Typhoid laryngitis: causes, symptoms, diagnosis, treatment

It is known that S. Typhi, discovered by Ebert Perth, and named in his honor by Eberthella typhi, has a large penetrance to lymphoid tissue, affecting mainly the lymphatic system of the abdominal cavity and in particular the group lymphatic follicles of the small intestine and solitary follicles. In a number of cases, this bacterium reaches the lymphoid apparatus of the upper respiratory tract, including the larynx, by the hematogenous pathway. In previous years, according to observations of Lusher (Liischer), the incidence of typhoid fever reached 10% of the total number of cases of this infectious disease. In the last 2-3 years, cases of typhoid fever are registered again in Russia, which does not exclude the appearance of typhoid fever.

Pathological anatomy. Usually typhoid laryngitis occurs during the first week of the disease with typhoid fever and is manifested by catarrhal inflammation, sometimes by superficial ulcers located symmetrically along the edges of the vocal folds, and starting from the 2nd week - by small rounded sores on the sites of lymphoid follicles. These necrotic changes in lymphoid tissue are localized mainly on the mucosa of the anterior larynx and the posterior surface of the cricoid cartilage. In patients who are weakened by a common infectious process, bedsores can appear between the plate of the arytenoid cartilage and the vertebral bodies. Similar bedsores and ulcers appear inside the larynx, which serve as a gateway for secondary infection with the occurrence of such complications as abscess, perichondritis and secondary cicatricial stenosis of the larynx, if the patient manages to be rescued.

Symptoms and clinical course of typhoid fever. During the period of catarrhal inflammation, the main symptoms are hoarseness and pain in the larynx during phonation. When there are ulcers and phenomena of perichondritis, dysphagia, otodonia, respiratory failure, stridor and paroxysmal cough appear. With laryngoscopy, edema and hyperemia of the mucous membrane, ulceration along the edges of the epiglottis and vocal folds, sometimes vitreous edema, false membranes in complicated forms are revealed. In the period of recovery and later, temporary phenomena of myogenic fungal growth can be observed.

Diagnosis of typhoid laryngitis is facilitated by the fact that it arises against the background of a common typhoid infection, which is typical of her picture, while the endoscopic picture and local subjective and objective symptoms do not contain a specific information for this disease. Primary forms of typhoid laryngitis are not known.

Treatment of typhoid laryngitis. Since typhoid fever is a secondary manifestation of typhoid fever, such patients, being on inpatient treatment in the infectious department and receiving the corresponding specific antibacterial treatment (levomycetin, ampicillin, biseptol, furazolidone, etc.), as well as the appropriate diet and regimen, need also to be observed and ENT specialist supervision. The task of the latter is to monitor the state of the larynx, the appointment of appropriate local treatment (inhalation solution ampicillin with hydrocortisone, alkaline-oil mixtures, proteolytic and mucolytic agents, etc.). When a respiratory obstruction appears, a preemptive tracheotomy is indicated.

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