Angina without fever: purulent, follicular, lacunar, catarral

Who among us has ever had a sore throat? A rare person does not know what it is. Most of the angina is familiar from childhood as something terrible, accompanied by terrible discomfort and sore throat, as well as rising temperatures to critical levels. It is high temperature that brings most of the inconveniences, in particular the need to comply with bed rest to avoid complications. And yet in some cases not all the symptoms of the disease are present, for example, the temperature remains at the previous levels. And after all, no matter how strange this sounds, the sore throat without temperature in this pathology is not even an exception, but one of the variants of the norm.

[1], [2], [3]

Epidemiology

Angina is one of the most contagious diseases. Transmitted by airborne and alimentary ways, it is able to spread rapidly among the population, and weakened immunity and unfavorable weather conditions only increase the probability of infection.

Most often, angina affects children 3-7 years. A wide spread of the disease among toddlers is connected with visiting children's institutions. Cases of illness are also frequent in young people of working age, up to about 40 years. Overwork, stress, inadequate nutrition and being in public places only contribute to the spread of the disease.

The patients most often diagnosed with coronary angina, which usually occurs without temperature. Slightly less common lacunar and follicular angina. Reflux and specific types of sore throat are found quite rarely as a complication of the above-mentioned types of angina or against the background of other infectious diseases and diseases of the blood system.

[4], [5], [6], [7], [8],

Causes of the sore throats without fever

Angina without fever is not a particular type of disease. The absence of an increase in temperature characterizes the lighter course of the disease with the absence of a strong or deep inflammatory process. The reasons for this pathology are the same as in angina accompanied by fever.

The most common cause of angina without temperature is the ingress of a bacterial infection into the respiratory tract. Usually it is a streptococcal infection. Infection occurs in almost 90% of cases of bacterial sore throat. Less often, the causative agent of angina is streptococci or pneumococci. In exceptional cases, the presence of other types of bacteria that can lead to the development of an inflammatory process in the oral cavity is diagnosed.

These pathogens most often lead to the development of typical types of angina (banal angina): catarrhal, follicular and lacunar, with certain differences in the symptomatology and course of the disease. Banal anginas are the most common, but without fever, only catarrhal sinus can flow.

The cause of the development of unilateral angina without temperature is often banal communication with the patient, since the airborne pathway of transmission of infection from person to person with this pathology is the most popular. However, cases of transmission of infection by an alimentary route, including the ingestion of contaminated food, the use of one dish and household items along with the patient, and insufficient hand hygiene are not uncommon.

[9], [10], [11]

Risk factors

Factors of risk of angina without temperature can be some of the conditions and pathologies that are already present in the body. For example, purulent inflammation of the nasopharynx (sinusitis, nasopharyngitis, rhinitis, etc.) by themselves can provoke angina, however, as well as vice versa.

The source of bacterial infection can also become diseased teeth (caries) and gums (periodontal disease), as well as inflammatory processes in the oral cavity (glossitis, purulent pharyngitis, stomatitis, etc.). And sometimes angina is caused by the activation of autoinfection, lurking in the crypts of the tonsils in completely healthy people.

There are cases when the angina is caused not by a bacterial infection, but by viruses. Most often these are herpes and influenza viruses. Viral angina refers already to the atypical form of the disease.

Very often, the development of pathology leads to the inability of the body to adequately respond to changes in the environment. So, the trigger for the development of the disease can serve as ordinary hypothermia, severe cooling of the lower extremities, the use of cold food and liquid.

Predisposing factors of the disease are also various injuries of the tonsils, as well as a genetic predisposition due to some constitutional anomalies (such babies have angina more often than others, even when there are no special reasons).

But by themselves, a bacterial or viral infection, a predisposition to a disease or the same hypothermia are incapable of causing the development of the disease. The trigger is always a decrease in the body's immunity due to various causes: constant overfatigue, deficiency of vitamins and minerals, previous illnesses, etc.

