Glossitis

This is an unpleasant, uncomfortable and quite dangerous disease. Glossitis is an inflammatory process affecting the tissues of the oral cavity, namely the tongue, and is caused by an infection, but may also be non-infectious.

Translated from Greek, glossa is a tongue. Glossitis of the tongue is an inflammation of non-infectious and infectious genesis, causing inflammation on the surface of the tongue or in its deep layers. This process can be a disease itself, provoked by pathogenic flora or infection. But it can be a symptom of deeper dangerous pathological disorders.

In addition, other factors can provoke this disease: thermal, chemical, mechanical. Many negative effects on the human body can cause this pathology.

According to the nature of its manifestations, the disease in question is classified as:

• On the acute course of the disease. The pathology appeared for the first time and is primary (independent) or secondary (developing against the background of other diseases).
• Chronic course of pathology. Such a diagnosis is made if the cause of the disease is not established or has not been eliminated. Glossitis can also become chronic due to failure to follow basic personal hygiene rules.

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Is glossitis contagious?

Having encountered the problem under consideration at least once, each person tries to learn more about the causes and consequences of the disease. It is impossible to answer the question of whether glossitis is contagious unequivocally due to the fact that there are a great many reasons for this disease. Therefore, if the cause of the pathology is established and it is not associated with an infectious lesion of tissues, then it is impossible to talk about the transmission of the disease from the carrier to a healthy person.

Any pathogen is not transmitted by airborne droplets, but with close tactile contact such a problem can arise (with direct contact with the patient's tongue) if the cause of the lesion is an infection, fungus or other pathogenic microflora.

If the inflammatory process in the tissues of the tongue is caused by reasons not associated with infectious tissue damage, for example, with anemia, then even with direct contact, infection does not occur.

Causes of glossitis

Before discussing methods of stopping the problem that has arisen, dealing with the diet and giving any recommendations for adjusting the lifestyle of people who have encountered this disease, it is necessary to establish the causes of glossitis. After all, only knowing the primary source can we talk about effective, complete treatment and a favorable outcome.

The development of inflammation on the surface or deeper areas of the tongue can be provoked by:

• Bacterial pathogens: Staphylococcus aureus, streptococci and other pathogenic bacteria.
• Viral infection. For example, herpes, measles, stomatitis.
• Fungal infections: yeast fungi of the genus Candida, other pathogens.
• Nicotine and alcohol can provoke inflammation.
• Thermal burn, for example from hot tea.
• Taking antibiotics.
• An allergic reaction of the body to various irritants.
• Chemical burns from various chemical compounds.
• Trauma to tongue tissue: impact, sharp end of tooth, prosthesis...
• Ignoring the rules of personal hygiene, including oral hygiene.

There are also multiple diseases known that can cause the pathology in question:

• Candidiasis.
• Deficiency of folic acid and vitamins B12, E, A in the patient’s body.
• Lichen planus is a chronic inflammation characterized by the appearance of itchy rashes on the mucous membranes and skin.
• Diphtheria is an infectious disease caused by the bacterium Corynebacterium diphtheriae (Loeffler's bacillus).
• Scarlet fever is an acute infectious pathology caused by group A beta-hemolytic streptococcus.
• Anemia is low levels of hemoglobin, or red blood cells, in the blood.
• Lesions of the mucous membrane of the gastrointestinal tract.
• Measles is a serious airborne infection.
• Worm infestation.
• Stomatitis.
• Lupus is a severe immune disease in which the human body perceives its own cells as foreign.
• Rheumatic manifestations.

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Symptoms of glossitis

The onset of this disease does not pass without symptoms, and the patient begins to feel discomfort, which gradually increases its unpleasant intensity. The symptoms of glossitis are uncomfortable and recognizable:

• A clearly visible coating appears on the upper surface of the tongue.
• The tongue begins to swell and its mobility becomes limited.
• There is a disruption in the functioning of the salivary glands.
• A burning sensation begins to be felt in the pathological area.
• Pain symptoms appear.
• There is an unpleasant, foul-smelling breath coming from the mouth.
• The natural color of the tongue is disrupted. It becomes burgundy, intensely red.
• There is a change in taste preferences, and a disturbance in the functioning of taste buds is felt.
• The surface of the tongue may be covered with erosions and ulcers.
• There may be a sensation of a foreign body in the mouth.
• The patient has a problem with nutrition.
• In the acute form or long-term chronic course of the disease, the quality of speech changes, since the tongue is directly involved in the production of sounds.
• If the problem is ignored, the situation can only worsen, and irreversible changes in the structural composition of the affected organ occur.
• If the process is neglected, mushroom-shaped growths may form on the surface of the tongue.
• In rare cases, an increase in body temperature is observed.
• Decreased body defenses.
• Signs of an abscess may appear.
• If the disease is complicated by phlegmon, the intensity of pain symptoms increases, breathing and nutrition problems may appear, up to and including complete refusal to eat.
• General signs of intoxication.
• Increased volume of regional lymph nodes.

Acute glossitis

If the symptoms of the pathology appear suddenly and are characterized by rich symptoms, doctors diagnose acute glossitis. The cause of its occurrence can be an invasive infection, as well as a pathology, the source of which is another disease, for example, an allergy (secondary glossitis). This form is manifested by severe symptoms: severe inflammation, swelling, hyperemia, pain.

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Chronic glossitis

This form of the disease is diagnosed when it is not possible to establish the cause of its occurrence, as well as when, even when the primary source is established, no relief measures are taken. Chronic glossitis is also diagnosed when this disorder is recurrent.

The symptoms of the chronic course are more restrained, but this form is already distinguished by structural changes affecting the affected organ. Treatment of this form cannot be carried out in a short period of time - it is a rather long process.

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Glossitis in children

When a person is more himself - it is hard, but if the disease overtakes a child, parents begin to worry doubly. As sad as it sounds, but glossitis is diagnosed in children, not as rarely as we would like.

The causes that can cause the disease in question are similar to those that are the catalyst in the adult population. The only difference is in some priority.

The pathology in question in children can be caused by:

• Parents ignoring the rules of personal hygiene, including the child’s oral cavity.
• An injury sustained during a fall. After all, a normal baby is an active and inquisitive little person and it is sometimes difficult to keep an eye on him.
• The child's body's reaction to the material of a dental filling.
• Unqualified installation of a seal.
• The body's reaction to braces, corrective plates or other orthodontic structures.
• The emergence of bad habits, when the baby bites his tongue quite often.
• Eating food that is too cold or too hot. This creates a double threat: the surface is directly injured by the burn and various infections that cause inflammation are exposed to the body.
• Invasion of worms and other protozoan parasites.
• If a child suffers from diabetes, there is a high risk of developing candidal inflammation.
• A similar situation can arise as a result of long-term use of antibiotic drugs.
• Weakened immune defense of the child's body.

Also, some diseases can cause the disease in question:

• In addition to the diabetes mellitus already mentioned above, atopic dermatitis can provoke the disease.
• Pathological changes affecting the child's endocrine system.
• Any infectious disease can provoke the disease.
• Blood diseases.
• A pathology affecting the organs of the gastrointestinal tract.

In this case, the baby may not complain about anything at all and only an attentive mother can notice the change in the mucous membrane. But in some cases, the child, having started to be capricious, is able to complain of pain in the tongue.

Glossitis during pregnancy

The time of conception of a child and the expectation of its birth is a rainbow, but also a very responsible period in the life of every woman. Any pathology can cause irreparable damage to the body of the unborn baby and the expectant mother. The fate of a woman does not bypass her defeat by the disease in question. Glossitis during pregnancy can develop in any form, but the leadership, nevertheless, is held by the desquamative nature of inflammation, developing against the background of hormonal restructuring of the expectant mother's body to her new status.

The reason for such failures in the body is also the increased consumption of vitamins, minerals and microelements during this period. The resulting deficiency gives impetus to the emergence and development of pathological changes.

If measures are not taken in a timely manner, the protective forces of the female body are also reduced, against which background a candidal inflammatory process can appear. Other forms can harm the female body in the ways described above.

In this case, the attending physician is obliged to conduct medical therapy taking into account the woman’s new status, excluding drugs prohibited for use by pregnant women.

Types of glossitis

The disorder in question is characterized by a fairly wide variety of manifestations. The following types of glossitis are distinguished:

• Desquamative or as it is also called - "geographical".
• Candidal.
• Mycotic.
• Yeast.
• Phlegmonous.
• Catarrhal.
• Gunterovsky.
• Diamond-shaped.
• Atrophic.
• Ulcerative.
• Herpetic.
• Folded.
• Aphthous.
• Benign wandering.
• Interstitial.
• Allergic.
• Hyperplastic.
• Villous.
• Deep.

