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Acute inflammation of the tonsils and pharyngeal mucosa. the term "acute tonsillitis" narrows the concept of "tonsillitis" and we do not recommend it. IN AND. Voyachek emphasized that it is necessary to pay particular attention to the defeat of the entire pharynx with angina. According to clinical data and pharyngoscopic picture, sore throats are divided into catarrhal, follicular, lacunar, ulcerative-membranous and necrotic. Differential diagnosis of tonsillitis is extremely difficult and requires a very careful and thorough approach from the doctor, especially since a military doctor has to meet with a military doctor from the very youngest level. Angina takes the third place among all diseases by the number of days of disability (after influenza and acute respiratory infections), with 75% of patients under 30 years old, which makes the angina problem especially relevant for military medicine. More than twenty diseases occur with symptoms of tonsillitis, in tab. 3.5.1 the main ones are indicated in the form of an incomplete classification.

Table 3.5.1

Classification of tonsillitis by etiological basis

Angina is a common non-specific infectious and allergic disease, mainly of streptococcal etiology, in which local inflammatory changes are most pronounced in the lymphadenoid tissue of the pharynx, most often in the tonsils and regional lymph nodes. It manifests itself clinically in the form of catarrhal, follicular and lacunar tonsillitis (Fig. 3.5). For the practice of a military doctor, the differential diagnosis of acute tonsillitis is extremely important, both from the point of view of rational treatment of the patient and the conduct of epidemiological measures. It must be emphasized that a number of common infectious diseases and blood diseases occur with a syndrome of damage to the lymphoid apparatus of the pharynx under the guise of a sore throat, or acute pharyngitis. It is advisable to systematize all these diseases in the form of a short list of them with an indication of the main symptoms.

1. Nonspecific tonsillitis - catarrhal, when only the mucous membrane of the tonsils is affected, follicular - purulent lesion of the follicles, lacunar - pus accumulates in the gaps. It is usually caused by group A streptococcus (from 30 to 70% according to various authors). However, there is pneumococcal tonsillitis, staphylococcal tonsillitis and tonsillitis in the etiology of which lies a mixed coccal flora. A variety of this sore throat is an alimentary tonsillitis caused by epidemic streptococcus and manifested in the form of epidemic outbreaks in connection with the infection of food that has not been subjected to heat treatment (cold snacks, milk, ice cream, jelly, etc.). The microbe is usually introduced in case of violation of the cooking technology by unscrupulous workers. There are epidemic outbreaks of tonsillitis, especially in newly forming groups in the presence of a small immune layer (having had tonsillitis), including military units after being equipped with conscripts, which must be taken into account in their practice.

2.Angina caused by adenoviruses. It proceeds in the form of spilled acute pharyngitis, although it can be accompanied by raids on the tonsils. Adenoviral infection is characterized by widespread lymph node damage and a very frequent combination with conjunctivitis. This is especially characteristic of type 3 adenovirus, which causes the so-called pharyngoconjunctival fever. A similar picture of spilled nasopharyngitis gives the influenza virus, but you must remember that the flu in 10-12% of cases can be combined with streptococcal angina.

3. Acute inflammation of the tonsils of a different location.

• Angina of the lingual tonsil, described in detail by Academician N.P. Simanovsky. It has characteristic symptoms - pain in the deep sections of the pharynx, sharply aggravated by an attempt to protrude the tongue. The diagnosis is facilitated if you resort to indirect laryngoscopy with the help of a laryngeal mirror.

• Angina of the nasopharyngeal tonsil. The pains are localized in the nasopharynx, a thick mucous discharge is secreted from the nose, an acute runny nose is noted, with posterior rhinoscopy, a swollen tonsil of cyanotic color is visible, sometimes with plaques, thick mucus flows down the back of the throat.

• Angina of the lateral ridges (acute lateral pharyngitis) or sore throat of granules of the pharynx (acute granulosa pharyngitis) are also described in detail by N.P. Simanovsky. Diagnosis is not difficult with a thorough examination of the pharynx. All these diseases occur, as a rule, against the background of high fever and general intoxication.

