Complications after angina on the heart, kidneys and joints: symptoms, treatment, how to avoid

Why, when diagnosing inflammation of the tonsils – angina (tonsillitis) – and prescribing the appropriate therapy, do doctors insist on patients following all recommendations? Because incomplete treatment of angina is fraught with negative consequences, since some complications of angina can seriously and permanently worsen the general health.

Complications after tonsillitis are especially dangerous in children, who suffer from this infectious ENT disease much more often than adults.

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

Why does angina cause complications?

What is dangerous about angina? And why does it cause complications – quite numerous and potentially life-threatening?

Everyone knows the symptoms of tonsillitis: sore throat (including when swallowing), red swollen tonsils (often with purulent plaque, causing halitosis), fever with chills, headache, fatigue, swollen lymph nodes in the neck, and pain in the ears or neck. For more information, see – Tonsillitis (Acute Tonsillitis) – Symptoms

But it is not the manifestations of the disease that matter, but its causes. Tonsillitis is caused either by bacteria (in 30-40% of cases) or viruses (60-70%). According to long-term studies, acute bacterial tonsillitis most often develops as a result of infection of the palatine tonsils with Streptococcus pyogenes (group A β-hemolytic streptococci) - 51.4% of cases; Staphylococus aureus (golden staphylococcus) - 12.5% (according to other data - 23%); Streptococcus pneumoniae (pneumococcus) - 8-12%; Haemophilus influenzae (hemophilus influenzae) - 15.5%; Psuedomonas aeruginosa (pseudomonas aeruginosa) - 2%. And purulent tonsillitis in 58-82% of cases is the result of the pathogenic effect of β-hemolytic streptococcus.

But viruses (respiratory syncytial and rhinovirus, adenovirus, influenza and parainfluenza viruses) are more often to blame for the development of catarrhal tonsillitis, and the course of the disease with viral etiology and complications of catarrhal tonsillitis can be milder.

The most studied are the reasons for complications of purulent tonsillitis - acute streptococcal tonsillitis. Penetrating the mucous epithelium of the palatine tonsils, β-hemolytic streptococcus group A (Streptococcus pyogenes) produces exotoxins that affect cells and cause disturbances in physiological processes and immune reactions.

Thus, membrane-active enzymes – streptolysins S and O (SLS and SLO) – damage the cytoplasmic membranes of epithelial and blood cells; blood erythrocytes and some subcellular organelles are completely destroyed by bacterial hemolysins; pneumolysin, entering the bloodstream, helps microbes spread throughout the body and colonize the respiratory system. Protease enzymes of this bacterium catalyze the hydrolysis of peptide bonds of cells at the site of introduction to obtain amino acids necessary for the synthesis of their own proteins.

In addition, S. pyogenes has immunomodulatory superantigens (SAg) that ensure the survival of bacteria. They are able to bypass the main histocompatibility complexes (lymphocyte antigens MHC-II) and bind to T-cell receptors (recognizing foreign antigens), “reprogram” their α- and β-genes and manipulate T-lymphocytes – directing them to healthy cells of interstitial tissues. This explains the manifestation of an abnormal immune response to extracellular or somatic antigens of β-hemolytic streptococcus.

Staphylococcus aureus also has a sufficient arsenal of cytolytic enzymes, causing complications of staphylococcal angina. S. aureus produces the already mentioned hemolysin; leukocidin, which dissolves leukocyte cells, as well as plasmin, which breaks down fibrous proteins (fibrins). Experts note that lymphoid hyperplasia and inflammation of the tonsils occur when streptococcus suppresses the cellular mechanisms of tissue protection, leading to bacteremia with multiple organ failure syndrome.

What complications can occur after tonsillitis?

Both local and general complications of angina are possible. In particular, such local complications of catarrhal angina as inflammation of regional (cervical) lymph nodes with the development of lymphadenitis are observed. Often, the inflammation affects the mucous membrane of the entire larynx - up to a generalized infection of the pharynx, and ENT doctors state acute catarrhal laryngitis. Bacterial tonsillitis causes complications in the ears - in the form of otitis media. Most often, such complications are noted after angina in children.