Desquamative glossitis

It is not uncommon for people to see signs that differ from the norm when examining their tongue, clearly showing that some pathological disorder is occurring in the body. Hyperemic spots appear and disappear, and the picture of the tongue surface changes periodically.

The specialist makes a diagnosis based on the symptoms that appear. That is, this form can be called a symptomatic disease.

The clinical picture is a mottled pattern of the tongue surface: hyperemic areas alternate with ulcerative manifestations, plaque areas. This characteristic of the "relief" is very reminiscent of a geographical map.

Pain symptoms also become more severe, and the burning sensation intensifies, especially during meals.

This form of the disease can develop against the background of disruptions in the functioning of the digestive tract, endocrine and circulatory systems of the human body.

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Candidal glossitis

The name of this variety directly indicates the cause of pathological changes. That is, the diagnosis is made if the causative agent of the disease is a fungus of the genus Candida. Its presence indicates a violation of the microflora of the oral cavity, a decrease in the immune forces of a person.

This form is predominantly found in elderly people (the immune system is already weakened due to the aging of the body), or in small children (the body's defenses are still quite unstable).

In chronic course, the disease manifests itself every time the immunity decreases. Such a picture is a response of the organism to its weakening associated with respiratory, infectious and other pathologies.

Long-term treatment with antibiotics can also provoke such a course of events.

Treatment therapy is based on antifungal drugs and immunomodulators.

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Mycotic glossitis

Fungal microorganisms are present in almost every human organism, but they begin to manifest themselves only when the immune system fails. Under unfavorable conditions, Candida fungal individuals begin to multiply rapidly, affecting nearby tissues. In a picture where a smear from the oral cavity shows an increased content of this parasite, as well as based on other symptoms (whitish plaque on the surface and back, swelling, obvious transverse and longitudinal grooves), a qualified doctor makes a diagnosis.

The development of this form can be triggered by long-term use of antibiotics. The treatment protocol includes antifungal drugs.

Yeast glossitis

This form of damage is manifested by the periodic or constant appearance of a pathological dirty-whitish coating on the surface of the affected organ. Yeast glossitis does not cause painful symptoms, so it does not particularly bother a person. The impetus for its development can be ignoring the rules of personal hygiene, irrational, unbalanced nutrition, bad habits of people (nicotine and alcoholic drinks of any strength). One of the most obvious symptoms is an unpleasant fetid odor appearing from a person's mouth. At the same time, such an odor is persistent, bringing emotional discomfort to its owner.

Catarrhal glossitis

The form of the disease in question can be caused by multiple reasons. These may be:

• Stomatitis is an inflammation of the mucous membrane of the oral cavity.
• The source of the disorder may be a superficial burn, received in any way:
  • Thermal cause of the lesion: hot soup or, conversely, very low temperatures.
  • Chemical causes of damage: alkali and acid vapors, household chemicals and other sources.
• A surface injury that can be caused by a blow, an incorrectly made prosthesis, or damage to teeth with the appearance of sharp edges.
• Anemia can also provoke the disease.
• Candidiasis affecting the oral cavity.

The main symptoms are swelling and the appearance of a dirty white coating. In this case, only the upper layers of the mucous membrane are affected. The pathology does not penetrate into the deep layers.

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Hunter's glossitis

Hunter's disease is a criterion signaling the development of anemia in the patient's body, which is mainly caused by a deficiency of folic acid and vitamin B12 in the body.

The main indicator of the development of this particular form are the following symptoms:

• the surface of the affected organ becomes smooth, almost polished.
• hyperemia is very intense, bright crimson.
• The patient may feel a slight burning sensation in the mouth.

Rhomboid glossitis

Pathological diseases affecting the gastrointestinal tract can cause the appearance of an unpleasant whitish coating on the surface of the patient's tongue. It is these disorders that provoke the disease in a person. Most often, based on the nature of the changes, these manifestations are chronic and recurrent.

The main symptomatology of this type can be called an increase in the thickness of the epidermis layer, as well as the appearance of a hyperemic area on the surface of the tongue, which is mainly oval or rhombus-shaped. Hence the name of the pathological change.