• Laryngeal tonsillitis (V.I. Voyacheka) - inflammation of the lymphoid tissue of the pharynx. See its description in the section "Larynx diseases".

4. Inflammation of the cellular spaces of the neck in the pharynx:

• phlegmonous tonsillitis or paratonsillar abscess

• parapharyngeal abscess

• retropharyngeal abscess

• phlegmon of the bottom of the oral cavity (Ludwig's sore throat).

A description of these groups of diseases will be given in detail below.

5. Angina as a syndrome of common infectious diseases.

a) angina with scarlet fever can occur under various clinical masks. Most often, this is a catarrhal sore throat (erythematous) and lacunar (gruel). In the classical course of scarlet fever, a characteristic redness of the soft palate around the pharynx is noted, which does not extend beyond the soft palate, swelling of the cervical lymph glands and a whitish thick coating on the tongue with its subsequent cleansing when the tongue takes on a bright color (raspberry tongue). However, at present, with the early and often uncontrolled use of antibiotics and sulfalenamides, it is practically impossible to distinguish these forms of scarlet fever from streptococcal sore throat only on the basis of the picture of the pharynx, it is necessary to take into account all the symptoms of the disease, and especially the scarlet rash in the region of the mastoid process and flexion surfaces of the limbs.
However, there are severe forms of scarlet fever, proceeding in the form of:

• false membranous tonsillitis with the formation of tonsils, pharynx, nasopharynx, and even cheeks of fibrinous exudate spread on the mucosa in the form of a thick film densely soldered to the underlying tissue of a grayish color, at the same time, there is a bright hyperemia of the circumference of the pharynx. The rash appears on the first day of the disease; the prognosis of this form of scarlet fever is unfavorable.

• ulcerative necrotic tonsillitis is characterized by the appearance of grayish spots on the mucosa, quickly turning into ulcers. Deep ulceration may occur with the formation of persistent soft palate defects. Lateral cervical lymph nodes are affected by extensive inflammation.

• gangrenous tonsillitis is rare. The process begins with tonsils with the appearance of a dirty gray plaque with subsequent deep destruction of tissues up to the carotid arteries.

b) tonsillitis with diphtheria can occur in various clinical forms. As with scarlet fever, very often signs of pharyngeal damage are not enough for differential diagnosis. This is due to the fact that with diphtheria go beyond the arches. For tonsillitis, the strict border of the spread of raids within the tonsils is pathognomonic. If plaques extend beyond the arches, the doctor must doubt the diagnosis of nonspecific tonsillitis. In the case when, even with diphtheria, plaques are located within the surface of the tonsils, conditions arise for diagnostic errors and in this case it is impossible to focus only on the pharyngoscopic picture, you need to consider the whole group of symptoms inherent in a particular disease. Bacteriological research cannot be absolutized as well, since with typical diphtheria Leffler’s bacillus may not be present in the crop, and, conversely, it is very often sown with typical angina. There is another fairly simple, but informative diagnostic test. Plaque is removed from the tonsil with a spatula and dissolved in a glass of cold water. If the water becomes cloudy, and the plaque dissolves - this is a sore throat. If the water remains transparent, and plaque particles have surfaced - this is diphtheria. Among the various forms of diphtheria, the most difficult is the differential diagnosis of the following three forms of the disease, the differential diagnostic signs of which are summarized in tables 3.5.2, 3.5.3, 3.5.4.

c) sore throat with measles occurs under the catarrhal mask in the prodromal period and during the rash. In the second case, the diagnosis of measles is not difficult, in the prodromal period it is necessary to monitor the appearance of measles enanthema in the form of red spots on the mucosa of the hard palate, as well as Filatov-Koplik spots on the inner surface of the cheeks at the opening of the stenon duct.

d) angina with the flu also proceeds as a catarrhal, but it is more correct to speak of acute pharyngitis, since diffuse hyperemia seizes the tonsils, arches, tongue, and posterior pharyngeal wall.