There may also be complications in the eyes, which manifest as catarrhal inflammation of the mucous membrane of the eye - conjunctivitis (with redness, burning, sensation of a foreign body in the eyes and their increased sensitivity to light). Local complications of staphylococcal tonsillitis include inflammation of the middle ear or mucous membrane of the edges of the eyelids (blepharitis).

Complications of purulent tonsillitis are complications of follicular tonsillitis, as well as

Complications of lacunar tonsillitis include swelling of the throat, accompanied by difficulty breathing, increased heart rate, cyanosis of the skin, and obstructive sleep apnea. Read more – Follicular and Lacunar Tonsillitis

When the infection spreads to the mucous membrane and underlying tissues of the area surrounding the tonsil, a peritonsillar abscess develops – a local complication of staphylococcal tonsillitis – phlegmonous and the follicular and lacunar ones that precede it. The formation of an abscess is accompanied by fever and chills, increasing pain in the throat, difficulty swallowing, general weakness and headache.

A peritonsillar abscess, in turn, can have negative consequences: phlegmon of the floor of the mouth (Ludwig's angina); development of a retropharyngeal abscess; thrombus formation and inflammation of the vessels of the cavernous sinus of the dura mater of the brain; damage to the endothelium and damage to the wall of the vessels of the parapharyngeal region with diapedetic bleeding; aspiration pneumonitis; airway obstruction.

Common complications of angina

Among the general negative consequences of bacterial tonsillitis, the most common are complications in the kidneys, heart, leg joints and rheumatism.

After 15-25 days from the onset of the disease, nephrological complications of staphylococcal tonsillitis, as well as tonsillitis caused by hemolytic pyogenic streptococcus, may make themselves known - in the form of severe inflammation of the filtering cells of the kidneys - glomerulonephritis. For more information, see - Symptoms of acute post-streptococcal glomerulonephritis.

Experts no longer doubt that complications to the heart after angina arise due to an abnormal response of the body's own immune system to β-hemolytic streptococci. The result of the body's autoimmune response is acute rheumatic fever (ARF). According to the Global Burden of Disease Study (WHO), ARF is diagnosed in 325,000 children aged 5 to 14 years every year; currently, approximately 33.5 million people have rheumatic carditis, and a significant proportion of it falls on complications of angina in adults (usually repeated and necessarily of bacterial etiology).

The development of ARF occurs approximately two to three weeks after infection with S. рyogenes and the onset of streptococcal tonsillitis or pharyngitis. In this case, rheumatism with swelling and pain in the joints of the extremities is noted - polyarthritis or migrating polyarthritis, that is, complications in the joints of the legs (especially the knees).

Painless granulomatous Aschoff bodies (Aschoff bodies) - foci of inflammation of interstitial tissues at the fibrosis stage - can appear anywhere, including in the membranes of the heart. Because of these nodes, three to four months after the disease, complications in the heart after angina appear: myocarditis (inflammation of the muscular walls of the heart), endocarditis (inflammatory process in the tissues of the inner lining of the heart chambers and valves), less often pericarditis (inflammation of the pericardium). With ARF and after bacterial angina, cardiomyopathy of inflammatory origin (rheumatic carditis) occurs mostly in children, adolescents and patients under 30 years of age.

In 5% of cases of acute rheumatic fever, erythema marginatum is observed – skin rashes in the form of slightly raised disc-shaped pink and red spots (with a pale center). Their typical localization is the trunk and inner surfaces of the extremities; the spots increase in size, but do not cause pain or itching.

Sydenham's chorea (rheumatic chorea or St. Vitus's dance), which is characterized by uncontrolled, disordered movements of the face and arms, occasionally occurs as a neurological complication of streptococcal sore throat or pharyngitis.

[ 8 ], [ 9 ], [ 10 ], [ 11 ], [ 12 ]

Complications of viral sore throat

According to otolaryngologists, special attention should be paid to the complication of herpetic angina - herpangina or enterovirus vesicular pharyngitis, which mainly affects children under 10 years of age and in most cases in the summer.

