Published: 10/22/2021 15:15:00 Updated: 10/25/2021
Sore throat is a disease of an infectious nature, manifested by acute inflammation of the lymphoid tissue of the pharynx. Most often the process affects the palatine tonsils, but other structures of the lymphadenoid pharyngeal ring can also be affected - the lingual and pharyngeal tonsils, lateral ridges or granules of the posterior pharyngeal wall.
The pathology in question is characterized by symptoms of intoxication, increased general temperature, sore throat that worsens during swallowing, enlarged and painful cervical lymph nodes. The palatine tonsils and arches are swollen, enlarged, bright red, and may have a white or dirty yellow coating.
Treatment of sore throat includes local treatment with antiseptics, painkillers and anti-inflammatory drugs, antibiotic therapy and detoxification measures. If complications develop or the process becomes chronic, surgical intervention may be required.
Causes of sore throat
Most often, inflammation is caused by the activity of beta-hemolytic streptococcus group A. Among the possible causative agents of the disease are also adenovirus, staphylococci, pneumococci, parainfluenza virus, mycoplasma, chlamydia, rhinovirus, respiratory syncytial virus, spirochete, Epstein-Barr virus, diphtheria bacillus, enterovirus Coxsackie B, fungi.
The risk of developing a sore throat increases when exposed to the following factors:
- general or local hypothermia;
- weakened immunity due to acute respiratory infections;
- fungal diseases;
- chronic pathologies of the nasopharynx, difficulty in nasal breathing, purulent processes and inflammation in the paranasal sinuses;
- caries;
- systematic exposure to irritating substances on the body, work in a smoky or dusty room;
- increased air dryness;
- regular drinking of alcohol, smoking;
- acute and chronic intoxication;
- poor nutrition, lack of vitamins in the diet.
Features of the disease
The peripharyngeal ring is a collection of lymphoid tissue, which is an important peripheral organ of the body's immune system. Pathogenic microorganisms that enter the body with food and water are retained in the oral or nasal cavity precisely by the tonsils of the peripharyngeal ring. As a result of the struggle between the body and the infectious agent, a local reaction of the tonsils occurs, which is expressed in increased production of lymphocytes and can lead to tissue inflammation.
Inflammation of the tonsils can also be caused by an internal infection of the body, namely diseases of the oral cavity or ENT organs: caries, sinusitis, rhinitis, otitis media, etc. When the body's immune defense is weakened due to illness or hypothermia, opportunistic microflora found in the growth or nasal cavity can provoke acute inflammation of the tonsils. Factors that provoke pathology are bad habits (smoking and alcohol abuse), diseases of the gastrointestinal tract, working in hazardous working conditions, and unhealthy diet.
The risk group for the disease includes pregnant women, the elderly and children, as well as people with chronic damage to the immune system.
Types and symptoms of sore throat
Depending on the cause, angina may be primary if the site of inflammation is initially localized in the tonsils.
A secondary or symptomatic type of pathology is considered a manifestation of another disease - infectious mononucleosis, diphtheria, scarlet fever, tularemia, typhoid fever, leukemia, alimentary-toxic aleukia, agranulocytosis. Inflammatory damage to the palatine tonsils is called tonsillitis, and to the nasopharyngeal tonsils - adenoiditis. There is also tonsillitis of the lingual tonsil, lateral ridges of the pharynx and laryngeal tonsillitis.
Based on the depth and nature of inflammation of the lymphoid tissue, the following forms of the disease are distinguished:
- catarrhal;
- lacunar;
- follicular;
- ulcerative-membranous;
- necrotic;
- combined.
Characteristic manifestations of any form of angina are general symptoms of intoxication, including increased body temperature, weakness, decreased appetite, headache, as well as enlarged and painful regional lymph nodes.
The incubation period depends on the type of pathogen and the state of immunity, ranging from several hours to a week or more. Other signs of angina, such as sore throat and external changes in the tonsils, may have varying severity depending on the form of the disease.
Catarrhal
The inflammatory process primarily involves the mucous membrane of the tonsils.
The disease begins acutely. The temperature during catarrhal tonsillitis rises within 37.1-38.0 °C, symptoms of intoxication and sore throat during swallowing are moderate. Characterized by enlargement of the lymph nodes located in front of the sternocleidomastoid muscle at the level of the angle of the lower jaw. The palatine tonsils are moderately swollen, their mucosa, as well as the surface of the palatine arches and the soft palate, are brightly hyperemic. The duration of the disease is 2-3 days, after which recovery occurs or a transition to a more severe form occurs.
Viral sore throat occurs with symptoms of ARVI - runny nose, cough. When infected with Coxsackie enterovirus, blistering rashes are observed on the mucous membrane of the palate and tonsils.
Lacunar and follicular
The clinical course of both lacunar and purulent tonsillitis is severe.
Characterized by fever from 38.0 to 40.0 °C, severe intoxication syndrome: headache, general weakness, aches in joints and muscles, pain in the projection of the heart, chills, sleep and appetite disturbances. The pain in the throat during swallowing is sharp, often radiating to the ear. Severe inflammatory changes lead to dysphonia - the voice takes on a nasal tone. Swelling of the tonsils may be accompanied by difficulty breathing and temporary hearing loss. When a child has a sore throat, there may be increased salivation, drowsiness, vomiting, convulsions, and abnormal bowel movements. In the first 2-4 days, the symptoms increase rapidly, and then disappear just as quickly. In the lacunar form of the disease, in addition to swelling and pronounced redness of the mucous membrane, white, irregularly shaped overlays with a yellowish tint appear on the tonsils, which can be easily removed with tweezers. In the case of follicular tonsillitis, suppuration of the follicles occurs; individual pinpoint yellowish formations of regular shape, no larger than a pinhead, appear through the epithelium. The tongue is dry, covered with a white coating. On the 4-5th day, the surface of the lacuna begins to clear, and the purulent blisters gradually disappear.