In this case, the shade of hyperemia can be either bright red or bluish.

Doctors conventionally distinguish between three types of diamond shape:

• Hyperplastic. It is determined by the appearance of flat growths on the affected surface against the background of a whitish coating.
• Tuberous - diagnosed when mushroom-shaped growths appear.
• Flat. The main characteristic of which is a “varnished” surface, with the absence of even minor papillae in the affected area.

Atrophic glossitis

This type of manifestation is similar to catarrhal. But it is diagnosed mainly in people with a history of viral, infectious or fungal infection, sometimes chronic. These include HIV infection, herpes, gonorrhea, Candida fungi and others.

Another reason for the development of pathological symptoms is hypovitaminosis, caused by a deficiency in the patient’s body of vitamins such as A and E.

Characteristic manifestations of this diagnosis are:

• Hyperemic spots with a smooth, “sliding” surface.
• Swelling of the affected organ.
• Degradation of taste buds.
• The appearance of painful symptoms.
• Atrophy of the muscle tissue of the tongue.

This form of the disease requires immediate therapeutic treatment. But the whole complexity of this situation is that it is quite difficult to identify the atrophic form of the disease at an early stage, since there are no obvious intense symptoms. When an uncomfortable condition appears in the oral cavity, diagnostics can reveal an already advanced process of pathological damage that cannot be regressed.

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Ulcerative glossitis

Most often, this form of pathological changes is transformed from an untreated or undertreated catarrhal form of pathology. The result of such a transformation is the appearance of multiple small ulcers - aphthae.

• Often manifested by minor bleeding.
• The patient's general condition worsens.
• The intensity of pain increases.
• The swelling increases in size.
• There is a partial deterioration in the motor activity of the tongue.

With this form of manifestation of the disease, pathological changes affect only the superficial layers of the affected organ.

Folded glossitis

This form of the disease is mainly congenital. It manifests itself in the presence of transverse and longitudinal grooves on the surface of the tongue. They are quite deep, with the most noticeable groove located longitudinally in the center, connecting the root of the tongue with its tip. The mucous membrane, in this situation, is not subject to any significant changes. Quite often, this is the only symptom indicating a malfunction in the body. Language functions are not affected.

In hypovitaminosis, an additional symptom accompanying the basic one depends on the specific vitamin, the deficiency of which is determined in the patient’s body.

In case of vitamin A deficiency:

• Dryness in the mouth appears.
• Cracks appear that take a long time to heal.
• The intensity of pain increases.
• The level of keratinization of the epithelium increases.

In case of folic acid or vitamin B12 deficiency:

• The epithelial layer begins to thin.
• Severe hyperemia takes on “bright colors.”
• The surface of the affected organ becomes smooth, “varnished”.
• The tongue becomes painfully sensitive when exposed to various irritants.

In case of vitamin C deficiency:

• Visual examination reveals the appearance of blood capillaries on the surface of the mucous membrane.

May occur in tandem with desquamative inflammation.

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Aphthous glossitis

It has already been stated that this form is a “continuation” of the progression of catarrhal inflammation, which was not treated or was not fully treated.

The disorders related to the form of manifestation under consideration are superficial and do not affect the deep layers of the tissue structures of the tongue.

The main symptom indicating the presence of this pathology is the appearance of numerous, but small, often bleeding ulcers on the surface of the affected organ.

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Interstitial glossitis

Often one of the symptoms of tertiary syphilis. The tongue tissues are affected quite deeply, the structure of the tongue is compacted and resembles a waffle towel. The motor activity of the speech organ is difficult due to pathological changes that have affected its structure.

If timely and adequate treatment is not undertaken, irreversible processes begin to occur. Muscle tissues are replaced by connective structures.

If such a situation occurs, there is a high probability of degeneration into malignant neoplasms. Tongue cancer is diagnosed.

Allergic glossitis

The modern world is marked by a high level of allergenicity. Today it is difficult to find a person, especially residents of large industrial cities, who would not have increased sensitivity to one or another irritant. It is a response of the human body to an external irritant.

The cause of the manifestation of the disease in question may be:

• Medicines.
• Individual food products.
• Toothpaste or disinfectant used to sanitize the oral cavity.
• The material from which the dental prosthesis is made.
• Other potential irritants.

