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

Why, diagnosing inflammation of the tonsils - angina (tonsillitis) - and by prescribing appropriate therapy, do doctors insist on the patients' compliance with all the recommendations? Because not completed treatment of angina is fraught with negative consequences, because some complications of angina can seriously and permanently worsen overall health.

In particular, complications after angina in children who suffer from this infectious ENT disease are more dangerous than adults.

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

Why does angina give complications?

What is dangerous angina?  And why does it give complications - numerous and potentially dangerous for life?

Everyone knows the symptoms of angina: sore throat (including swallowing), red swollen tonsils (often with a purulent coating causing halitosis), fever with chills, headache, fatigue, swollen lymph nodes in the neck and ear or neck pain . For more details see -  Angina (acute tonsillitis) - Symptoms

But the matter is not in manifestations of the disease, but in its causes. Angina is caused either by bacteria (in 30-40% of cases) or by viruses (60-70%). According to many years of research, acute bacterial tonsillitis most often develops due to infection of palatine tonsils Streptococcus pyogenes (group A beta-hemolytic streptococci) - 51.4% of cases; Staphylococus aureus (Staphylococcus aureus) - 12.5% (for other data - 23%); Streptococcus pneumoniae (pneumococcus) - 8-12%; Haemophilus influenzae (haemophilus influenzae) - 15.5%; Psuedomonas aeruginosa (Pseudomonas aeruginosa) - 2%. A purulent angina in 58-82% of cases is the result of the pathogenic effect of β-hemolytic streptococcus.

But in the development of catarrhal angina, viruses (respiratory syncytial and rhinovirus, adenovirus, influenza and parainfluenza viruses) are more often responsible, and the course of the disease in viral etiology, and complications of catarrhal angina may be more mild.

The most studied reasons for which complications of purulent tonsillitis - acute streptococcal tonsillitis. Penetrating into the mucous epithelium of palatine tonsils, β-hemolytic streptococcus of group A (Streptococcus pyogenes) produces exotoxins acting on cells and causing disturbances in physiological processes and immune responses.

So, membrane-active enzymes - streptolysins S and O (SLS and SLO) - damage the cytoplasmic membranes of the cells of the epithelium and blood; the red blood cells and some subcellular organelles are completely destroyed by bacterial hemolysins; pneumolysin, getting into 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 implantation to produce amino acids necessary for the synthesis of intrinsic proteins.

In addition, S. Pyogenes have bacterial survival immuno-modulating superantigens (SAg). They are able to bypass the main histocompatibility complexes (lymphocyte antigens MHC-II) with T-cell receptors (which recognize foreign antigens), "reprogram" their α- and β-genes and manipulate T-lymphocytes - direct 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.

A sufficient arsenal of cytolytic enzymes has also Staphylococcus aureus, which causes complications of staphylococcal angina. S. Aureus produces the already mentioned hemolysin; leukocidin-leukocyte-dissolving cells, as well as plasmin, which cleaves fibrous proteins (fibrins). Specialists note that lymphoid hyperplasia and inflammation of the tonsils occur when streptococcus inhibits cellular mechanisms of protecting their tissues, leading to bacteremia with multiple organ dysfunction syndrome.

What complications can be after a sore throat?

Possible as local complications of angina, and general. In particular, such local complications of catarrhal sinus as inflammation of the regional (cervical) lymph nodes with the development of lymphadenitis are observed. Often the inflammation seizes the mucosa of the entire larynx - before the generalized infection of the pharynx, and ENT doctors ascertain the  acute catarrhal laryngitis. Bacterial tonsillitis gives complications to the ears - in the form of otitis media. Most often, such complications after angina in children.

There may also be eye complications, which are manifested by catarrhal inflammation of the eye mucosa - conjunctivitis (with redness, cutting, sensation of foreign body in the eyes and their increased sensitivity to light). Local complications of staphylococcal angina include inflammation of the middle ear or mucous edges of the eyelids (blepharitis).

Complications of purulent sore throat - complications of follicular sore throat, as well as

Complications of lacunar angina - swelling of the throat, accompanied by difficulty breathing, increased pulse, cyanosis of the skin, obstructive sleep apnea. Read more -  Follicular and lacunar angina

When the infection passes to the mucosa and underlying tissues surrounding the amygdala of the zone, a parathonsillar abscess develops-a local complication of staphylococcal angina-phlegmous and preceded by follicular and lacunar abscess. The formation of the abscess is accompanied by fever and chills, growing pain in the throat, difficulty swallowing, a general decline in strength and a headache.

The parathonsillar abscess, in turn, can have negative consequences: phlegmon of the bottom of the oral cavity (Ludwig's angina); development of the retropharyngeal abscess; formation of thrombus and inflammation of the vessels of the cavernous sinus of the solid membrane of the brain; endothelial damage and damage to the wall of the vessels of the parapharyngeal region with diapedesis bleeding; aspiration pneumonitis; obstruction of the airways.

Common complications of angina

Among the common negative consequences of bacterial tonsillitis, complications on the kidneys, on the heart, on the joints of the legs and rheumatism are most often identified.

