Medical expert of the article
New publications
Angina (acute tonsillitis): symptoms
Last reviewed: 23.04.2024
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Symptoms of sore throats begin acutely: a burning sensation, dryness, tickling, and then a mild sore throat, which is worse when swallowing. The patient complains of indisposition, fatigue, headache. Body temperature is usually low-grade, in children it can rise to 38.0 degrees. C. The tongue is usually dry, white coated. A slight increase in regional lymph nodes is possible.
Symptoms of catarrhal angina
Symptoms of angina in children are more severe, often with high fever and intoxication. The disease can turn into another, more severe form (follicular, lacunar). From acute catarrh of the upper respiratory tract, influenza, acute and chronic pharyngitis, catarrhal angina is characterized by a predominant localization of inflammatory changes in the tonsils and palatine arches. Although catarrhal sore throat compared with other clinical forms of the disease differs relatively easy course, it must be borne in mind that after the catarrhal sore throat can also develop severe complications. The duration of the disease is usually 5-7 days.
[3]
Symptoms of follicular angina
A more severe form of inflammation, involving not only the mucous membrane, but also the follicles themselves. Symptoms of sore throat begin acutely, with a rise in temperature of up to 38-39 C. A severe pain in the throat appears, sharply aggravated when swallowing, and radiating to the ear is often possible. Intoxication, headache, weakness, fever, chills, sometimes pain in the lower back and joints are expressed. In children, often with increasing temperature, there is vomiting, symptoms of meningism may occur, and confusion may occur.
In children, the symptoms of angina usually occur with severe symptoms of intoxication, accompanied by drowsiness, vomiting, and sometimes convulsive syndrome. The disease has a pronounced course with increasing symptoms during the first two days. The child refuses to eat, infants show signs of dehydration. On the 3-4th day of the disease, the child's condition improves somewhat, the surface of the tonsils is cleared, but the sore throat persists for 2-3 days.
The duration of the disease is usually 7-10 days, sometimes up to two weeks, while the end of the disease is recorded by the normalization of the main local and general indicators: the pharyngoscopic picture, thermometry, blood and urine indicators, and the patient's well-being.
Lacunar angina is characterized by a more pronounced clinical picture with the development of purulent-inflammatory process in the orifices of the lacunae with further spread to the surface of the tonsil. The onset of the disease and the clinical course are almost the same as in the case of follicular angina, but lacunar tonsillitis is more severe. The phenomena of intoxication come to the fore.
At the same time as the temperature rises, a sore throat appears, with hyperemia, infiltration and swelling of the tonsils, and with marked infiltration of the soft palate, speech becomes slurred, with a nasal shade. The regional lymph nodes become enlarged and painful on palpation, which causes pain when the head turns. The tongue is coated, the appetite is reduced, the patients feel an unpleasant taste in the mouth, there is a smell from the mouth.
The duration of the disease is up to 10 days, with a prolonged duration of up to two weeks, taking into account the normalization of functional and laboratory indicative.
[4]
Symptoms of phlegmonous sore throat
Intra-tonsillar abscess is extremely rare, it is an isolated abscess in the depth of the amygdala. The cause is represented by tonsil injury with various small foreign objects, usually of an alimentary nature. Defeat is usually one-sided. The amygdala is enlarged, its tissues are strained, the surface can be hyperemic, and the palpation of the amygdala is painful. In contrast to paratonsillar abscess, with intratungsular abscess, general symptoms are sometimes not significant. Intra-tonsillar abscess should be differentiated from the often observed small superficial retention cysts, translucent through the epithelium of the tonsils in the form of yellowish rounded formations. From the inner surface, such a cyst is lined with crypt epithelium. Even with suppuration, these cysts can be asymptomatic for a long time and can only be detected by accidental examination of the pharynx.
Symptoms of atypical angina
The group of atypical angina includes relatively rare forms, which in some cases complicates their diagnosis. The causative agents are viruses, fungi, a symbiosis of a spindle-shaped stick and spirochetes. It is important to take into account the clinical and diagnostic features of the disease, because it is not always possible to verify the causative agent with laboratory methods when the patient first visits the doctor, the result is usually obtained only after a few days. At the same time, the appointment of etiotropic therapy in these forms of angina is determined by the nature of the pathogen and its sensitivity to various drugs, therefore an adequate assessment of the characteristics of local and general body reactions in these forms of angina is especially important.