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Hyperplastic glossitis

It exists as one of the varieties of rhomboid manifestation. The distinctive feature of this type of disease is that flat compacted formations are formed on the surface of the tongue plate, noticeable against the background of a whitish shade covering the affected area.

Villous glossitis

The cause of the onset and progression of the disease has not yet been precisely established.

There were cases when the disease in question began to progress without having any obvious causes or sources. Therefore, doctors assume that this disease has a genetic etiology.

It is also assumed that the catalyst for the process may be:

• Bad habits: smoking and alcoholism.
• Some pharmacological drugs.
• A candidal infection affecting the oral cavity.

There is an overgrowth of filiform papillae on the mucous surface. Keratinization of these tissues occurs gradually. The mucous shade changes to a darker color.

A patient with the diagnosis in question begins to feel a sore throat. Sometimes a person feels the presence of a foreign body in the throat. A gag reflex may appear.

Deep glossitis

But doctors have to observe deeper lesions of the tongue tissues. Phlegmonous inflammation, the pathological process begins to affect almost all layers of the affected organ. For example, such a picture can be observed with an abscess, the lymph nodes and adjacent tissues are also affected.

• With such a pathological change, the patient begins to feel a significant deterioration in his health and weakness.
• An increase in body temperature is noted.
• A spasmodic pain appears.
• The patient begins to suffer from headaches.
• Swelling of the oral cavity is observed, especially hyperemia and swelling is noticeable around the formed abscess.
• In such a situation, it becomes difficult for a person to consume food. The appetite disappears, and the patient may refuse to eat at all.
• High levels of swelling can make breathing significantly difficult.

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Diagnosis of glossitis

When a patient comes to us with such a problem as the appearance of discomfort symptoms in the oral cavity, diagnostics begins with a visual examination of the patient. Already at this stage of diagnostics, a qualified doctor is able to make correct assumptions about the nature and form of the disease, as well as to suggest the source of pathological changes.

• These may be anatomical damage and changes.
• The patient's blood is sent for testing: general analysis and biochemical analysis. The result is confirmation or denial of the presence of an inflammatory process in the patient's body.
• Saliva analysis is also performed. The presence of infection and identification of its pathogen are determined.
• If necessary, an ultrasound examination of the digestive tract is performed: gastroscopy, colonoscopy, and others.

If there is a problem with establishing a diagnosis, additional examination may be required:

• RPR test – anticardiolipin study – a laboratory test performed to detect antibodies to cardiolipin antigen.
• Bacteriological nature.
• Examination of scrapings from the surface of the tongue for pale treponema.
• Cytology.
• Polymerase chain reaction (PCR) is a highly accurate method for diagnosing various infections.
• Biochemical tests.
• Enzyme-linked immunosorbent assay (ELISA) is a method of detecting antigens using corresponding antibodies conjugated to a labeling enzyme.

Only after establishing the correct diagnosis can the doctor give any recommendations and prescribe the necessary therapy.

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Treatment of glossitis

First of all, treatment of glossitis begins with paying close attention to the necessary daily oral care, which requires brushing your teeth at least twice a day and rinsing your mouth after each meal.

What doctor treats glossitis?

If a person is concerned about the appearance of his tongue, or other pathological symptoms associated with the oral cavity have appeared, it is necessary to make an appointment with a specialist without delay.

If you need a consultation with a qualified specialist, you should contact your local therapist or make an appointment with a dentist. If necessary or if there is a problem with diagnosis, the attending physician can prescribe a consultation with a specialized doctor: gastroenterologist, hematologist, endocrinologist, dermatologist.

During therapy, it is necessary to exclude hot and highly peppered dishes from your diet, high temperatures reduce the quality of treatment, increasing the time of therapy. The diet itself is adjusted - the doctor prescribes a diet.

From the pharmacological side, the necessary medications are included in the treatment process.

The patient has to rinse his mouth with various sanitizing preparations throughout the day. This could be, for example, a weak solution of potassium permanganate, chlorhexidine or furacilin.

The antiseptic drug chlorhexidine is usually used in a 0.05% or 0.1% solution, two to three rinses (or irrigations) throughout the day. The active ingredient of the drug is chlorhexidine bigluconate.

Contraindications for this drug include increased individual sensitivity to the components of the drug, as well as if the patient has a history of dermatitis of any genesis. The duration of administration is determined by the attending physician individually for each patient, based on his history and clinical picture of the disease.

