Follicular quinsy – the acute infectious disease of usually bacterial nature which is shown defeat of the follicular device of almonds (is more often than palatal), increase in regionarny lymph nodes and symptoms of the general intoxication (a hyperthermia, a fever, a headache, muscle pains, weakness). Diagnostics includes survey of a throat (faringoskopiya), a research of function of internals and the musculoskeletal device for an exception of complications from heart, kidneys and joints, carrying out laboratory analyses. Principles of treatment: influence on an infecting agent (antibiotics, antiviral means), anti-inflammatory therapy, rinsings of a throat, physical therapy.
Follicular quinsy – the sharp inflammatory process with localization in the lymphoid device of a throat developing at penetration into fabric of almonds of pathogenic microorganisms bacterial is more rare – the virus nature with defeat, first of all, than parenchyma follicles. Most often the inflammation mentions palatal almonds. Approximately in 75-85% of cases the beta and hemolytic streptococcus of group A is the reason of development of a disease. The clinical picture is caused by the general intoxication and defeat of a pharyngeal lymphoid ring. At the untimely beginning of etiotropny treatment development of complications is very probable: paratonsillitis, myocarditis, nephrite, polyarthritis.
Reasons of follicular quinsy
The major etiologichesky factor leading to developing of quinsies is bacterial, is more rare – a viral and fungal infection.
- Streptococci. At children of school age and adults the major etiotropny factors of developing of follicular quinsy are group A streptococci (more rare – the C and G groups). The majority of late complications is also connected with these activators.
- Other bacterial agents. Stafilokokki (staphylococcal quinsy quite often is complicated by development of paratonzillyarny abscess), a hemophilic stick, a moraksella, a pneumococcus, neysseriya, a spindle-shaped stick and a spirokheta (cause Simanovsky-Vincent's quinsy).
- Viruses. Adenovirus (is more often at children up to five years), viruses of simple herpes, Koksaki, Epstein-Barre, a cytomegalovirus. At secondary quinsies of an infectious origin – viruses of scarlet fever, measles.
- Other microorganisms. Mycoplasmas, hlamidiya, mushrooms. Rather rare causal factor (no more than 1-2% of cases).
Infection usually occurs during contact with the patient with quinsy or the asymptomatic carrier. The infectious agent gets into an organism through the top airways, is more rare – at meal and contact with objects on which there are pathogenic microorganisms. The disease arises only at decrease in resistance of an organism owing to influence of adverse external factors (overcooling, wet weather, harmful emissions in the atmosphere), defective food, excess reception of excessively cooled products and drinks, existence of associated diseases (chronic pharyngitises, rinosinusita, streptococcal impetigo etc.), hereditary predisposition.
At decrease in protective properties of an organism and massive penetration of microorganisms – potential causative agents of follicular quinsy pathological inflammatory process of the infectious and allergic nature in lymphoid formations of a pharyngeal ring develops. The greatest pathogenic activity is noted at hemolytic streptococci which are steady against phagocytes of immune system of the person, produce the mass of the ekzotoksin affecting a cardiac muscle and tissue of kidneys that leads to development of complications in 2-4 weeks after infection.
Quinsy – uniform pathological process which consistently takes place several stages including follicular, but can stop at one of stages at the timely beginning of adequate therapy. At the same time follicular quinsy is characterized by primary defeat of a parenchyma of lymphoid fabric and its follicles with development of leykotsitarny infiltration, sometimes – up to a necrosis.
Symptoms of follicular quinsy
The sharp onset of the illness is characteristic, in the first days the general symptomatology is most expressed: the body temperature increased to 38-40 °C, fever, perspiration, all body pains, a bad dream and appetite, weakness. Soon the sore throat which becomes more intensive when swallowing saliva and food begins to disturb the patient, quite often irradiates in an ear. Morbidity of regionarny lymph nodes increases (uglochelyustny, cervical). Examining a throat, it is possible to notice the increased in volume, hyperemic almonds with the follicles translucent through epitelialny fabric filled with purulent contents.
At children at the age of 5-10 years follicular quinsy proceeds especially hard – with the expressed intoxication, defeat of brain covers (severe pains in the head, nausea and vomiting, convulsive attacks, an unconscious state). There can be dispepsichesky manifestations (pains in epigastralny area and on the intestines course, a meteorizm, a liquid chair). The refusal of the child of meal, irritability, a capriciousness, violation of quality of a dream, decrease in volume of the emitted urine is quite often observed. At the same time pain in a throat when swallowing can appear only in 2-3 days after an onset of the illness. Duration of a course of quinsy makes from 1 to 3 weeks.