d) erysipelas is a serious disease, often occurring along with erysipelas of the face. It begins with high fever and severe pain when swallowing. The mucous membrane is painted in bright red color with sharp outlined boundaries of redness, it seems lacquered due to edema, it is very dangerous if this edema extends to the larynx due to the threat of stenosis.

e) angina with tularemia begins acutely with chills, general weakness, facial flushing, enlarged spleen. For differential diagnosis, it is important to find out contact with rodents (water rats, house mice and gray voles) or blood-sucking insects (mosquitoes, horseflies, ticks). Angina with tularemia, however, in most cases occurs when infected by an alimentary route - with the use of water, food after contamination by rodents after an incubation period of 6-8 days. Another differential diagnostic sign is the formation of buboes - packages of neck lymph nodes, sometimes reaching the size of a chicken egg. Lymph nodes may suppurate. The picture of the pharynx can resemble a catarrhal or more often filmy angina, mistakenly diagnosed as diphtheria.

6. Angina with blood diseases.

a) monocytic tonsillitis (infectious mononucleosis, or Filatov’s disease) can clinically proceed in a variety of ways: from catarrhal to ulcerative necrotic. The etiology of this disease has not been fully clarified, the most common point of view is caused by an unknown filtering virus. Clinically correct diagnosis helps an increase in the liver and spleen (hepatolienal syndrome), the presence of lymph nodes compressed and painful to the touch: cervical, occipital, submandibular, often axillary and inguinal, and even polylymphadenitis. A pathognomonic symptom is the appearance in the peripheral blood of atypical mononuclear cells.

b) agranulocytic tonsillitis is associated with the complete or almost complete disappearance of granulocytes in the peripheral blood with the preservation of monocytes and lymphocytes against the background of sharp leukopenia. The etiology of the disease is not clarified, it is considered polyethiological.

Table 3.5.2

Table 3.5.3

Table 3.5.4

Treatment of nonspecific tonsillitis local and general. Local in the form of rinses with antiseptic or alkaline solutions, general - the appointment of antibiotics, desensitizing agents, aspirin, given its immunoprotective properties. With diphtheria or even suspicion of it, the introduction of antidiphtheria serum is necessary.
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  1. Differential diagnosis of angina Comparative signs of various forms of angina