Symptoms of a sore throat ulcerative-necrotic nature
The ulcer-membranous, angina of Simanovsky Poluut-Vensan, fusospirochetosis angina is caused by the symbiosis of the spindle-shaped stick (You. Fusiformis) and the spirochetes of the oral cavity (Spirochaeta buccalis). In usual time the disease proceeds sporadically, differs in rather favorable current and small contagiousness. However, during the years of social upheaval, with insufficient nutrition and the deterioration of the hygienic living conditions of people, a significant increase in the incidence is noted and the severity of the disease increases. Of the local predisposing factors, insufficient care for the oral cavity, the presence of carious teeth, and oral respiration, contributing to the drying of the oral mucosa, are important.
Often the disease manifests itself as a single symptom of a sore throat - a feeling of awkwardness, a foreign body when swallowing. Often, the only reason for going to a doctor is a complaint about the unpleasant putrid breath that has appeared (salivation is moderate). Only in rare cases, the disease begins with fever and chills. Usually, despite pronounced local changes (raids, necrosis, ulcers), the patient's general condition suffers little, the temperature is low-grade or normal.
Usually one amygdala is affected, a bilateral process is extremely rare. Usually pain when swallowing is insignificant or completely absent, the unpleasant putrid breath from the mouth draws attention. The regional lymph nodes are moderately enlarged and slightly painful on palpation.
Dissociation attracts attention: pronounced necrotic changes and insignificance of common symptoms of angina (no pronounced signs of intoxication, normal or subfebrile temperature) and lymph node reactions. In its relatively favorable course, this disease is an exception among other ulcerative processes of the pharynx.
However, without treatment, ulceration usually progresses and within 2-3 weeks it can spread to most of the surface of the amygdala and go beyond it - to the arms, less often to other parts of the pharynx. When the process spreads deep into it, erosive bleeding can occur, perforation of the hard palate, destruction of the gums. The addition of a coccal infection can change the overall clinical picture: a general reaction occurs, which is characteristic of angina caused by pyogenic pathogens, and the local reaction - hyperemia near ulcers, severe pain when swallowing, salivation, putrid breath from the mouth.
Symptoms of viral sore throats
They are divided into adenoviral (the causative agent is often the adenovirus 3, 4, 7 types in adults and 1, 2 and 5 in children), influenza (the causative agent is the influenza virus) and herpes. The first two types of viral tonsillitis are usually combined with lesions of the mucous membrane of the upper respiratory tract and are accompanied by respiratory symptoms (cough, rhinitis, hoarseness), sometimes there is conjunctivitis, stomatitis. Diarrhea.
Herpes sore throat, which is also referred to as vesicular (vesicular, vesicular-ulcerous), is observed more frequently in other species. The causative agents are Coxsackie virus A9, B1-5, ECHO virus, human herpes simplex virus type 1 and 2, enteroviruses, picornavirus (the causative agent of foot and mouth disease). In summer and autumn, it may be in the nature of epidemic, and during the rest of the year it usually appears sporadically. The disease is more common in young children.
The disease is highly contagious, transmitted by airborne, rarely fecal-oral routes. The incubation period is from 2 to 5 days, rarely 2 weeks. Symptoms of sore throat are characterized by acute events, fever up to 39-40 C, difficulty swallowing, sore throat, headache and muscle pain, sometimes vomiting and diarrhea. In rare cases, especially in children, the development of serous meningitis is possible. Together with the disappearance of the vesicles, usually by the 3rd or 4th day, the temperature normalizes, the enlargement and soreness of the regional lymph nodes decreases.
Often the symptoms of angina are one of the manifestations of an acute infectious disease. Changes in the pharynx are non-specific and can be diverse: from catarrhal to necrotic and even gangrenous, therefore, with the development of angina, one should always remember that it can be the initial symptom of any acute infectious disease.
Symptoms of tonsillitis in diphtheria
Diphtheria pharynx occurs in 70-90% of all cases of diphtheria. It is believed that this disease is more common in children, but the increase in the incidence of diphtheria in the last two decades and in Ukraine is noted mainly due to unimmunized adults. Children of the first years of life and adults over 40 years of age are seriously ill. The disease is caused by a diphtheria bacillus, a bacillus of the genus Corynebacterium diphtheriae, its most virulent biotypes, such as gravis and intermedius.