[12], [13], [14]

Pathogenesis

Angina, or acute tonsillitis, is an infectious and inflammatory process that occurs mainly in the palatine tonsils. Nevertheless, there are cases when the pathological process spreads to other parts of the pharynx and larynx. For example, it can be diagnosed in the area of the tongue, larynx and nasopharyngeal tonsils. Such an angina is called a lingual, laryngeal or retro-nasal (nasopharyngeal), respectively.

Develops angina as an allergic-hyperergic reaction to the impact of certain factors, whether it is external exposure or an infection that has already settled in the body due to other diseases. With increasing sensitivity of the body (sensitization) to various stimuli, such factors as bacterial or viral infection, hypothermia, etc. May trigger the development of pathology. Hyperergic reaction - is the body's response to the introduction of the causative agent in the form of antibodies, in other words a positive reaction to the presence of the causative agent of the disease.

The inflammatory process is nothing but a hyperergic reaction. Its development is accompanied by the ingress of toxins and decay products formed during inflammation into the bloodstream, hence we observe signs of intoxication and fever in angina.

Nerve endings also can not stand aside, when an inflammatory process is localized near them. Pain in the throat is an ordinary nervous reaction to irritation. Irritation of the nervous system affects negatively the health of the patient as a whole, and the work of many organs and systems of the body, particularly the kidneys and the heart.

[15], [16], [17], [18]

Symptoms of the sore throats without fever

Angina is a disease with a relatively small incubation period. It can manifest itself after 10 hours from the moment of getting the infection into the body, although in some cases this interval can increase up to 3 days. Nevertheless, the onset of the disease is always acute. The first signs of angina are discomfort in the throat and pain in swallowing, chills, and a sharp increase in temperature, sometimes well above 38 degrees.

There is an opinion that angina without pain and temperature does not happen, most likely the diagnosed diagnosis does not correspond to the present state of affairs. But if you take, for example, catarrhal sore throat, then its course often passes without a rise in temperature, or the indicators t ^o fluctuate within 37-38 degrees.

And with mild disease, even pain sensations are so insignificant that they simply can not be ignored, thus provoking the development of more serious forms of sore throat. Moreover, angina begins not with pain, but with some discomfort in the throat, which includes dryness of the mucosa, as well as perspiration, tingling and burning on it, which are not always associated with the inflammatory process.

In addition to sore throat, worse when swallowing, with angina, there is often a painful headache. And sometimes it is not so easy to cope with it. Many patients complain of weakness, rapid fatigue, drowsiness, sometimes there is a so-called "ache in the bones".

Unpleasant sensations in the throat and pain when swallowing lead to a decrease in appetite. The tongue appears quite a dense white coating, and the tonsils and palatine arches acquire a distinct red tint due to the blood vessels radiating through the mucosa. Very often, the back of the pharynx, the hard and soft palate, are also involved in the process. Tonsils swell and become larger in size, and lymph nodes may also increase slightly.

All these symptoms are characteristic of any angina, and it does not matter whether it is without a temperature or with a temperature. In more severe cases, changes in the blood composition, specific plaque, purulent vesicles or sores in the tonsil may occur, patients complain of muscle pain, digestive disorders, increased sweating, and malfunctioning of the heart.

Angina without temperature in a child is a fairly common phenomenon, when it comes to children older than 4-5 years. After all, if as a result of communicating with sick peers, a small number of pathogenic bacteria got to the baby, the temperature rise may not be observed. In this case, it is important for parents to pay attention to other symptoms of the disease, such as lethargy, sore throat and redness, impaired appetite. Something parents will notice themselves, and about something the baby will say. It is important to notice the onset of the disease in time and prevent it from moving into a more serious form.

Children most often diagnosed with catarrhal angina, considered the easiest. Usually, with appropriate treatment, it lasts only 5-6 days. If the angina is not treated or cured, it is fraught with the development of more severe forms of the disease, in which recovery can be noticeably prolonged.