  2. Angina
    Angina is a common acute infectious disease in which local acute inflammation affects the lymphadenoid tissue of various tonsils of the pharynx. In the vast majority of cases, tonsillitis is tonsillitis, other tonsils are involved in the inflammatory process much less frequently. Therefore, in medical practice it is customary to mean the tonsillitis under the term “tonsillitis"
  3. Angina
    Training target: using diagnostic algorithms, be able to diagnose angina and its complications (paratonsillitis, paratonsillar abscess), determine the clinical form of the disease and prescribe adequate treatment; be able to conduct dispensary observation. Assignment for independent study of the topic. Using the textbook, guidelines and lecture material for the acquisition
  4. Sore throats
    The clinical picture of Sore throat is infectious - diseases with the most pronounced local inflammatory process in the area of ​​lymphoid tissue of the pharynx. Palatine tonsils are more often affected. Overcooling and other unfavorable factors leading to weakening of the body contribute to the disease. With catarrhal sore throat, the patient has malaise, fever, chills, headache
  5. Complications of tonsillitis
    C onclusion of General and Complicated ana ng. The most severe and formidable are common complications, since they cause persistent damage to vital organs and systems of the body. Among them in the first place (in frequency, but not in severity) rheumatism with its attacks and lesions of the heart and joints, often no less serious complications of tonsillitis in the kidneys,
  6. Angina
    Since tonsillitis is an acute inflammation of the tonsils, see the article ALMOND
  7. Angina (acute tonsillitis)
    Angina - a common acute infectious and allergic inflammation of the tonsils, often palatine, other tonsils are involved in the inflammatory process much less often. Forms of tonsillitis differ in etiology, mechanisms of disease development and clinical course. Among the various microbial pathogens of tonsillitis, which include cocci, rods, viruses, spirochetes, mushrooms, Klebsiella, in the first place
  8. Classification of angina. Treatment principles
    Classification of angina I. According to B.S. Preobrazhensky. It is based on pharyngoscopic signs, supplemented by data obtained in a laboratory study, sometimes with information of an etiological or pathogenetic nature. The following forms of angina are distinguished: catarrhal; follicular; III - lacuna; IV - fibrinous; V - herpetic; VI - phlegmonous
  9. Laryngeal tonsillitis
    Laryngeal tonsillitis (angina laryngis) is an acute inflammation of the lymphadenoid tissue of the larynx (in the area of ​​the scooped palatine folds, the intercarpal space, in the morgan ventricles, in the pear-shaped sinuses and individual follicles). As an independent disease, it is rare, it can occur as a result of hypothermia, after the flu, with TjfeBMe larynx by a foreign body, etc. K l
  10. differential diagnosis of angina
    Differential diagnosis of angina should be carried out with diseases that occur with tonsillitis syndrome: a) localized forms of diphtheria (islet and membranous) - differ from angina by the gradual onset of the disease, specific manifestations of general intoxication in the form of pale skin, moderate adynamia and lethargy ( chills, body aches, muscle and joint pains, characteristic
  11. Angina with leukemia
    Various forms of leukemia are characterized by a progressive systemic disease of the hematopoietic tissue, in which foci of pathological hematopoiesis are formed in various organs, which eject immature leukocytes into the peripheral blood. The disease is considered as neoplasia of the hematopoietic tissue, in which damage to the tissues of the pharynx can occur. With acute leukemia, tonsillitis is one of
  12. Prevention of tonsillitis and chronic tonsillitis
    Prevention of chronic tonsillitis is largely a prophylaxis of tonsillitis and is carried out in two aspects - individual and social. Individual prevention consists in strengthening the body, increasing its resistance to infectious influences and adverse environmental conditions, especially to cold. Very often, angina develops after local or
  13. Sore throats. Etiology, symptoms, prevention, care for sick children
    Angina is an acute infectious disease with a primary lesion of the tonsils. Etiology. The causative agents of infection are staphylococci, streptococci, stable in the external environment. Predisposing factors: local and general hypothermia; decreased immunity. Possible routes of transmission: airborne; contact. There are forms of angina: catarrhal, follicular,
  14. Laryngeal tonsillitis. Etiopathogenesis, clinic, treatment
    Laryngeal tonsillitis is an acute inflammation of the lymphadenoid tissue of the larynx (in the area of ​​scooped-epiglottis folds, the intercarpal space, in the pear-shaped sinuses and individual follicles). Etiopathogenesis. The disease can occur as a result of hypothermia, after the flu, with a trauma to the larynx by a foreign body, etc. Clinic. The patient is worried about pain when swallowing, pain when
  15. differential diagnosis of pharyngeal diphtheria (infectious mononucleosis, tonsillitis)
    For angina, the following differences are characteristic: acute onset (with chills, aches in the body and joints) of the disease, intoxication (severe general weakness, headache, agitation), as well as the purulent nature of tonsillitis. 2. For infectious mononucleosis, the following differences are characteristic: polyadenitis, hepatolienal syndrome, membranous with crumbling, and not a dense coating on tonsils tonsils,
  16. Acute tonsillitis (tonsillitis). U-03.
    {foto6} Treatment outcome: Clinical criteria for improving the patient's condition: 1. Normalization of temperature. 2. Normalization of laboratory parameters. 3. Improving the clinical symptoms of the disease (pain, difficulty swallowing, purulent discharge from
  17. Scarlet fever
    Scarlet fever is an infectious disease characterized by a small point rash. Scarlet fever begins acutely, with fever and sore throat. After about a day, a rash appears, and the whole body of the patient turns bright red. See the articles Fever, Sore Throat, SKIN (PROBLEMS) and SKIN RED, with the addition that a person feels intense anger caused by some kind of unexpected
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