The source of infection is a patient with diphtheria or a bacterial carrier of toxigenic strains of the pathogen. After a postponed illness, convalescents continue to secrete diphtheria sticks, but most of them stop carriage for 3 weeks. The release of convalescents from diphtheria bacteria can be hindered by the presence of chronic foci of infection in the upper respiratory tract and a decrease in the overall resistance of the organism.
According to the prevalence of the pathological process, localized and widespread forms of diphtheria are distinguished; by the nature of local changes in the pharynx, catarrhal, insular, membranous and hemorrhagic forms are distinguished; depending on the severity of the course - toxic and hypertoxic.
The incubation period lasts from 2 to 7, rarely up to 10 days. In milder forms of diphtheria, local symptoms predominate, the disease proceeds as a sore throat. In severe forms, along with local symptoms of angina, signs of intoxication develop rapidly as a result of the formation of a significant amount of toxin and its massive flow into the blood and lymph. Light forms of diphtheria are usually observed in vaccinated, severe - in people who do not have immune protection.
In catarrhal form, local symptoms of angina are manifested by dim hyperemia with cyanotic tinge, moderate edema of tonsils and palatine arches. Intoxication symptoms in this form of diphtheria of the pharynx are absent, the body temperature is normal or subfebrile. The reaction of the regional lymph nodes is not pronounced. Diagnosis of the catarrhal form of diphtheria is difficult, since there is no characteristic sign of diphtheria — fibrinous raids. Recognition of this form is possible only through bacteriological examination. In case of catarrhal form, recovery can occur on its own, but after 2-3 weeks, isolated paresis, usually soft palate, mild cardiovascular disorders appear. Such patients are dangerous in epidemiological terms.
The island form of diphtheria is characterized by the appearance of single or multiple islands of fibrinous overlays of a grayish-white color on the surface of the tonsils outside the lacunae.
The attacks with the characteristic hyperemia of the mucous membrane around them persist for 2-5 days. Subjective sensations in the pharynx are mild, regional lymph nodes are slightly painful. The temperature of the gel is up to 37-C, headache, weakness, and indisposition can be noted.
The membranous form is accompanied by a deeper lesion of the tonsil tissue. Palatine tonsils are enlarged, hyperemic, moderately edematous. On the surface of them formed solid deposits in the form of films with a characteristic bordering area of hyperemia around. Initially, the plaque may be in the form of a translucent pink film or arachnoid mesh. Gradually, the delicate film is impregnated with fibrin and by the end of the first (beginning of the second) day it becomes dense, whitish-gray in color with a pearl luster. Initially, the film goes away easily, further necrosis becomes more and more deep, the plaque turns out to be tightly welded to the epithelium with fibrin filaments, is removed with difficulty, leaving the ulcer defect and bleeding surface.
The toxic form of diphtheria of the pharynx is quite a severe defeat. The onset of the disease is usually acute patient can call the hour when it originated.
Symptoms of sore throat are characteristic, allowing to identify the toxic form of diphtheria before the appearance of the characteristic edema of the subcutaneous fatty tissue of the neck: severe intoxication, edema of the pharynx, reaction of regional lymph nodes, pain syndrome.
Severe intoxication is manifested by an increase in body temperature to 39-48 ° C and persistence at this level for more than 5 days, headache, chills, severe weakness, and anorexia. Pale skin, adynamia. The patient noted pain when swallowing, drooling, difficulty breathing, cloyingly sweet smell from the mouth, open nasal. Pulse frequent, weak, arrhythmic.