At the untimely address to the doctor and inadequate etiotropny treatment complications quite often develop. On 1-2 week there can be paratonsillitis and zaglotochny abscess, at the same time temperature becomes febrilny, the sore throat amplifies, opening of a mouth and swallowing is at a loss even more, there are difficulties at meal. Rendering emergency aid is necessary, opening of abscess can be required.
In 2-4 weeks after the beginning of a disease the late complications connected with infectious and allergic damage of internals and joints can develop. Among them – the damage of a cardiac muscle (myocarditis of various etiology, including revmokardit) which is shown repeated temperature increase, pains in heart, violation of a rhythm, short wind. Quite often at rheumatism large joints (rheumatic polyarthritis) with the advent of pains, feeling of constraint, difficulties at the movement are involved in process. One more late complication of follicular quinsy – the damage of kidneys (glomerulonefrit) which is characterized by restriction of daily volume of urine, emergence of hypostases, increase in arterial pressure, symptoms of a renal failure.
At repeatedly repeating quinsies there is chronic tonsillitis which is shown the erased course of disease with a long subfebrilny temperature, unpleasant feelings in a throat, the general decrease in working capacity. At an exacerbation of a disease the classical clinical picture of quinsy of a bacterial etiology is observed.
The analysis of anamnestichesky data, performing careful clinical examination of the patient by the otolaryngologist, if necessary with involvement of other experts (the infectiologist, the cardiologist, the nephrologist, the rheumatologist), and also purpose of laboratory researches helps to establish the correct diagnosis. At a faringoskopiya the typical picture characteristic of follicular quinsy is noted: the increased in volume and hyperemic almonds, existence of the multiple follicles translucent through an epithelium filled with white-yellow contents. At a palpation of regionarny lymph nodes their hypertrophy, morbidity is noted.
For assessment of activity of inflammatory process clinical blood test is made: increase in quantity of leukocytes at the expense of neutrophils, increase in SOE is defined at a bacterial etiology of follicular quinsy and a small leykopeniya at viral tonsillitis. For identification of a concrete infecting agent bacteriological and virologic researches of dabs from a mucous throat and almonds are conducted, serological techniques are used. Differential diagnostics is performed with other diseases of an ear, throat and nose, an infectious mononukleoz, scarlet fever and measles, herpes, blood diseases, new growths.
Treatment of follicular quinsy
Main objectives of treatment of follicular quinsy – elimination of inflammatory process in almonds and surrounding fabrics, influence on the causative agent of a disease, the prevention of early and late complications.
- Mode, diet. In the first days the bed rest is necessary, then – house with the maximum restriction of physical activities. Plentiful reception of liquid (tea, a fruit drink etc.), prevalence in a diet of digestible products is recommended.
- Etiotropny treatment. At bacterial (generally streptococcal) the nature of quinsy antibacterial therapy with application of antibiotics of a penicillinic row (penicillin, and also amoxicillin, including together with klavunalovy acid), macroleads (erythromycin, ), tsefalosporin, karbapenem is used. Identification of a fungal etiology provides cancellation of antibiotics of a broad spectrum of activity and purpose of antifungal medicines – a flukonazol, an itrakonazol and other means. At herpetic tonsillitis application of an acyclovir, tiloron is shown.
- Symptomatic means. For elimination of the infectious and allergic process which is often accompanying local and system displays of follicular quinsy according to indications antihistamines and nonsteroid anti-inflammatory medicines are appointed. The all-strengthening treatment with use of vitamins, immunomodulators is shown. Development of complications from cardiovascular system and kidneys demands purpose of specialized treatment.
- Local therapy. Rinsing of a throat by antiseptics (solutions of Furacilin and peroxide of hydrogen, broths of officinal herbs), application of physiotherapeutic procedures in the period of a convalescence is widely applied.
Forecast and prevention
At early detection of follicular quinsy and fully carried out therapy recovery occurs within 10-15 days. The forecast worsens at development of complications (rheumatic myocarditis, an endocarditis, a glomerulonefrit). Actions for the prevention of infections which are transferred in the airborne way, elimination of adverse meteorological factors, strengthening of an organism by the tempering procedures, exercises, observance of the correct work-rest schedule are necessary for prevention of quinsies.