Angina without fever during pregnancy is the exception to the rule. Nevertheless, it requires special attention, since the absence of temperature can be a consequence of the very weak immunity of the future mother, and yet the health of the unborn baby also depends on her health. By itself, a decrease in immunity may indicate that in the body of a pregnant woman, not everything is in order, there are some health problems that adversely affected immunity.

The pain in the throat, even in the absence of heat, is a danger to pregnant women. Transition of the disease into a severe form will cause an increase in the symptoms of intoxication, and toxins through the mother's blood will be delivered to the fetus, poisoning the body not yet strengthened. Hence the various pathologies of fetal development.

In addition, angina is fraught with the development of complications. In many cases, it primarily hits the kidneys, which during pregnancy and so bear a heavy load. And failures in the work of the kidneys are fraught with premature birth. And heart problems in this situation can become indications for early termination of pregnancy.

Forms

Angina itself is a collective name. This term hides many types of inflammatory throat disease. Some of them, such as catarrhal, lacunar and follicular, occur more often, others are much rarer. For all types of angina characterized by the above symptoms, but there are some features that distinguish one species from another. This is the localization of inflammation, and pathogens, and specific symptoms.

Catarrhal, lacunar and follicular angina are classified as banal or nonspecific angina. Their pathogens are most often bacterial (staphylococcus or streptococcus) infections. In this case streptococcal angina, especially if it flows without temperature and its treatment is not given due attention, is dangerous because it can cause dangerous heart diseases.

Lacunar angina is a more severe case of the disease and begins with a fever of 39-40 degrees with severe intoxication and the appearance of a plaque in the tonsils. It is believed that without temperature lacunar angina can not flow.

Follicular angina, when the inflammatory process extends not only to the mucous throat, but also to the follicles, also does not do without raising the temperature to 39 degrees.

Fibrous tonsillitis can easily be confused with lacunar or follicular. The only difference is the localization of a grayish-yellow coating on the entire mucosa.

An incorrect approach to the treatment of lacunar and follicular angina in rare cases can lead to the development of phlegmonous angina, which is characterized as an isolated abscess in the tonsils. This pathology is characterized by an extremely severe course accompanied by a high temperature.

All the above-described types of angina, with the exception of catarrhal, can be classified as purulent bacterial angina. Purulent sore throat always begins with high temperatures, and without a temperature, only after the start of antibiotics.

Viral angina, which refers to an abnormal variation in angina, also can not occur without fever, no matter what virus it was caused (adenovirus, influenza or herpes viruses). True, there are cases that herpes angina (a type of viral tonsillitis) passes without appreciable temperature rise (to 37.4 ^of C). But it only says that because of severely weakened immunity, the body simply can not fight infection. The same applies to other types of angina.

Against the background of reduced immunity, under the influence of pathogenic bacteria, ulcerative-film angina (Simanovsky-Vincent's angina) can also develop, which often also dispenses with temperature.

If angina is caused not by a viral or bacterial, but by a fungal infection, it is called fungal angina. This type of sore throat is not characterized by an increase in temperature. Usually fungal angina occurs with a small (subfebrile) temperature or without temperature and pronounced plaque. Very rarely, in acute tonsillitis with strong white film temperature may rise to 38 ^about C.

Any angina in its development is 4 stages. The shortest of these is most often the incubation period and the initial stage of the disease. On the second day from the onset of the disease, the period of the height of the illness begins, when there is a significant and persistent temperature increase (or lack thereof). Somewhere on the 4th-5th day the period of recovilence (recovery) begins.

Complications and consequences

Angina belongs to a group of diseases that, with improper treatment or absence of any kind of therapy, are fraught with the development of serious complications affecting vital organs.

The consequences of incorrect treatment of angina are the transition of the disease to a heavier form, usually accompanied by a significant increase in temperature. And even if the fever is still absent, you should not relax, because this can be just an indicator of reduced immunity. In addition, in this situation, there is a greater likelihood of developing various complications that adversely affect the health of the heart, kidneys, joints.