Pharyngeal edema begins with the tonsils, extends to the arms, the tongue of the soft palate, the soft and hard palate, paratonsillar space. Edema diffuse, without sharp boundaries and protrusions. The mucous membrane over the edema is intensely hyperemic, with a cyanotic hue. On the surface of enlarged tonsils and edema palate, you can see a grayish web or a gelatinous translucent film. The raids extend to the palate, the root of the tongue, the mucous membrane of the cheeks. Regional lymph nodes enlarged, dense, painful. If they reach the size of a chicken egg, this indicates a hypertoxic form. Hypertoxic fulminant diphtheria is the most severe form, developing, as a rule, in patients over 40 years of age. Representatives of the "non-immune" contingent. It is characterized by a vigorous onset with a rapid increase in severe signs of intoxication: high temperature, repeated vomiting, impaired consciousness, delirium, hemodynamic disorders of the type of collapse. At the same time, significant edema of the soft tissues of the pharynx and neck develops with the development of phenomena of pharyngeal stenosis. The forced position of the body, trismus, rapidly increasing gelatinous edema of the pharyngeal mucosa with a clear demarcation zone separating it from the surrounding tissues is noted.
Complications of diphtheria are associated with the specific action of the toxin. The most dangerous are complications of the cardiovascular system, which can occur with all forms of diphtheria, but more often with the toxic, especially II in the III degree. The second place in frequency is occupied by peripheral paralyzes, which usually have the character of polyneuritis. They can occur in cases of abortively occurring cases of diphtheria, their frequency is 8-10%. The most frequently observed paralysis of the soft palate is associated with damage to the pharyngeal branches of the vagus and glossopharyngeal nerves. In this case, it takes nasal, nasal shade, liquid food gets into the nose. The palatine curtain hangs sluggishly, immobile during phonation. Rarely observed paralysis of the muscles of the extremities (lower - 2 times more often), even less often - paralysis of the abducent nerves, causing convergent strabismus. Lost functions are usually fully restored after 2-3 months, less often - through longer periods. In young children, and in severe cases in adults, the development of laryngeal stenosis and asphyxia in diphtheria (true) croup can be a serious complication.
Symptoms of angina with scarlet fever
It occurs as one of the manifestations of this acute infectious disease and is characterized by a feverish state, general intoxication, a punctate rash, and changes in the pharynx, which can vary from catarrhal to necrotic angina. The toxigenic hemolytic streptococcus group A acts as the causative agent of scarlet fever. The transmission of infection from the patient or bacilli carrier occurs mainly through airborne droplets; children between the ages of 2 and 7 are most susceptible. The incubation period is 1-12 days, usually 2-7. The disease begins acutely with a rise in temperature, malaise, headache and sore throat when swallowing. In severe intoxication, repeated vomiting occurs.
Symptoms of tonsillitis usually develop before the onset of a rash, often simultaneously with vomiting. Sore throat with scarlet fever is a permanent and typical symptom of it. It is characterized by bright hyperemia of the pharyngeal mucosa ("flaming throat"), extending to the hard palate, where a clear boundary of the zone of inflammation is sometimes observed against the background of the pale mucous membrane of the sky.
By the end of the first day (less often on the second day) of the disease, a bright pink or red punctate rash appears on the skin with a hyperemic background, accompanied by itching. It is especially abundant in the lower abdomen, on the buttocks, in the groin, on the inner surface of the limbs. The skin of the nose, lips, chin area remains pale, forming the so-called nasolabial triangle Filatov. Depending on the severity of the disease, the rash lasts from 2-3 to 3-4 days or longer. The tongue becomes bright red by the 3-4th day, with the papillae protruding on the surface - the so-called crimson tongue. Palatine tonsils are edematous, covered with a greyish-dirty coating, which, unlike diphtheria, is not continuous and is easily removed. The attacks can extend to the palatine arches, the soft palate, the tongue, the floor of the oral cavity.
In rare cases, mainly in young children, the larynx is involved in the process. Developed edema of the epiglottis and the outer ring of the larynx can lead to stenosis and require urgent tracheotomy. Necrotic process can lead to perforation of the soft palate, defect of the uvula. As a consequence of the necrotic process in the pharynx, bilateral small necrotic otitis and mastoiditis can be observed, especially in young children.
Recognition of scarlet fever in a typical course is not difficult: an acute onset, a significant increase in temperature, a rash with its characteristic appearance and location, a typical lesion of the pharynx with a reaction of lymph nodes. With erased and atypical forms of great importance is the epidemic history.
[16]
Symptoms of tonsillitis with measles
Measles is an acute, highly contagious infectious disease of viral etiology, occurring with intoxication, inflammation of the mucous membrane of the respiratory tract and lymphadenoid pharyngeal ring, conjunctivitis, spotty-papular rash on the skin.