Necrotic
The most severe form of the disease. A pronounced intoxication syndrome is characterized by persistent fever, impaired consciousness, and repeated vomiting that does not bring relief. Dirty yellow spots with a greenish tint, ulcers and ulcers appear on the surface of the tonsils.
Ulcerative-membranous
Simanovsky-Plaut-Vincent angina is caused by a spirochete and a spindle-shaped rod that constantly live in the oral cavity.
With exhaustion, a pronounced decrease in immunity or hypovitaminosis, opportunistic microorganisms can become active, causing inflammation. The difference between ulcerative membranous tonsillitis and other forms is the one-sidedness of the process. An ulcer with a gray-yellow coating on the surface appears on the tonsil mucosa. Characterized by a putrid odor from the mouth, moderate sore throat and enlarged regional lymph nodes on the same side as the inflammation. Symptoms of intoxication may be absent or mild. The duration of the disease is from 7 to 12 days. After cleansing of plaque, the ulcerative defect heals without scar formation. Extensive ulcerations can lead to bleeding, damage to the periosteum, and perforation of the palate.
Complications of sore throat
During the disease, the infection can spread to neighboring organs, causing otitis media, lymphadenitis, sinusitis, and peritonsillitis. Among the local purulent complications of tonsillitis, one can note the formation of an abscess or phlegmon in the inflamed tissues. Their occurrence is accompanied by a new wave of fever, increasing sore throat, problems with swallowing and breathing. In the case where the pathology is caused by streptococcus, 3-4 weeks after clinical recovery, glomerulonephritis, reactive arthritis or rheumatic carditis may develop due to subsequent autoimmune processes.
Classification of the disease
Inflammatory pathology of the tonsils varies:
- by type of pathogen, can be bacterial, viral or fungal in nature;
- by the nature of the course - acute or chronic;
- according to the clinical picture - catarrhal, follicular or lacunar.
Sore throat can be primary (simple), which occurs when a bacterial infection penetrates, secondary, which occurs against the background of other diseases of the body, and also specific, caused by the action of a specific agent.
Diagnosis of sore throat
At the patient’s initial visit, the doctor collects complaints and anamnesis, specifying the duration and circumstances of the onset of symptoms, and the nature of the pain.
This is followed by a general examination of the patient, a visual assessment of the mucous membranes of the mouth and throat, and palpation of regional lymph nodes. An endoscopic examination of the ENT organs – pharyngoscopy – is mandatory. It allows you to examine the tonsils in detail and thus determine the form of the disease. For angina, the following tests are prescribed:
- Clinical blood test. Inflammation is indicated by neutrophilic leukocytosis with a shift to the left and accelerated ESR.
- General urine analysis. It is possible that protein may appear in the biomaterial.
- Rapid test from the tonsils using diagnostic strips to detect group A beta-hemolytic streptococcus.
- Bacteriological examination of a smear for beta-hemolytic streptococcus and diphtheria. Material is collected from the surface of the palatine tonsils and the posterior wall of the oropharynx before using local antiseptic drugs and taking antibiotics.
- If a patient is suspected of having infectious mononucleosis, a blood test is performed to test for IgM antibodies or to identify the genetic material of the Epstein-Barr virus.
- As part of the diagnosis of herpetic sore throat, enterovirus RNA is determined in the blood and throat smear using the PCR method.
Diagnosis of complications of angina after clinical recovery includes the following laboratory and instrumental studies:
- Control general analysis of blood and urine.
- Rheumatic test. Determination of rheumatoid factor, C-reactive protein, antistreptolysin-O, seromucoid in the blood.
- ECG. The electrocardiogram may show signs of hypoxia and conduction disturbances.
Treatment of sore throat
Depending on the severity of the patient’s condition, treatment of angina occurs under the supervision of a doctor at home or in a hospital.
Bed rest is mandatory, a gentle dairy-vegetable diet enriched with vitamins, and plenty of warm drinks are recommended. For bacterial sore throat, broad-spectrum antibiotics are prescribed. If the disease is caused by streptococcus, penicillin drugs are used. In case of severe intoxication syndrome, intravenous infusion of glucose-saline solutions is performed. Non-steroidal anti-inflammatory drugs are used as antipyretics and pain relievers.
For sore throat, gargling with alkaline and water-salt solutions and irrigating the pharynx with painkillers and antiseptics are recommended. The use of drugs in the form of a spray for the treatment of sore throat is possible only in adults and children over 3 years of age. With the development of purulent complications of the disease, hospitalization of the patient followed by surgical intervention is required.
Author:
Pugonina Tatyana Alekseevna, Therapist
Literature
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- Clinical recommendations Acute tonsillopharyngitis // National Medical Association of Otorhinolaryngologists / 2016. - P. 36.
- S. A. Artyushkin, N. V. Eremina Acute and chronic tonsillitis, pharyngitis: terminology, etiology, diagnosis, treatment // Otorhinolaryngology Pulmonology No. 10 (98) / 2014 - P. 66-70.
- A.V. Gurov, M.A. Yushkina Local therapy of inflammatory diseases of the pharynx // Breast cancer. 2022. No. 11. - pp. 792–796.
- Clinical recommendations “Differential diagnosis and treatment of acute tonsillpharyngitis.” // National Medical Association of Otorhinolaryngologists / Moscow - 2014. - P. 22.
- E.I. Krasnova. Differential diagnosis and therapeutic tactics for acute tonsillitis (tonsillitis) at the present stage // E. I. Krasnova, N. I. Khokhlova, V. P. Provorova, A. N. Evstropov // Attending physician No. 11, 2022. - C 58-63.
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