Angina with smallpox: causes, symptoms, diagnosis, treatment

Smallpox is a natural, highly contagious disease of a viral nature, characterized by severe course, intoxication, fever, rashes on the skin and mucous membranes, often leaving scarring behind. Smallpox is genetically close to a disease known as alastrim, a viral disease that is a variety of smallpox. Symptoms are similar to smallpox, but it is easy, the rash does not leave scarring.

Epidemiology. The source of the causative agent of infection is only a sick person, which is most dangerous in the period of flowering rash and opening of pustules. Infection occurs by contact with a sick person, through his personal belongings and objects contaminated with its secretions. The susceptibility to smallpox is not universal. Immunity after the disease is persistent, lifelong. With artificial immunization with a smallpox vaccine, passive immunity is not as stable and prolonged. It should be noted, however, that similar diseases occur in many animals (smallpox of cows, horses, sheep), and the viruses causing them are so close to the variola virus that, when in contact with humans, they give stable cross-immunity that is used for active immunization against smallpox.

The cause of angina with a smallpox. The causative agent of smallpox is the largest virus, belongs to the family of poxviruses, is resistant to environmental conditions, and persists for a long time in crusts of pustules.

Pathogenesis and pathological anatomy. The virus penetrates through the mucous membranes of the upper respiratory tract, less often through the skin into the regional lymph nodes, where it multiplies. After 1-2 days, it appears in the blood, from where it enters the skin, liver, bone marrow and other organs. The interest of the otorhinolaryngologist to smallpox lies in the fact that the virus is kept in the mucous membrane of the mouth, tongue, pharynx, larynx, trachea, where it multiplies and forms lesions. Reproduction of viruses in tissue cells and excretion into exotoxin blood leads to fever and other early symptoms of the disease. The toxin of the virus causes dystrophy and inflammatory changes in the parenchymal organs. The suppuration of the vesicles and the release of pyrogenic substances associated with it determines the second rise in body temperature, which occurs on the 9th-10th day of the disease.

Symptoms of angina at a smallpox. The incubation period is 10-12 days. The disease begins acutely, with a chill, raising the body temperature to 39.5-40 ° C. There is nausea, vomiting, painful headache and pain in the sacrum. Children may have cramps. Inflammation of the mucosa of the soft palate and nasopharynx is noted. On the 2-3rd day, there may appear a so-called prodromal rash on the face, limbs and trunk, which in appearance looks like a rash in measles or scarlet fever. After 12-24 hours, it disappears without a trace. By the end of the prodromal period, the body temperature decreases and the general condition of the patient improves. At the same time, there is a characteristic rash. First of all, it arises on the mucous membrane of the mouth, soft palate, nasopharynx, conjunctiva and then spreads throughout the body. A characteristic symptom is the appearance of rashes on the palms and feet. The rash evolves in the following sequence: macula, papule, vesicle, pustule and the stages of crusting and scarring. It is also characteristic that with smallpox on the skin and mucous membrane, it is possible to observe simultaneously elements of the rash that are in different stages of development.

Bucopharyngeal enanthema is characterized by the appearance on the mucous membrane of the soft palate, pharynx, tongue, nasopharynx of rounded red spots, which transform into vesicles, which are rapidly inflated and ulcerated. Similar changes can occur in the larynx and trachea, and then painful coughing, hoarseness of the voice, pain, swallowing, swallowing in the throat, dysphagia, and croup phenomena are possible in children. Bucopharyngeal ulcers may be the starting point of the distribution of opportunistic microbiota along the lymphatic pathways into neighboring tissues and organs and cause their inflammation with the appearance of peritonsillar abscesses, purulent inflammation of the okoloblocous spaces and other complications.

Among the atypical forms of smallpox, isolated cases of pharyngeal involvement have been described, which is manifested only by fever, angina, and diffuse catarrhal inflammation of the pharyngeal mucosa. Often such a form of the fall passes "under the flag" of banal angina or pharyngitis, which in epidemiological terms is a great danger.

Complications. Complications include bronchitis, pneumonia, abscesses of the skin and bucopharyngeal space, phlegmon, otitis, orchitis, encephalitis, meningitis, myocarditis, septic endomyocarditis, acute psychosis. The defeat of the cornea or the mucous membrane of the eyes leads to partial or complete blindness.

The diagnosis is based on symptoms characteristic of smallpox, the clinical picture and the results of virological research. The main method of investigation is electron microscopy. To detect the pathogen, examine the contents of vesicles, pustules, scrapings of papules, crusts, rinses from the mouth, blood. A valuable diagnostic method, starting from the 5th-6th day of the disease, is the determination of the titer of antihemagglutinins by the hemagglutination inhibition reaction.

Treatment of angina with a smallpox is carried out in a specially equipped hospital for especially dangerous infections. Great importance is attached to caring for the patient, local therapy for eye, middle ear, oral cavity, pharynx and larynx. At the expressed toxic syndrome appoint agents detoksikatsionnoj therapies (introduction vodno-electrolytic and protein solutions). It is necessary to use antibiotics of a wide spectrum of action for prevention and treatment of purulent complications. Food should be easily digestible, rich in vitamins.

Forecast. Smallpox in vaccinated people occurs favorably with mild disease without complications and scarring. In severe forms, the outcome is usually lethal, especially in infants and the elderly.

Prevention. It is considered that the smallpox on our planet has been eliminated, but this state should not be considered final or sustainable, not requiring permanent preventive measures. These activities are carried out by special sanitary and anti-epidemic services throughout the country. The main one is the implementation of planned anti-inoculation vaccinations.

If a smallpox is suspected, the patient is referred to an infectious inpatient facility where he is under special treatment. Persons who come in contact with a smallpox patient or with his things are isolated for observation for 14 days. Along with vaccination, emergency preventive measures should be taken: intramuscular injection of donor anti-aspirated y-globulin (0.5-1 ml per 1 kg of body weight) and administration of per os of the antiviral drug metisazone (adults - 0.6 g 2 times a day , children - 10 mg per 1 kg of body weight) for 4-6 days.

Each case of suspected smallpox should immediately be reported to the Sanitary and Epidemiological Supervision Authority and the district health department. The focus is on current and final disinfection.

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