The spread of the causative agent of infection, the measles virus, occurs through airborne droplets. The most dangerous for others around the patient in the catarrhal period of the disease and on the first day of the rash. On the 3rd day of the appearance of the rash, contagiousness decreases sharply, and after the 4th patient is considered non-infectious. Measles belongs to childhood infections, it is more common for children between the ages of 1 and 5 years; however, people can get sick at any age. The incubation period is 6-17 days (usually 10 days). During measles there are three periods: catarrhal (prodromal), periods of rash and pigmentation. According to the severity of symptoms of the disease, primarily intoxication, distinguish mild, moderate and severe for measles.
In the prodromal period, on the background of moderate fever, catarrhal phenomena develop on the part of the upper respiratory tract (acute rhinitis, pharyngitis, laryngitis, tracheitis), as well as signs of acute conjunctivitis. However, often the symptoms of angina are manifested in the form of a lacunar form.
First, the measles enanthema appears as red spots of various sizes on the mucous membrane of the hard palate, and then quickly spreads to the soft palate, the arms, the amygdala and the back wall of the pharynx. Merging, these red spots cause a diffuse hyperemia of the mucous membrane of the mouth and pharynx, resembling a picture of banal tonsillopharinitis.
The pathognomonic early sign of measles, observed 2-4 days before the onset of the rash, is represented by Filatov Koplik's spots on the inner surface of the cheeks, in the area of the parotid gland duct. These whitish specks of 1-2 mm in size, surrounded by a red rim, appear in an amount of 10–20 pieces on a sharply hyperemic mucosa. They do not merge with each other (the mucous membrane appears to be sprinkled with drops of lime) and disappear after 2-3 days.
In the period of rash, along with increased catarrhal phenomena of the upper respiratory tract, a general hyperplasia of the lymphadenoid tissue is observed: the palatine and pharyngeal tonsils swell, and the increase in the cervical lymph nodes is noted. In some cases, mucopurulent plugs appear in the gaps, which is accompanied by a new rise in temperature.
The pigmentation period is characterized by a change in the color of the rash: it begins to darken, acquires a brown tint. First comes the pigmentation on the face. Then on the trunk and on the limbs. A pigmented rash usually lasts 1-1.5 weeks, sometimes longer, then a small, scaly, peeling. Complications of measles are mainly associated with the addition of secondary microbial flora. Most often observed laryngitis, laryngotracheitis, pneumonia, otitis media. Otitis seems to be the most frequent complication of measles, usually occurs during pigmentation. Usually there is catarrhal otitis, purulent is relatively rare, however, there is a high likelihood of developing bone and soft tissue necrotic lesions of the middle ear and the transition process to chronic.
Symptoms of tonsillitis in blood diseases
Inflammatory changes in the tonsils and mucous membranes of the mouth and pharynx (acute tonsillitis, symptoms of tonsillitis, stomatitis, gingivitis, periodontitis) develop in 30-40% of hematological patients already in the early stages of the disease. In some patients, oropharyngeal lesions are the first signs of a disease of the blood system and their timely recognition is important. The inflammatory process in the pharynx with blood diseases can be very diverse - from catarrhal changes to necrotic ulcers. In any case, infection of the oral cavity and pharynx can significantly worsen the health and condition of hematological patients.
Symptoms of monocytic angina
Infectious mononucleosis, Filatov's disease, benign lymphoblastosis is an acute infectious disease, observed mainly in children and young people, occurring with lesion of the tonsils, polyadenitis, hepatosplenomegaly and characteristic blood changes. The causative agent of mononucleos most researchers now recognize the Epstein-Barr virus.
The source of infection is the sick person. Infection occurs through airborne droplets, the entrance gate is represented by the mucous membrane of the upper respiratory tract. The disease is classified as low contagious, the transmission of the pathogen occurs only through close contact. More often sporadic cases are observed, family and group outbreaks are very rare. In persons older than 35-40 years, mononucleosis is extremely rare.
