Quinsy at pregnancy
Quinsy at pregnancy — an acute infectious inflammation palatal, lingual almonds, limfoadenoidny fabrics on a back wall of a throat and in a throat, arisen in the gestational period. It is shown by a hyperthermia, the expressed intoksikatsionny syndrome, a sore throat, increase and morbidity of submaxillary, is more rare than cervical lymph nodes. The bakposeva of dab from a rotoglotka is diagnosed by means of a faringoskopiya. Apply tsefalosporina, macroleads, β-laktamny penicillin, NPVS, antiseptic solutions to treatment. At heavy it is purulent - destructive process possibly opening of abscesses and carrying out an abstsesstonzillektomiya.
Quinsy at pregnancy
Quinsy (sharp tonsillitis) — the infectious disease of the top airways, the third on prevalence (after flu and a SARS) diagnosed at pregnancy. As the activator strikes fabrics not only almonds, but also a throat, recently for the description of a disease began to use the term sharp tonzillofaringit. As at 82% of patients the β-hemolytic streptococcus of group A is allocated, earlier quinsy called only streptococcal sharp tonsillitis. Now the understanding of an etiology of a disease is expanded. Quinsy is more often observed at pregnant women aged up to 30-35 years in the second half of a gestation. Heavier current of an inflammation is noted in the 3rd trimester of pregnancy. The peak of incidence of bacterial forms of sharp tonsillitis is the share of early spring, virus — for the autumn and winter period.
Quinsy reasons at pregnancy
Sharp tonsillitis at pregnant women belongs to category of antroponozny infections with mainly airborne mechanism of transfer. Develops as a result of infection of lymphoid formations of a pharyngeal ring with pathogenic and opportunistic microflora. Bystry emergence of inflammatory process and deeper destruction of fabrics is promoted by natural decrease in immunity at a gestation which prevents rejection of genetically alien fruit. Causative agents of quinsy during pregnancy are the same infectious agents, as out of the gestational period:
- Bacteria. More than sharp tonsillitis at pregnancy is caused in 80% of patients by a β-hemolytic streptococcus of group A. Streptococci of other groups, staphylococcus, pneumococci, meningokokk, gonokokk, klebsiyella, bryushnotifozny and hemophilic sticks, anaerobe bacterias, Vincent's spirokheta in association with a spindle-shaped stick become more rare causative agents of a disease.
- Viruses. In recent years prevalence of quinsies of a virus origin increases. The inflammation of almonds at pregnant women can be a complication of an adenoviral, enteroviral, herpetic SARS. A part of patients to low immunity against the background of primary virus defeat of lymphoid fabric has a secondary colonization of an epithelium bacterial flora.
In sporadic cases quinsy arises owing to infection with hlamidiya and mycoplasmas. At a part of women from separated almonds associations of cocci from kandida are sown. Overcooling, insufficient food, stay of pregnant women in the dusty and polluted rooms with a large number of employees or visitors, existence of caries and chronic diseases of gums become the contributing factors to a disease of sharp tonsillitis.
Infection source usually are the bacillicarriers sick with a sharp tonzillofaringit, sometimes — rekonvalestsenta. The causative agent of a disease is more often transferred in the airborne way, is more rare — contact and household through the polluted ware or alimentary with water and food. The starting moment of development of quinsy at pregnancy is hit of a microorganism on an epithelium of a rotoglotochny lymphoid ring. Thanks to existence of the M-protein suppressing local immunity, the lipoteykhoyevy acid having affinity to an epithelium of almonds, and other factors of pathogenicity, infectious agents are fixed to mucous and begin to breed actively, allocating ekzo-and endotoxins.
In response to the damaging action of bacteria, viruses, mushrooms there is a local inflammatory reaction: due to increase in permeability of capillaries lymphoid fabric swells and infiltrirutsya by neutrophils. In the subsequent under the influence of proteases of macrophages lymphoid follicles melt, pus is formed. In hard cases of destruction not only the epitelialny layer, but also Strom of almonds is exposed. Rejection of nekrotizirovanny sites is followed by formation of the bleeding defects which epitelizirutsya subsequently. As a result of spread of an infection on lymphatic ways regionarny lymph nodes are surprised, and hit of microorganisms from the septic center in a system blood-groove promotes their distribution on an organism, development of the general intoxication and polyorgan reaction.