The most common complications after angina related to the health of our "motor" are cardiac form of rheumatism (inflammation in the heart membranes) and myocarditis (inflammation of the muscle tissue of the heart). Such serious pathologies are a consequence of streptococcal angina, occurring with or without temperature, as well as other diseases caused by this microorganism.

If the angina occurs without fever, patients often carry it on their feet, without thinking about the consequences. But this is the main reason for the development of the above-described complications. At first everything seems to be cloudless, the disease recedes, but after a couple of weeks other diseases that have developed as a result of the "healed" sore throat come to replace it.

On the kidneys, angina beats especially often, as a result of its "labors", pyelonephritis or a more severe pathology, glomerulonephritis, can often develop, often leading to chronic kidney failure. For joints launched angina is fraught with the development of rheumatism, arthritis, bursitis, etc. Pathologies that adversely affect the mobility of the joints.

Improper treatment of angina can lead to the development of otitis (especially with purulent angina), laryngeal edema (threatening asphyxia), lymphadenitis (inflammation of the lymph nodes), bronchitis and even pneumonia. In adults, on the background of frequent exacerbations of angina, apnea may develop, and even cardiac arrest in sleep, even short-term, is an open threat to human life. However, like meningitis or septicemia, developing in parallel with angina.

If even with the wrong approach to the therapy of angina, nothing of the sort happened, there is a high probability of the transition of the disease to a chronic form (chronic tonsillitis). And this means that the disease will worsen at every "convenient" case, provoking even a slight decrease in immunity. And frequent tonsillitis can not but lead to complications.

Some patients are interested in the question: is it possible to sunbathe with angina without fever, will this cause unpleasant complications? Doctors say that it is perfectly permissible to sunbathe and even swim, if there is no heat, but you need to know the measure, that is, do not overcool in water and do not overheat in the sun.

[19], [20]

Diagnostics of the sore throats without fever

Diagnosis of angina without temperature should be given special attention, because the disease that occurs with a lack of heat, can easily be confused with other pathologies. For example, chronic tonsillitis resembling follicular angina, very often does not cause a noticeable increase in temperature. The same can be said about infectious mononucleosis with obvious signs of purulent sore throat or herpetic stomatitis with localization of sores in the tonsils.

The symptomatology of angina with normal temperatures can also resemble manifestations of the disease, which is diagnosed as an acute respiratory viral infection, especially if its causative agent is an adenovirus infection.

That is why, for an accurate diagnosis in order to start an effective treatment in a timely manner, a doctor should not be limited to listening to complaints and examining the patient's throat. You can distinguish angina from SARS by enlarged lymph nodes, and to confirm or refute the diagnosis of "infectious mononucleosis" you will need to do some tests, in particular, a general blood test.

Sometimes angina can develop against a background of some blood diseases. A clinical blood test will just help diagnose pathology data.

To determine the causative agent of the disease, it is enough to hand over smears from the surface of the tonsils or the posterior pharyngeal wall.

The main and the most effective method of instrumental diagnosis of angina remains pharyngoscopy, which allows to determine the appearance of angina from the appearance of the mucous throat and distinguish it from pharyngitis, diphtheria and other pathologies.

[21], [22], [23]

Differential diagnosis

Differential diagnosis of angina without temperature is to determine the type of angina and its pathogen based on instrumental and laboratory studies, as well as taking into account the patient's complaints, or to make another diagnosis in order to begin a fruitful treatment.

Usually, the diagnosis and treatment of angina is handled by an otolaryngologist. Although in some cases this responsibility can be assumed by the therapist by coordinating his diagnosis and appointment with the above specialist.

[24]

Treatment of the sore throats without fever

The fact that the angina flows without temperature does not at all mean that it is not dangerous, and it can be left untreated. If a simple discomfort in the throat and soreness when swallowing a wave of his hand, you can get "as a gift" more serious illness.