The duration of the incubation period is 4-28 days (usually 7-10 days). The disease usually begins acutely, although sometimes in the prodromal period there is malaise, sleep disturbance, loss of appetite. Mononucleosis is characterized by a clinical triad of symptoms: fever, symptoms of angina, adenosplenomegaly and hematological changes, such as leukocytosis with an increase in the number of atypical monocuclear cells (monocytes and lymphocytes). The temperature is usually around 38 ° C rarely high, accompanied by moderate intoxication; temperature increase is usually observed within 6-10 days. The temperature curve may have a wave-like and recurring nature.
Early detection of regional (occipital, cervical, submandibular), and then distant (axillary, inguinal, abdominal) lymph nodes is characteristic. They are usually palpation plastic consistency, moderately painful, not soldered; reddening of the skin and other symptoms of periadenitis, as well as suppuration of the lymph nodes, is never observed. Simultaneously with an increase in lymph nodes for 2-4 days of the disease, an increase in the spleen and liver is observed. The reverse development of enlarged lymph nodes of the liver and spleen usually occurs on the 12-14th day, by the end of the febrile period.
An important and permanent symptom of mononucleosis, which is usually guided in the diagnosis - the occurrence of acute inflammatory changes in the pharynx, mainly from the palatine tonsils. A slight hyperemia of the pharyngeal mucosa and an increase in the tonsils are observed in many patients from the first days of the disease. Monocytic angina can occur in the form of lacunar membranous, follicular, necrotic. Tonsils dramatically increase and are large, uneven, nodular formations protruding into the pharyngeal cavity and, together with an enlarged lingual tonsil, make it difficult to breathe through the mouth. Offensive gray patches remain on the tonsils for several weeks or even months. They can be located only on the tonsils, but sometimes extend to the arms, the back of the pharynx, the root of the tongue, the epiglottis, recalling the picture of diphtheria.
The most characteristic symptoms of infectious mononucleosis are represented by changes in peripheral blood. In the midst of the disease, moderate leukocytosis and significant changes in the blood formula (pronounced mononucleosis and neutropenia with the presence of a nuclear left shift) are observed. The number of monocytes and lymphocytes increases (sometimes up to 90%), plasma cells and atypical mononuclear cells appear, characterized by large polymorphism in size, shape and structure. These changes reach a maximum by the 6-10th day of the disease. During the recovery period, the content of atypical mononuclear cells gradually decreases, their polymorphism becomes less pronounced, plasma cells disappear; However, this process is very slow and sometimes drags on for months and even years.
Symptoms of angina with leukemia
Leukemia is a neoplastic blood disease with a mandatory damage to the bone marrow and the replacement of normal hemopoietic germs. The disease can be acute or chronic. In acute leukemia, the bulk of the tumor cells are represented by low-differentiated blasts; in chronic it consists mainly of mature forms of granulocytes or erythrocytes, lymphocytes or plasma cells. Acute leukemia is observed approximately 2-3 times more often than chronic.
Acute leukemia occurs under the guise of a serious infectious disease, affecting mainly children and young people. Clinically, it is necrotic and septic complications due to impaired phagocytic function of leukocytes, pronounced hemorrhagic diathesis, severe progressive anemia. The disease is acute with high fever.
Changes on the part of the tonsils can occur both at the onset of the disease and at later stages. In the initial period, simple hyperplasia of the tonsils is observed against the background of catarrhal changes and edema of the pharyngeal mucosa. In the later stages, the disease becomes septic in nature, symptoms of a sore throat develop, first lacunar, then ulcerous-necrotic. The surrounding tissues are involved in the process, necrosis can spread to the palatine arches, the back of the pharynx, and sometimes to the larynx. The frequency of pharyngeal lesions in acute leukemia is from 35 to 100% of patients. Hemorrhagic diathesis, also characteristic of acute leukemia, may also manifest as petechial skin rashes, subcutaneous hemorrhages, and gastric hemorrhages. In the terminal phase of leukemia, necrosis often develops at the site of hemorrhage.
Changes in the blood are characterized by a high content of leukocytes (up to 100-200x10 9 / l). However, leukopenic forms of leukemia are also observed, when the number of leukocytes decreases to 1.0-3.0x10 9 / l. The most characteristic symptom of leukemia is the prevalence of undifferentiated cells in the peripheral blood - various types of blasts (hemogystioblasts, myeloblasts, lymphoblasts), up to 95% of all cells. Changes are also noted on the part of red blood: the number of erythrocytes progressively decreases to 1.0-2.0x10 12 / l and the concentration of hemoglobin; also the number of platelets decreases.
