Brucellotyphoid laryngitis: causes, symptoms, diagnosis, treatment

It is known that S. typhi, discovered by Ebert Perth and named Eberthella typhi in his honor, has a high penetrance in relation to lymphoid tissue, affecting mainly the lymphatic system of the abdominal cavity and, in particular, group lymphatic follicles of the small intestine and solitary follicles. In some cases, this bacterium reaches the lymphoid apparatus of the upper respiratory tract, including the larynx, by the hematogenous route. In previous years, according to Luscher's observations, the incidence of typhoid laryngitis reached 10% of cases of the total number of people with this infectious disease. In the last 2-3 years, cases of typhoid fever have been registered in Russia again, which does not exclude the occurrence of typhoid laryngitis.

Pathological anatomy. Typhoid laryngitis usually occurs during the first week of typhoid fever and is manifested by catarrhal inflammation, sometimes superficial ulcers located symmetrically along the edges of the vocal folds, and starting from the second week - small round ulcers at the sites of lymphoid follicles. These necrotic changes in the lymphoid tissue are localized mainly on the mucous membrane of the vestibule of the larynx and the posterior surface of the cricoid cartilage. In patients weakened by the general infectious process, bedsores may appear between the plate of the arytenoid cartilage and the bodies of the vertebrae. The same bedsores and ulcers appear inside the larynx, which serve as a gateway for secondary infection with the development of complications such as abscess, perichondritis and secondary cicatricial stenosis of the larynx, if the patient is saved.

Symptoms and clinical course of typhoid laryngitis. During the period of catarrhal inflammation, the main symptoms are hoarseness and pain in the larynx during phonation. With the development of ulcers and perichondritis, dysphagia, otodynia, respiratory failure, stridor and paroxysmal cough appear. Laryngoscopy reveals edema and hyperemia of the mucous membrane, ulcers along the edges of the epiglottis and vocal folds, sometimes vitreous edema, false membranes in complicated forms. During the recovery period and later, temporary phenomena of myogenic phonasthenia may be observed.

Diagnosis of typhoid laryngitis is facilitated by the fact that it occurs against the background of a general typhoid infection, manifested by a typical picture, while the endoscopic picture and local subjective and objective symptoms do not contain information specific to this disease. Primary forms of typhoid laryngitis are unknown.

Treatment of typhoid laryngitis. Since typhoid laryngitis is a secondary manifestation of typhoid fever, such patients, being hospitalized in the infectious diseases department and receiving appropriate specific antibacterial treatment (levomycetin, ampicillin, biseptol, furazolidone, etc.), as well as an appropriate diet and regimen, also need observation and supervision of an ENT specialist. The latter's task includes monitoring the state of the larynx functions, prescribing appropriate local treatment (inhalation of ampicillin solution with hydrocortisone, alkaline-oil mixtures, proteolytic and mucolytic agents, etc.). If respiratory obstruction occurs, preemptive tracheotomy is indicated.

The prognosis for uncomplicated typhoid fever is favorable. With the development of complications, especially with intestinal perforation and the development of peritonitis, or with pronounced necrotic lesions of the larynx with respiratory obstruction, the prognosis becomes serious or even unfavorable. Mortality in typhoid fever in our time is a fraction of a percent.