Moreover, angina, regardless of the temperature, remains all the same contagious, and therefore represents a danger to others. Therefore, the question of whether a hospital is given in a sore throat without a temperature should be resolved only positively. And it is a great pity that this is not always the case.

Angina is a disease of the infectious plan, therefore the main means of its treatment are antibiotics. The fact that there is no temperature does not mean that the microorganisms that caused the disease are inactive. On the contrary, they happily reproduce and have a negative impact on our body, which is unable to fight it on its own. Here antibiotics of penicillin (1 place in the frequency of prescriptions) and cephalosporin series (3 place), as well as antibacterial drugs from the group of macrolides (2 nd place) come to the rescue.

Popular antibiotics for angina with no temperature : "Ampicillin", "Amoxicillin", "Flemoxin", "Cephalexin", "Ceftriaxone", "Clarithromycin", etc.

"Flemoxin" - a strong antibiotic penicillin series with a gentle effect on the digestive tract. It is available in the form of tablets with various dosages of the active substance (amoxicillin), which is very convenient for the administration of the drug.

The way of using the drug is very simple. The medicine in the prescribed dosage is taken orally regardless of the meal. Tablets can be chopped or swallowed whole, which is preferable. Shredded tablets can be used to make a syrup, which, thanks to its pleasant fruit taste, even babies drink without objection.

The drug also requires an individual approach in dosing. This takes into account both the severity of the disease and the age of the patient. For example, for the treatment of pathologies of mild and moderate severity in patients older than 10 years, the dosage is 1000-1500 mg, evenly distributed in 2 or 3 doses. For children 3-10 years, the daily dose is 2 times less. In the therapy of children 1-3 years adhere daily dosage of about 500 mg, and for the smallest dose is calculated based on body weight - from 30 to 60 mg per 1 kg per day.

Duration of the drug is prescribed by the doctor, usually 5-10 days. The disappearance of the symptoms of the disease is not a signal to stop the drug.

Reception of the drug may be accompanied by some side effects: a digestive disorder, a change in taste perception, changes in blood and urine composition, irritability and sleep disorders, headaches, dizziness, shortness of breath, allergic manifestations.

Contraindications to the use of "Flemoxin" are increased sensitivity to this drug or antibiotics penicillin and cephalosporin series. In addition, care should be taken in patients with kidney failure, gastrointestinal diseases (with colitis in particular), as well as during pregnancy and lactation.

"Clarithromycin" refers to antibiotics from the macrolide group. Its effectiveness is due to the fact that drugs of this group do not dissolve in the stomach, rapidly forming the right concentration of active ingredient in the tonsils, and rarely causing side effects.

The daily dose for adult patients ranges from 0.5 to 2 g, divided into 2 doses, for children under 12 years of age, the dosage is determined based on body weight: from 7.5 to 15 mg per kg per day.

Contraindications to the use of the drug can be considered ventricular arrhythmia and tachycardia, hypokalemia, hepatic insufficiency against the background of renal dysfunction, hepatitis, porphyria. You can not take the drug in the first trimester of pregnancy and during breastfeeding.

Cephalosporins are prescribed if penicillin antibiotics and macrolides can not stop the development of the infectious process.

"Ceftriaxone" is an antibiotic in the form of a powder for intravenous or intramuscular injections, which has virtually no contraindications, except hypersensitivity to the components of the drug.

With angina without fever, the drug is usually given intramuscularly at a dosage of 250 mg once a day. For children under 12 years of age, the daily dosage ranges from 20 to 50 mg per kg of body weight.

With the injection of the drug can be observed: soreness at the injection site, digestive disorders, symptoms of hepatitis, changes in the composition and characteristics of blood and urine, allergic reactions.

"Ceftriaxone", like "Flemoxin", is excreted in breast milk in small concentrations, which can not cause significant harm to the health of the fetus.