Chronic leukemia, unlike acute, is a slowly progressive disease, prone to remission. The defeat of the tonsils, oral mucosa and pharynx is not so pronounced. It usually occurs in older people, men get sick more often than women. The diagnosis of chronic leukemia is based on the identification of high leukocytosis with a predominance of immature forms of leukocytes, a significant increase in the spleen in chronic myeloid leukemia and a generalized increase in lymph nodes in chronic lymphocytic leukemia.
Symptoms of angina with agranulocytosis
Agranulocytosis (agranulocyte angina, granulocytopenia, idiopathic or malignant leukopenia) is a systemic blood disease characterized by a sharp decrease in the number of leukocytes with the disappearance of granulocytes (neutrophils, basophils, eosinophils) and ulcerative necrotic lesion. The disease occurs predominantly in adulthood; women get agranulocytosis more often than men. The agranulocyte reaction of hematopoiesis can be caused by various adverse effects (toxic, radiation, infectious, systemic lesion of the hematopoietic apparatus).
Symptoms of tonsillitis are initially erythematous and erosive, then quickly become ulcerated-necrotic. The process can spread to the soft palate, not limited to soft tissues and moving to the bone. Necrotic tissue breaks up and is rejected, leaving deep defects. The process in the pharynx is accompanied by severe pain, a violation of swallowing, copious salivation, putrid odor from the mouth. The histological picture of the lesion in the throat is characterized by the absence of an inflammatory response. Despite the presence of a rich bacterial flora, there is no leukocytic inflammatory reaction and suppuration in the lesion focus. When making a diagnosis of granules of octosis and determining the prognosis of the disease, it is important to assess the state of the bone marrow detected during the sternum puncture.
[25], [26], [27], [28], [29], [30]
Pseudomembranous (non-diphtheritic, difteroid) tonsillitis
Etiological factor is pneumococcus or streptococcus, rarely staphylococcus; is rare and is characterized by almost the same local and general symptoms as diphtheria pharynx. Streptococcus may be associated with corynebacterium diphtheria, which causes the so-called streptodiphtheria, characterized by an extremely severe course.
The final diagnosis is established according to the results of bacteriological examination of pharyngeal smears. In the treatment of diphtheroid forms of tonsillitis, in addition to the above described for lacunar angina, before establishing the final bacteriological diagnosis, it is advisable to include the use of diphtheria serum.
[31]
Acute ulcerative amygdalitis
Moure's disease - a form of sore throat is characterized by an insidious onset without pronounced general phenomena with minor and notoriously unspecified pain when swallowing. Bacteriological examination revealed a variety of pathogenic microorganisms in symbiosis with a nonspecific spirillus microbiota. When pharyngoscopy at the upper pole of one of the palatine tonsils is determined necrotizing ulcer, while in the amygdala itself, any parenchymal or catarrhal inflammatory phenomena are absent. Regional lymph nodes are moderately increased, body temperature rises to 38 ° C at the height of the disease.
At the initial stage of diagnosis, this form of tonsillitis is easily confused with syphilitic chancre, in which, however, neither its characteristic signs, nor massive regional adenopathy, or Simanovsky-Plaut-Vincent's angina are observed, in which, unlike the form in question, a thuso-chyle microbiota is determined from a pharyngeal smear. The disease lasts for 8-10 days and ends with a spontaneous recovery.
Topical treatment with gargles with 3% solutions of boric acid or zinc chloride.
Symptoms of angina mixed forms
Rarely encountered and characterized by a combination of symptoms of angina, inherent in the various forms described above.
With an unfavorable course of sore throat, the development of local and general complications is possible. Most often as a local complication, paratonsillitis is observed, less often - parafaryngitis, however, it is characterized by an extremely severe course. In young children, a sore throat can lead to the development of a pharyngeal abscess. Among the common complications that develop more often after suffering streptococcal angina caused by beta-hemolytic streptococcus group A, the most severe are acute rheumatic fever with subsequent rheumatic damage to the heart and joints and post-streptococcal glomerulonephritis.