The process can spread to the soft palate, not limited to soft tissues and moving to the bone. Necrotic tissues disintegrate and are rejected, leaving deep defects. The process in the pharynx is accompanied by severe pain, difficulty swallowing, profuse salivation, and a putrid odor from the mouth. The histological picture in the affected areas of the pharynx is characterized by the absence of an inflammatory reaction. Despite the presence of rich bacterial flora, there is no leukocyte inflammatory reaction and suppuration in the lesion. When diagnosing granulomatosis and determining the prognosis of the disease, it is important to assess the condition of the bone marrow, revealed by puncture of the sternum.

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Pseudomembranous (non-diphtheritic, diphtheroid) angina

The etiologic factor is pneumococcus or streptococcus, less often staphylococcus; it is rare and is characterized by almost the same local and general symptoms as diphtheria of the pharynx. Streptococcus can be associated with Corynebacterium diphtheriae, which causes the so-called streptodiphtheria, which is characterized by an extremely severe course.

The final diagnosis is established based on the results of a bacteriological examination of throat smears. In addition to what is described above for lacunar tonsillitis, it is advisable to include the use of antidiphtheria serum in the treatment of diphtheroid forms of tonsillitis until the final bacteriological diagnosis is established.

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Acute ulcerative tonsillitis

Moure's disease - a form of angina characterized by an insidious onset without pronounced general symptoms with minor and sometimes vague pain when swallowing. Bacteriological examination reveals various pathogenic microorganisms in symbiosis with non-specific spirillosis microbiota. Pharyngoscopy reveals a necrotizing ulcer on the upper pole of one of the palatine tonsils, while there are no parenchymatous or catarrhal inflammatory phenomena in the tonsil itself. Regional lymph nodes are moderately enlarged, body temperature at the height of the disease rises to 38 ° C.

This form of angina is often easily confused at the initial stage of diagnosis with syphilitic chancre, in which, however, neither its characteristic signs nor massive regional adenopathy are observed, or with Simanovsky-Plaut-Vincent angina, in which, unlike the form under consideration, fuso-snirochial microbiota is determined in a smear from the throat. The disease lasts for 8-10 days and ends with spontaneous recovery.

Local treatment involves rinsing with 3% solutions of boric acid or zinc chloride.

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Symptoms of mixed angina

They are rare and are characterized by a combination of symptoms of angina, inherent in the various forms described above.

In case of unfavorable course of angina, local and general complications may develop. Most often, paratonsillitis is observed as a local complication, less often - parapharyngitis, however, it is characterized by an extremely severe course. In small children, angina can lead to the development of a retropharyngeal abscess. Among the general complications that develop more often after a previous streptococcal angina caused by beta-hemolytic streptococcus group A, the most severe are acute rheumatic fever with subsequent rheumatic damage to the heart and joints and post-streptococcal glomerulonephritis.

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