But in the treatment of angina with antibiotics alone, acting on an infectious agent from the outside, you can not do. To help them come bacteriostatic drugs from a number of sulfonamides ("Biseptol", "Streptocide", etc.) and antiseptic drugs. Antiseptic anti-inflammatory drugs are prescribed for angina as for oral administration in the form of tablets for resorption (Septefril, Efizol, Faringosept), and for external use in the form of sprays and solutions for gargling (Furacilin, Kameton , Ingalipt, Geksoral, Tantum Verde, Stopangin, Chlorophyllipt, etc.).

"Efizol" - effective tablets for resorption, which have antiseptic, antifungal and antibacterial properties. They have a local bacteriostatic effect on the pathogenic microflora in the oral cavity. In parallel with sulfonilamides, the drug is able to enhance the action of antibiotics.

It is used for the therapy of patients older than 4 years. The resorption tablets are kept in the mouth until completely dissolved. Take them one tablet every 2-3 hours. The usual daily dose is 4-5 tablets, the maximum dosage is 10 tablets. The interval between taking the tablets and eating should be at least half an hour.

The reception of "Efizol" is sometimes accompanied by unpleasant sensations such as burning in the throat or dryness of mucous membranes. Side effects of the drug include nausea and vomiting, increased blood pressure, headaches and insomnia, heartburn, kidney problems, etc.

The drug is not prescribed for thrombosis and propensity to form blood clots, diabetes mellitus, severe renal dysfunction, with increased sensitivity and susceptibility to allergic reactions, in younger children (patients under 4 years).

Antiallergic agents such as Suprastin or Tavegil will help prevent allergic reactions in angina without temperature.

If the angina occurs at subfebrile temperatures below 38 degrees, the use of antipyretics is considered inexpedient. So, "Paracetamol", often prescribed in case of angina against a background of intense heat, is usually not applied if the disease runs without temperature. Its purpose is possible as an anti-inflammatory agent, if the temperature has risen to a mark of 38 degrees and remains on it for a while.

With viral and fungal angina, antiviral and antifungal drugs, fortifying medicines, and, of course, vitamins (ideally vitamin-mineral complexes) that can help the body find strength to fight diseases can be prescribed .

Other methods of treatment of sore throat

Along with medication, physiotherapeutic treatment of angina without fever is also carried out . Usually it is inhalation medicinal solutions or centimeter wave therapy. Not prohibited with angina without temperature and compresses. It is better if they are made on an alcohol basis (water and alcohol in a ratio of 50/50).

To an operative treatment of a sore throat without a temperature resort extremely seldom. Thus, in themselves, catarrhal or purulent angina are not indications for surgical intervention. It is resorted to only if the frequency of purulent angina is more than 4 times a year.

Operative treatment of angina consists in the removal of palatine tonsils - tonsillectomy. But it must be taken into account that as a result of this, a decrease in the protective properties of the organism is observed.

As an alternative to conventional surgical intervention, innovative methods of tonsillectomy - laser lacunotomy and cryotherapy (freezing of tonsils after pre-treatment with ultrasound for the purpose of early healing of tissues) come to the forefront in recent years.

Alternative treatment of angina without fever

Alternative means for the treatment of angina, which do not disdain and doctors, include all kinds of gargling. Rinse compositions can be different, the main thing is that they have an antiseptic and soothing effect:

• warm aqueous solution: soda plus salt
• warm aqueous solution: salt plus iodine (1 tsp salt plus 3-4 drops of iodine per glass of warm water)
• brine
• weak solution of potassium permanganate or furicillin
• weak vinegar
• an aqueous solution of propolis tincture (35-40 drops of tincture on a glass of warm water).

With angina without a temperature, the reception of warm drinks also has a positive effect. Especially effective is warm milk, especially in combination with a spoonful of honey. It is not only useful, but also delicious, as, however, and raspberry jam, which does not allow the heat to come.

By the way, honey can be lubricated reddened and swollen with angina tonsils. Thanks to antibacterial and anti-inflammatory action, honey quickly deal with the described symptoms.

