Quinsy - infectious and allergic process at which local changes affect a pharyngeal lymphoid ring, most often palatal almonds. The course of quinsy is characterized by temperature increase of a body, an obshcheintoksikatsionny syndrome, a sore throat when swallowing, increase and morbidity of cervical lymph nodes. At survey hyperaemia and a hypertrophy of almonds and palatal handles, sometimes – a purulent raid comes to light. Quinsy is diagnosed by the otolaryngologist on the basis of data of a faringoskopiya and bacteriological crops from a pharynx. At quinsy local treatment (rinsing of a throat, washing of lacunas, processing of almonds medicines), antibiotic treatment, physical therapy is shown.
Quinsy – group of acute infectious diseases which are followed by an inflammation of one or several almonds of a pharyngeal ring. As a rule, palatal almonds are surprised. Less often the inflammation develops in nasopharyngeal, guttural or lingual almonds. Infecting agents get into fabric of almonds from the outside (exogenous infection) or from within (endogenous infection). From the person quinsy is transmitted to the person in the airborne or alimentary (food) way. At endogenous infection microbes get to almonds from carious teeth, additional bosoms (at sinusitis) or a nasal cavity. When easing immunity quinsy can be caused by bacteria and viruses which constantly are present on mucous a mouth and a throat.
Classification of quinsies
In otolaryngology allocate three types of quinsy:
- Primary quinsy (other names – banal, simple or usual quinsy). Acute inflammatory disease of the bacterial nature. Symptoms of the general infection and symptoms of defeat of lymphoid fabric of a pharyngeal ring are characteristic.
- Secondary quinsy (symptomatic quinsy). Is one of displays of other disease. Some sharp infectious diseases (infectious , diphtheria, scarlet fever), diseases of system of blood can be followed by defeat of almonds (a leukosis, an alimentary and toxic aleykiya, ).
- Specific quinsy. The disease is caused by the specific infectious agent (fungi, a spirokhet etc.).
About 85% of all primary quinsies are caused by ß - a hemolytic streptococcus of group A. In other cases the pneumococcus, golden staphylococcus or the mixed flora acts as the activator. Primary quinsy on prevalence is in the second place after a SARS. Develops in the spring and in the fall more often. Strikes mainly children and adults aged up to 35 years. It is usually transferred in the airborne way. Sometimes develops as a result of endogenous infection. The probability of developing of quinsy increases at the general and local overcooling, decrease in immunity, hypovitaminoses, violations of nasal breath, the increased dryness of air, after postponed by a SARS.
The general symptoms of quinsy are caused by penetration into blood of waste products of microbes. Microbic toxins can become the reason of toxic defeat of cardiovascular and nervous system, provoke development of a glomerulonefrit and rheumatism. The risk of emergence of complications increases at a frequent recurrence of streptococcal quinsy.
Depending on depth and the nature of defeat of lymphoid fabric of a pharyngeal ring allocate catarrhal, lacunary, follicular and necrotic primary quinsy, depending on severity – easy, moderate severity and a severe form of quinsy.
Duration of the incubatory period fluctuates from 12 hours to 3 days. The sharp beginning with a hyperthermia, oznoba, pains when swallowing is characteristic, increase in regionarny lymph nodes.
At catarrhal quinsy it is observed subfebrilitt, moderate general intoxication, softly expressed inflammation signs on blood tests. At a faringoskopiya the poured bright hyperaemia of a back wall of a throat, a hard and soft palate comes to light. Catarrhal quinsy proceeds within 1-2 days. Recovery or transition to other form of quinsy (follicular or catarrhal) can be an outcome.
More expressed intoxication is characteristic of follicular and lacunary quinsy. Patients show complaints to a headache, the general weakness, joint, muscles pains and areas of heart. The hyperthermia to 39-40C is noted. In the general blood test decides on shift to the left. SOE increases to 40-50 mm/h.
At faringoskopichesky survey of the patient with lacunary quinsy the expressed hyperaemia, expansion of lacunas comes to light, swelled also infiltration of almonds. The purulent raid extends out of limits of lacunas and forms a friable raid on an almond surface. The raid has an appearance of a film or the separate small centers, does not extend out of almond limits, easily is removed. During removal of a raid fabric of an almond does not bleed.
At follicular quinsy on a faringoskopiya the hypertrophy and the expressed hypostasis of almonds, a so-called picture of "star sky" (the multiple white-yellow suppurated follicles) comes to light. At spontaneous opening the follicle is formed a purulent raid which does not extend out of almond limits.
The expressed intoxication is characteristic of necrotic quinsy. Persistent fever, confusion of consciousness, repeated vomiting is observed. On blood tests comes to light expressed with sharp shift to the left, , significant increase in SOE. At a faringoskopiya the dense gray or chartreuse raid with the uneven, dim, pitted surface is visible. During removal of a raid fabric of an almond bleeds. After rejection of sites of a necrosis there are defects of fabric of irregular shape with a diameter of 1-2 cm. Distribution of a necrosis out of almond limits on a back wall of a throat, a uvula and handles is possible.
Early complications of quinsy (otitis, lymphadenitis of regionarny lymph nodes, sinusitis, paratonzillyarny abscess, peritonzillit) arise during a disease at distribution of an inflammation on close located bodies and fabrics.
The diagnosis is based on symptoms of a disease and data of a faringoskopiya. For confirmation of the nature of the infectious agent the bacteriological research of slime from almonds and serological blood test is carried out.
Treatment, as a rule, out-patient. At a severe form of quinsy hospitalization is shown. To patients appoint the sparing diet, plentiful drink, antibacterial medicines (tsefalosporina, macroleads, sulfanylamides). The course of treatment makes 5-7 days. Locally apply , , , rinsings by broths of herbs and solutions of anti-septic tanks, irrigation of almonds hlorgeksidiny, norsulfazoly, streptocide.
Kandidozny (fungal) quinsy.
Is caused by drozhzhepodobny mushrooms of the sort Candida albicans. In recent years growth of number of cases of kandidozny quinsy caused by broad application of glucocorticoids and antibiotics is observed. Fungal quinsy, as a rule, develops against the background of other disease after long courses of antibiotic treatment.
The general symptomatology is not expressed or expressed poorly. At a faringoskopichesky research the pointed white or yellowish imposings on almonds sometimes extending to a mucous membrane of cheeks and language come to light. The raid easily is removed.
The diagnosis is confirmed by results of a mycologic research. Treatment consists in the cancellation of antibiotics, purpose of anti-fungal medicines all-strengthening therapies, washing of almonds solutions of nystatin and a levorin.
Quinsy of Simanovskogo-Plauta-Vensana (ulcer and filmy quinsy).
Develops at chronic intoxications, exhaustion, hypovitaminoses, immunodeficiencies. Is caused by representatives of saprofitny flora of an oral cavity – being in symbiosis spirokhety Vincent and Plauta-Vincent's stick.
The general symptomatology is not expressed or expressed poorly. Usually one almond is surprised. On its surface the superficial ulcers covered with a gray-green raid with a putrefactive smell are formed. During removal of a raid the almond bleeds. After rejection of the nekrotizirovanny site the deep ulcer which in the subsequent heals without formation of defect is formed.
The diagnosis of ulcer and filmy quinsy is confirmed by results of a bacteriological research. The all-strengthening therapy is carried out. Affected areas grease with solution of boric acid or methylene blue, appoint rinsings weak solution of permanganate of potassium and peroxide of hydrogen. At deep necroses and a long current antibiotic treatment is shown.