Complications are caused, as in the case of sore throats of bacterial origin, by the characteristics of the pathogen. And this pathogen is not Herpesvirus hominis (HVH), but single-stranded RNA viruses Coxsackie (CV) type A (family Picornaviridae, genus Enterovirus), transmitted by the fecal-oral route, usually infecting the skin and mucous membranes, including the tonsils and pharynx (Latin herpes means lichen). And such sore throat should be distinguished from the defeat of the pharynx by the herpes zoster virus.

Characteristic symptoms of angina of this etiology: small red rash or clusters of small red spots on the mucous membrane of the oral cavity and tonsils (may be on the skin of the face, hands and feet), transforming into vesicles filled with exudate, then their ulceration and inflammation of the resulting wounds, which are covered with fibrous crusts, occur. Histologically, the membranes of the affected epithelial cells are damaged, signs of intracellular and extracellular edema are revealed. The throat hurts, the cervical and other regional lymph nodes are hypertrophied, fever and general malaise are observed. The duration of symptoms is about 7-10 days.

Complications of herpetic angina include conjunctivitis, inflammation of the membranes of the brain - serous meningitis (with headache and stiff neck), inflammation of the brain (encephalitis), and rarely - viral myocarditis or pericarditis.

[ 13 ], [ 14 ], [ 15 ], [ 16 ], [ 17 ]

How to recognize complications after tonsillitis?

To determine complications after a sore throat, the doctor studies the patient's medical history, listens to his complaints, examines him and prescribes tests, including blood tests: general, ESR, C-reactive protein, activated B- and T-lymphocytes, titers of antistreptococcal antibodies (antistreptolysin), RF (rheumatoid factor).

Urine or cerebrospinal fluid testing may be needed.

Depending on the localization of the pathologies that have arisen, the patient is referred to specialized specialists - an otolaryngologist, cardiologist, nephrologist, rheumatologist, ophthalmologist, who use all diagnostic methods, including hardware visualization (X-ray, ultrasound, MRI), ECG, EEG, etc.

For example, read how it is carried out – Diagnosis of acute poststreptococcal glomerulonephritis.

Treatment of complications of angina

After the treatment of angina has seemingly been completed, treatment for its complications is prescribed, depending on their nature and symptoms.

For example, bacteria present in the purulent contents of a peritonsillar abscess can penetrate into the adjacent jugular vein, infecting the blood and causing sepsis. This condition is called Lemierre's syndrome and can be fatal if not treated promptly and properly. Therefore, without delay, an ENT surgeon opens the abscess in a hospital setting, removes the pus by aspiration and prescribes antibiotics (usually third-generation cephalosporins, intramuscular injections) and antiseptic gargling. Many recommend using the antiseptic Miramistin for local complications after tonsillitis.

In addition to a course of antibiotic injections in the treatment of acute rheumatic fever - for pain relief and inflammation reduction - NSAIDs can be used, such as Paracetamol, Nimesil (only for adults), Ibuprofen (for children - only after 6 years), etc.

Inflammation of the heart muscle – myocarditis – usually goes away on its own. There is no cure for myocarditis, the main thing is strict bed rest (for children – in the intensive care unit) and maintaining heart function.

The principles of treating complications of angina on the heart are described in the publication – Treatment of infective endocarditis.

Read also:

• Treatment of glomerulonephritis
• Treatment of Coxsackie and ECHO infections

How to avoid complications?

Prevention of complications of tonsillitis largely depends on mandatory cultural (microbiological) testing - a smear from the throat and from the surface of the inflamed tonsils, which is carried out to accurately determine the causative agent of the disease and prescribe the correct medication.

For example, not all antibiotics for sore throat cope with β-hemolytic streptococcus (S. pyogenes). Therefore, if antibiotics are prescribed without microbiological testing, the treatment will be ineffective, and complications may arise as a result.

For their part, in order to avoid complications of angina, patients should demonstrate maximum compliance, that is, obediently follow all prescriptions, and especially adhere to the duration of the course of antibiotic therapy - in accordance with the instructions of the attending physician.