Treatment of sore throats in addition to ingesting anti-inflammatory infusions also includes rinsing with decoctions of medicinal herbs such as chamomile, sage, St. John's Wort. Such rinses help to remove perspiration and sore throat. For the same purposes use a decoction from the bark of oak or eucalyptus.

Alternative physicians believe that the sore throat without temperature will quickly recede if gargle with the juice of beets, but inside take the following remedy. Shredded peeled beetroot pour boiling water and insist for at least 6 hours. Filtered infusion take every 2 hours.

With viral sore throat, an effective treatment is the intake of freshly squeezed lemon juice.

If the angina occurs without fever, then there are no contraindications to inhalation with medicinal herbs and decoctions, as well as aromatic oils.

Well, of course, warming water-alcohol (water plus vodka in a ratio of 1: 1 or water plus vinegar) compresses. This is truly an alternative means, not applicable at the temperature, it is able to quickly remove pain and redness in the throat region, and also to remove the edema on tonsils with angina if the temperature adheres to normal values.

Sometimes you can hear advice that for a quick cure for angina, you need to visit the bath, the warming effect of which has a beneficial effect on the patient's condition. In the heat, such pleasure is unacceptable, but with a sore throat without temperature, the bath can really have a positive effect if the air and water in it are not too hot, and after visiting the bath the patient will not be supercooled. By the way, with purulent angina, even if it is not accompanied by fever, such a procedure is undesirable.

[25], [26], [27], [28]

Homeopathy with angina without fever

Homeopathy with angina without temperature is not aimed at removing the symptoms of the disease, but on maintaining the body in the fight against the disease, stimulating the defenses of the body. Therefore, it should not be surprising that many homeopathic medicines are used to treat various, sometimes unrelated health pathologies.

In this situation, the decisive role is played not by the name of the disease itself, but by its symptoms, the development stage of the pathology, the general condition of the patient, its constitutional and psychoemotional features. And this is one of the reasons why self-medication of homeopathy preparations is considered unacceptable.

Ferrum phosphoricum (Ferrum phosphoricum) is a drug effective at the onset of the disease, when the symptoms of the disease are almost not expressed.

Apis (Apis) is recommended when symptoms of angina are already clearly visible: swollen and painful glands that react sharply to heat, subfebrile temperature, thirst is absent.

Barita muriaticum (Barita muriaticum) is indicated for inflammation, which covers the tonsils and the posterior wall of the pharynx.

Gepar Sulfur (Hepar Sulfur) is prescribed if a person is shivering, pain swallows in the ears, there is a foreign body sensation in the throat. Relief comes from warm drinking.

Phytolacca (Phytolacca) - a drug that has a therapeutic effect for pain, giving in the ear, especially if the pain is localized on the left side. There is a chill and aching in the extremities. In this case, from a warm drink, the condition deteriorates.

All drugs are used in 30 dilutions of 3 grains per 1 reception. The interval between doses is from 2 to 4 hours, depending on the severity of the condition. Take before the onset of persistent improvement. If the third dose of the drug does not give a result, it is recommended that the medicine be changed.

Prevention

The best preventive treatment when it comes to angina without a fever is the maintenance and strengthening of the body's immune system. In people with strong immunity the probability of "catching" angina is negligible. And yet you should avoid hypothermia of limbs and the body as a whole, keep oral hygiene, treat infectious diseases and ENT diseases in time, and, of course, replenish your body with vitamins and microelements necessary for it.

To prevent complications after the transited angina, it is important to completely complete the course of treatment, and then for another 3 weeks to take the vitamins A, C, D, as well as vitamins B and immunomodulators shown by the doctor.

If angina has been caused by a streptococcal infection after the termination or ending of a course of treatment it is desirable to hand over analyzes of a blood and urine, and also to make an electrocardiogram.

[29], [30], [31]

Forecast

The prognosis of angina without a temperature is generally positive, if its treatment is started on time and corresponds to the real state of affairs. Otherwise, the likelihood of developing dangerous complications is significantly increased.

[32]