Angina in smallpox: causes, symptoms, diagnosis, treatment

Smallpox is an acute, highly contagious viral disease characterized by a severe course, intoxication, fever, rash on the skin and mucous membranes, often leaving scars. Smallpox is genetically close to a disease known as alastrim, a viral disease that is a type of smallpox. Its symptoms resemble smallpox, but it is mild, and the rash does not leave scars.

Epidemiology. The source of the infectious agent is only a sick person, who is most dangerous during the period of blooming rash and opening of smallpox pustules. Infection occurs through contact with a sick person, through his personal belongings and objects contaminated with his secretions. Susceptibility to smallpox of people who have not had the disease is universal. Immunity after the disease is stable, lifelong. With artificial immunization with smallpox vaccine, passive immunity is not so stable and long-lasting. It should be noted, however, that smallpox-like diseases occur in many animals (cowpox, horsepox, sheeppox), and the viruses that cause them are so close to the smallpox virus that when in contact with humans, they provide stable cross-immunity, which is used for active immunization against smallpox.

The cause of sore throat in smallpox. The causative agent of smallpox is the largest virus, belongs to the poxvirus family, is resistant to environmental conditions, and persists for a long time in the crusts of smallpox pustules.

Pathogenesis and pathological anatomy. The virus penetrates through the mucous membranes of the upper respiratory tract, less often through the skin into the regional lymph nodes, where it multiplies. After 1-2 days, it appears in the blood, from where it is carried into the skin, liver, bone marrow and other organs. The otolaryngologist's interest in smallpox is that the virus remains for a long time in the mucous membrane of the mouth, tongue, pharynx, larynx, trachea, where it multiplies and forms lesions. Reproduction of viruses in tissue cells and the release of exotoxin into the blood leads to the appearance of fever and other early symptoms of the disease. The virus toxin causes dystrophy and inflammatory changes in the parenchymatous organs. Suppuration of the vesicles and the associated release of pyrogenic substances cause the second rise in body temperature, which occurs on the 9th-10th day of the disease.

Symptoms of sore throat in smallpox. The incubation period is 10-12 days. The disease begins acutely, with chills, an increase in body temperature to 39.5-40 ° C. Nausea, vomiting, excruciating headache and pain in the sacrum appear. Convulsions are possible in children. Inflammation of the mucous membrane of the soft palate and nasopharynx is noted. On the 2nd-3rd day, the so-called prodromal rash may appear on the face, limbs and trunk, which in its appearance resembles a rash with measles or scarlet fever. After 12-24 hours, it disappears without a trace. By the end of the prodromal period, the body temperature lytically decreases, and the general condition of the patient improves. At the same time, a characteristic rash appears. First of all, it appears on the mucous membrane of the oral cavity, soft palate, nasopharynx, conjunctiva and then spreads throughout the body. A characteristic symptom is the appearance of a rash on the palms and feet. The rash evolves in the following sequence: macule, papule, vesicle, pustule and stages of crust formation and scarring. It is also characteristic that with smallpox, rash elements in different stages of development can be observed simultaneously on the skin and mucous membrane.

Bucopharyngeal enanthem is characterized by the appearance of round red spots on the mucous membrane of the soft palate, pharynx, tongue, nasopharynx, transforming into vesicles that quickly fester and ulcerate. Similar changes can occur in the larynx and trachea, and then painful swallowing, sore throat, dysphagia are accompanied by a painful cough, hoarseness, and croup may occur in children. Bucopharyngeal ulcers can be the starting point for the spread of opportunistic microbiota through the lymphatic pathways to adjacent tissues and organs and cause their inflammation with the development of peritonsillar abscesses, purulent inflammation of the peripharyngeal spaces and other complications.

Among the atypical forms of smallpox, cases of isolated pharyngeal lesions have been described, which manifest only as fever, sore throat, and diffuse catarrhal inflammation of the mucous membrane of the pharynx. Often, this form of smallpox occurs "under the flag" of common sore throat or pharyngitis, which is very dangerous in epidemiological terms.

Complications. Complications include bronchitis, pneumonia, skin and bucopharyngeal abscesses, phlegmon, otitis, orchitis, encephalitis, meningitis, myocarditis, septic endomyocarditis, acute psychosis. Damage to the cornea or mucous membrane of the eye leads to partial or complete blindness.

The diagnosis is based on the symptoms characteristic of smallpox, the clinical picture and the results of virological testing. The main method of examination is electron microscopy. To detect the pathogen, the contents of vesicles, pustules, scrapings from papules, crusts, washings from the oral cavity, and blood are examined. A valuable diagnostic method, starting from the 5th-6th day of illness, is the determination of the antihemagglutinin titer using the hemagglutination inhibition reaction.

Treatment of angina in smallpox is carried out in a specially equipped hospital for especially dangerous infections. Great importance is attached to patient care, local therapy for lesions of the eyes, middle ear, oral cavity, pharynx and larynx. In case of pronounced toxic syndrome, detoxification therapy is prescribed (administration of water-electrolyte and protein solutions). It is necessary to use broad-spectrum antibiotics for the prevention and treatment of purulent complications. Food should be easily digestible, rich in vitamins.

Forecast. Smallpox in vaccinated people proceeds favorably with a mild course of the disease without complications and scarring. In severe forms, the outcome is usually fatal, especially in infants and the elderly.

Prevention. It is generally accepted that smallpox has been eradicated from our planet, but this condition should not be considered final or stable, requiring no permanent preventive measures. These measures are carried out by special sanitary and anti-epidemic services throughout the country. The main one is the implementation of planned smallpox vaccinations.

If smallpox is suspected, the patient is sent to an infectious diseases hospital, where he or she receives special treatment. People who have come into contact with a smallpox patient or his or her belongings are isolated for observation for 14 days. Along with vaccination, they should undergo emergency prophylaxis: intramuscular injection of donor anti-smallpox y-globulin (0.5-1 ml per 1 kg of body weight) and per os administration of the antiviral drug methisazone (for adults - 0.6 g 2 times a day, for children - 10 mg per 1 kg of body weight) for 4-6 days.

Every case of suspected smallpox must be immediately reported to the sanitary and epidemiological authorities and the district health department. The outbreak site undergoes routine and final disinfection.

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