To reduce pain, a local anesthetic is prescribed: chloral hydrate, anesthesin solution in glycerin, lidocaine, trimecaine.

Lidocaine is used locally, in the form of irrigation or lotions, 5-10 ml of 2% solution. It is not recommended to take it in case of individual intolerance of its components by the patient's body.

To restore the integrity of the mucous membrane, the patient is prescribed vinylin, peach oil, solcoseryl, retinol solution or rosehip oil.

Romazulan or Rotokan solutions are used as a sanitizing agent.

For oral administration, Romazulan is diluted in a ratio of 0.5 teaspoon per glass of hot water. For external use, the ratio is 0.5 teaspoon of the drug per liter of water. It is used for rinsing, irrigation and internally. It is not recommended to take the drug only in case of individual intolerance of the patient's body to its components.

At the same time, there are also individual approaches to treating a specific form of the disease:

Deep inflammation is treated by surgical removal of the abscess or purulent phlegmon. Postoperative therapy is a course of antibacterial drugs.

The desquamative nature of the pathology is relieved by treating the source of inflammation.

Rhomboid disorders generally do not require any significant intervention. Sometimes it is enough to correct the patient's diet and adhere to the culture of body hygiene. Only in case of progression of papillomatous disorder is surgical intervention performed, which involves excision of the affected area. Such a technique will reduce the risk of cancer transformations. Hunter's disorders are not a separate pathology, but are one of the symptoms of B12-folate deficiency anemia. Therapy is aimed at eliminating the deficiency of folic acid and vitamin B12 in the patient's body. At the same time, the functioning of the digestive tract is normalized.

In the villous form, the altered papillae are removed with tweezers. The surface is then sanitized with salicylic alcohol, resorcinol, or a 3% solution of copper sulfate. The candidal form requires the introduction of antifungal drugs into the treatment protocol.

Diet for glossitis

Not the last, but perhaps even one of the leading places in the prevention and treatment of the disease is nutrition. The diet for glossitis is not particularly strict, but following its recommendations will significantly reduce the risk of developing such changes.

The human diet should avoid very hot and overly spicy dishes. Such a diet welcomes strained cream soups, pureed main courses, viscous porridges.

If the patient's digestion is characterized by a reduced processing speed, the doctor may recommend drinking a decoction of calamus rhizomes three times a day. It is quite easy to prepare it at home: put 600-700 ml of water and 15 g of chopped plant product into a saucepan, cover with a lid, put on the fire and boil for a quarter of an hour from the moment of boiling. The liquid at room temperature should be drunk in courses: three months of treatment - one break.

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Prevention of glossitis

The disorder in question in the human body is related to pathologies, some forms of which, manifestations of which can be effectively prevented, or significantly reduced in intensity. Prevention of glossitis is a simple but tangible lever that allows protecting the human body from such damage, it is worthwhile to simply adhere to simple recommendations in your life.

Daily hygiene:

• Teeth should be brushed at least twice a day.
• After each meal, rinse your mouth with clean water to remove food debris.
  • Wash your hands more often: after going outside, before and after meals, and so on.
  • Don't ignore regular dental checkups.
  • Periodic examination for hypovitaminosis and anemia.
  • Getting rid of bad habits. This especially concerns smoking.
  • Reduce consumption of spicy foods and avoid eating hot dishes.
  • Treat infectious pathologies and other diseases that may be the source of the problem in question in a timely manner and until complete recovery.

Glossitis prognosis

If the diagnosis is made in time and adequate treatment is carried out, the prognosis for glossitis is favorable and recovery occurs fairly quickly. But if it is aphthous, villous, deep or similar inflammation in terms of severity of pathology and the patient is admitted to the doctor with an advanced form of the disease, then the doctor cannot predict anything specific, because under certain circumstances the pathological change can transform into a cancerous disease that requires other methods of relief. With some forms of the disease, frequent relapses are also possible.

This disease is insidious in that it does not always give uncomfortable symptoms that can serve as a signal to consult a doctor. But in order not to miss the progression of the disease, it is worth being a little more attentive to yourself, not ignoring preventive measures and personal hygiene rules. Such basic actions can significantly reduce the risk of the occurrence and development of such a pathology as glossitis. After all, it depends only on the person how quickly the diagnosis will be made and the necessary therapy will be carried out.