Systematization of clinical forms of quinsy at a gestation is based on features of a current and the nature of morphological changes in lymphoid fabric. In general classification displays staging of development of infectious and inflammatory process though partially considers also an etiologichesky factor. Experts in the sphere of otorhinolaryngology, obstetrics and gynecology distinguish the following options of the sharp tonsillitis diagnosed at pregnancy:
- Catarrhal quinsy. Rather infrequent option of a tonzillyarny inflammation with mainly local symptoms, moderate intoxication, lack of pus. At sufficient reactivity and timely therapy the disease can not pass into purulent forms. Frequent has a virus origin.
- Purulent quinsy. Depending on prevalence of an inflammation happens follicular to dot gnoynichka, lacunary to the centers of raids, fibrinozny to involvement in an inflammation of all almond and transition to adjacent fabrics. Usually at pregnancy one of purulent forms of sharp tonsillitis comes to light.
Rather seldom at a stage of a gestation arise flegmonozny quinsy with purulent fusion of a part of an almond and ulcer and necrotic Simanovskogo-Plauta-Vensana. Taking into account specificity of a clinical picture as separate option of a disease allocate sharp tonzillofaringit a herpetic origin at which on mucous almonds and a rotoglotka bubbles with reddish contents are formed.
Quinsy symptoms at pregnancy
Usually the disease develops sharply on an extent from several hours to 2 days from the moment of infection. At the initial stages of a tonzillofaringit the body temperature of the pregnant woman increases to 38-40 °C, there are a fever, head, muscular and articulate pain, an ache in a waist, at a heavy current — deterioration in appetite, nausea, vomiting, an abdominal cavity pain. The woman feels the expressed weakness, weakness. Against the background of intoxication there is a sore throat which amplifies during the swallowing, a conversation, can irradiate in an ear. Further submaxillary lymph nodes are condensed, increase to 1-2 cm in the diameter, become painful. From a mouth the unpleasant smell is felt, the voice sounds hoarsely.
In the sharp period, as well as out of a gestation, quinsy at the pregnant woman can be complicated by sharp laryngitis, sharp cervical lymphadenitis, average otitis, paratonsillitis, formation of okologlotochny abscess. At contact distribution of the activator emergence of a mediastinit, meningitis is possible. The massive dissemination of microorganisms against the background of the reduced immunity leads to development of sepsis and infectious and toxic shock. 2-4 weeks later after streptococcal quinsy at the woman symptoms of a sharp glomerulonefrit, the sharp rheumatic fever, a revmokardit caused by autoimmune reaction of an organism can be shown.
Specific complications of early terms of pregnancy are strengthening of toxicosis, at the expressed intoxication and a hyperthermia — a spontaneous abortion. In 2-3 trimesters violation of a placentary blood-groove and a hypoxia of a fruit, an otsloyka of a placenta, premature birth are possible. A number of the infectious agents causing quinsy are capable to get through a fetoplatsentarny barrier, causing pre-natal infection of the child. Considerable defeat of fabrics of a fruit can result in anomalies of development, pregnancy dying down, increase in indicators of perinatal mortality. At the patients who had sharp tonsillitis weakness of patrimonial activity is more often observed.
In most cases diagnosis of quinsy at pregnancy does not present special difficulties. Infectious defeat of almonds is usually demonstrated by their hyperaemia, puffiness, identification of white follicles with a diameter of 2-3 mm, yellow-white separated. At a necrotic form the deep defects of lymphoid fabric the sizes to 2 cm with a hilly bottom formed after rejection of dark gray nekrotizirovanny sites are observed. Emergence on a mucous membrane of a rotoglotka of reddish bubbles is characteristic of seldom diagnosed herpangina. The recommended methods of inspection are:
- Faringoskopiya. The inspection performed otorinolaringoly with use of special tools allows to define more precisely a state mucous a pharynx. During the research character and prevalence of pathological changes of lymphoid fabric are estimated.
