Simanowsky-Plaut-Vensant's angina.

Simanovsky-Plaut-Vincent angina, or ulcerative-necrotic angina, is caused by a fusiform bacillus (B. fusiformis) in symbiosis with a common spirochete of the oral cavity (spirochacta buccalis).

A mass outbreak of ulcerative-membranous tonsillitis was observed in Finland by S.P. Botkin in 1888. Later, according to B.S. Preobrazhensky (1956), its epidemiology was studied by N.P. Botkin and in 1890 he gave a detailed description of this disease. However, its pathogen remained unknown. In 1898, the French doctor K. Plaut and somewhat later his colleague H. Vincent discovered a characteristic pathogen of this disease.

Simanovsky's angina most often occurs in people who are exhausted and weakened by previous illnesses, suffer from hypovitaminosis, alimentary dystrophy, especially with a deficiency of proteins and amino acids in the food products they consume. The disease sometimes occurs sporadically, sometimes it is epidemic in nature. In some cases, Simanovsky's angina is caused by the presence of carious teeth, periodontitis, gingivitis and other odontogenic causes that contribute to the vegetation of the fusiform bacillus.

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How does Simanovsky's angina manifest itself?

The general condition of the patient remains practically normal, the state of health is satisfactory. Often he consults a doctor due to the appearance of an unpleasant, putrid odor from the mouth and salivation. In uncomplicated cases, the body temperature is usually normal or subfebrile, only sometimes the disease begins with a high temperature (38 ° C and above) and chills. Such an onset is more typical for epidemic outbreaks. Moderate leukocytosis can be determined in the blood. Later, pain appears when swallowing and an increase in regional lymph nodes in relation to the palatine tonsils and oropharyngeal region, painful on palpation.

Pharyngoscopy most often reveals damage to one tonsil and concomitant stomatitis. The tonsil is enlarged, hyperemic, covered with a yellowish-gray loose coating, which is easily removed. Under it, a slightly bleeding ulcer with a grayish-yellow bottom and uneven edges, soft to the touch, is found. The ulcer, in addition to the tonsil, can spread to the arches, and sometimes to other parts of the oropharynx, the mucous membrane of the cheeks and gums. In an uncomplicated course, the duration of the disease does not exceed 2-3 weeks. In typical cases of Simanovsky's angina, a disproportion is noted between the pronounced destructive changes in the pharynx (plaque, ulcers, necrosis) and the relatively mild general condition of the patient. The sometimes accompanying coccal infection dramatically changes the overall clinical picture: severe pain appears when swallowing, the body temperature rises significantly, chills may appear. Patients with severe forms of the disease must be hospitalized.

Complications of Simanovsky's angina are rare, but if they occur, they are severe with extensive necrotic destruction in the oral cavity and pharynx (perforation of the hard palate, destruction of the gums, extensive necrosis of the tonsil, etc.), which can cause erosive bleeding.

How is Simanovsky's angina diagnosed?

The diagnosis of Simanovsky's angina is established on the basis of the clinical picture and the results of bacteriological examination, in which a large number of spindle-shaped rods and spirochetes of the oral cavity are found in the removed plaque or scrapings from the bottom of the ulcer. It should, however, be taken into account that fusospirochete symbiosis is sometimes detected in other diseases of the pharynx, for example, in ulcerated cancer. Simanovsky's angina is differentiated from diphtheria of the pharynx, syphilis, tuberculosis and ulcerated malignant tumor of the tonsil.

How is Simanovsky's angina treated?

Treatment consists of rinsing the mouth with solutions of hydrogen peroxide, potassium permanganate, and dusting the ulcer surface with osarsol powder. If there is no effect, penicillin and nicotinic acid are prescribed.