After 15-25 days after the onset of the disease, nephrologic complications of staphylococcal angina and angina caused by hemolytic pyogenic streptococcus can manifest themselves in the form of marked inflammation of the filtering cells of the kidneys - glomerulonephritis. More information, see -  Symptoms of acute poststreptococcal glomerulonephritis.

Experts no longer doubt that complications on the heart after angina arise from an abnormal response of one's own immunity to β-hemolytic streptococci. The result of an autoimmune response of the body is acute  rheumatic fever  (ORL). Annually, according to the Global Burden of Disease Study (WHO), ORL is detected in 325,000 children aged 5 to 14 years; At present, about 33.5 million people have rheumatic carditis, and a significant proportion of it falls on complications of angina in adults (usually repeated and necessarily - bacterial etiology).

The development of ARF occurs approximately two to three weeks after infection of S. Pyogenes and the onset of streptococcal angina or pharyngitis. Thus rheumatism with a swelling and painfulness of joints of extremities is noted - polyarthritis or migrating polyarthritis, that is complications on joints of legs (especially knees).

The painless granulomatous bodies of Aschoff bodies (the foci of inflammation of interstitial tissues at the stage of fibrosis) can appear anywhere, including in the membranes of the heart. Because of these nodes, after three to four months after the disease, there are complications on the heart after angina:  myocarditis  (inflammation of the muscular walls of the heart), endocarditis (inflammation in the tissues of the inner shell of the heart cells and valves), less often  pericarditis  (inflammation of the pericardial sac). In ORL and after bacterial angina, cardiopathies of inflammatory origin (rheumatic carditis) occur mostly in children, adolescents and patients up to 30 years of age.

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

As a neurological complication of streptococcal angina or pharyngitis, Sydenham's chorea (rheumatic chorea or St Vitus dance) occasionally occurs, in which uncontrolled disorderly movements of the face and hands are observed.

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

Complications of viral sore throat

In the opinion of otolaryngologists, special attention deserves complication of herpes sore throat -  herpangina  or enterovirus vesicular pharyngitis, which is affected mainly by children under 10 years old and in most cases in the summer.

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

Characteristic symptoms of angina of this etiology: a small red rash or a cluster of small red spots on the mucosa of the mouth and tonsils (can be on the skin of the face, hands and feet), transforming into exudate-filled vesicles, then their ulceration and inflammation of the formed wounds that are covered fibrous crusts. Histologically, the membranes of affected epithelial cells are damaged, signs of intracellular and extracellular edema are revealed. The throat hurts, cervical and other regional lymph nodes hypertrophied, fever, general malaise. The duration of symptoms is about 7-10 days.

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

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

How to recognize complications after a sore throat?

To determine the complications after the angina, the doctor studies the patient's anamnesis, listens to his complaints, examines and prescribes the examination, including blood tests: total, for ESR, C-reactive protein, activated B- and T-lymphocytes, for antistreptococcal antibody titers (for antistreptolysin) , on RF (rheumatoid factor).

It may be necessary to analyze urine or cerebrospinal fluid.

Depending on the location of the pathologies that arise, the patient is referred to specialized specialists - 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 done -  Diagnosis of acute poststreptococcal glomerulonephritis.

Treatment of complications of sore throat

After the treatment of the sore throat seems to be completed, treatment of its complications is prescribed, depending on their nature and symptoms.

For example, bacteria present with purulent contents of the paratonsillar abscess can penetrate into the adjacent jugular vein, infecting the blood and causing sepsis. This condition is called Lemierre syndrome and can be fatal if it is not treated quickly and appropriately. Therefore, without delay in a hospital setting, an ENT surgeon opens the abscess, removes pus by aspiration, and prescribes antibiotics (most commonly third-generation cephalosporins, IM injections) and rinsing with antiseptics. Many recommend using an antiseptic drug  Miramistin  from a local complication after a sore throat.

In addition to the course of antibiotic injections in the treatment of acute rheumatic fever, NSAIDs such as Paracetomol, Nimesil (adults only), Ibuprofen (for children only after 6 years), etc. Can be used to treat pain and relieve inflammation.

Inflammation in the heart muscle - myocarditis - usually goes away on its own. There are no medications for myocarditis, most importantly - strict bed rest (for children - in the intensive care unit) and maintenance of heart functions.

Principles of treatment of complications of angina heart outlined in the publication -  A echenie infective endocarditis.

Read also:

• Treatment glomerulonephritis
• Treatment of Coxsackie and ECHO infection

How to avoid complications?

Prevention of complications of angina largely depends on the mandatory culture (microbiological) study - a smear from the pharynx and from the surface of the inflamed tonsils, which is performed to pinpoint the causative agent of the disease and prescribe the correct medication.

For example, not all antibiotics for angina cope with β-hemolytic streptococcus (S. Pyogenes). Therefore, when prescribing antibiotics without a microbiological study, treatment will be ineffective, and as a result complications may occur.

For their part, to avoid complications of angina, patients should show maximum compliance, that is, obediently fulfill all the prescriptions, and especially observe the duration of the course of antibiotic therapy - in accordance with the prescribing doctor's instructions.