- Crops of dab from a throat on microflora. Definition of the activator facilitates differential diagnosis of quinsy with other infectious processes. During the microbiological research sensitivity of a microorganism to antibacterial medicines is established.
- Blood test. Indicators of the general blood test correspond to signs of sharp infectious process. Usually are defined increase in quantity of leukocytes, mainly at the expense of neutrophils, shift of a leykotsitarny formula to the left, moderate increase in SOE. As additional methods of identification of the infectious agent in difficult clinical cases RIF, IFA, PTsR-diagnostics are recommended.
Quinsy at a gestation is differentiated with flu, a SARS, diphtheria, scarlet fever, defeat of lymphoid educations, a mucous throat and lymph nodes at an infectious mononukleoz, listeriosis, syphilis, tuberculosis, a tulyaremiya, a typhoid, neoplaziya, hematologic diseases. According to indications the pregnant woman, except the obstetrician-gynecologist and the LOR-specialist, is advised by the infectiologist, the venereologist, the phthisiatrician, the hematologist, the oncologist, .
Treatment of quinsy at pregnancy
At a catarrhal, follicular, lacunary, fibrinozny inflammation and lack of obstetric complications out-patient maintaining the patient is recommended. Hospitalization is shown at the heavy flegmonozny or atypical course of sharp tonsillitis, an ulcer and necrotic form of a disease, signs of pre-natal defeat of a fruit, threat of termination of pregnancy. In the period of a hyperthermia and the first days of a convalescence are shown to the woman a bed rest, the use of a large amount of warm liquid (water, rather weak tea, broth of a dogrose, fresh berries and dried fruits compotes).
Basis of drug treatment of bacterial quinsy is the etiotropny system antibiotic treatment taking into account sensitivity of the activator and possible influence of medicine on a fruit added with symptomatic means. To pregnant women with sharp tonsillitis the following groups of medicines can be appointed:
- Antibacterial means. The majority of the antibiotics recommended for treatment of quinsy at pregnancy are forbidden because of their fetotoksichnost. In the period of a gestation and feeding the breast allows use of some tsefalosporin, natural and semi-synthetic macroleads, β-laktamny penicillin of a broad spectrum of activity. At viral quinsies antibiotics are not applied.
- Febrifugal medicines. Are appointed restrictedly at temperature increase to 39 °C and more. Choice medicines at pregnancy are antipiretik from group of anilid which application is admissible on all terms. In 1-2 trimesters use of derivatives of feniluksusny and propionic acids is possible. Except decrease in temperature, NPVS render moderate analgesic effect.
- Disinfecting solutions. For sanitation of a pharynx regular rinsings of a throat are recommended by nitrofuranovy, phenolic, cationic antiseptics of local action. A part of pharmaceutical antiseptic medicines are effective not only concerning bacteria, but also viruses, mushrooms. Broths of officinal herbs (an eucalyptus, a camomile, a sage) can become an alternative to pharmacological solutions.
For reduction of a sore throat steam and hardware inhalations are shown to pregnant women. Implementation of special LOR-procedures — processings of a back wall of a throat and almonds medicines, physiotherapeutic treatment on the device Tonzillor is possible. At purulent fusion of lymphoid fabric and an abstsedirovaniya opening of paratonzillyarny abscess, an abstsesstonzillektomiya is carried out.
Forecast and prevention
Against the background of adequate antibiotic treatment the symptomatology of a disease is completely stopped within 7-10 days, catarrhal quinsy recovers in 3-5 days. More serious is the forecast of destructive forms of quinsy. Preventive actions at pregnancy are directed to restriction of contacts with possible carriers of the activator — restriction of time of stay in public places, especially during off-season, wearing a medical mask at contacts with people during SARS epidemics, visit of the stomatologist and otorhinolaryngologist for timely sanitation of the centers of an infection in oral cavities.
A nonspecific role in the prevention of a disease is played by immunity strengthening, decrease in level of physical activities and psychological stresses. For prevention of the late complications of quinsy capable to worsen the course of pregnancy, active medical observation within the first month after the postponed infection with purpose of the general blood tests and urine, carrying out the ECG on 1 and 3 weeks is recommended.