Angina in adults

Angina was described as early as the XNUMXth-XNUMXth centuries BC. Hippocrates. But to this day, this disease is still relevant. Angina is an infectious and inflammatory disease with severe manifestations of intoxication. In severe cases, patients may develop complications that affect other organs.

Angina was described as early as the XNUMXth-XNUMXth centuries BC. Hippocrates. The name of the disease comes from the Latin “ango”, which translates as “compress, squeeze, choke.” To date, this name is used only in everyday life, and in the language of medicine it is acute tonsillitis.

Angina is an infectious and inflammatory disease with severe manifestations of intoxication. In severe cases, patients may develop complications that affect other organs.

What is angina

Angina is an infectious disease accompanied by inflammation of the elements of the pharynx, most often the palatine tonsils.¹. The causes of the disease can be different. Most often, acute tonsillitis is often caused by microorganisms – streptococcus or staphylococcus, as well as viruses or fungi.¹. In addition, angina is also called exacerbation of chronic tonsillitis.

All clinical symptoms of angina are associated with lesions of the tonsils.²:

• pain in the throat of varying intensity when swallowing;
• swelling of the palatine tonsils;
• inflammation of the submandibular lymph nodes;
• increased body temperature;
• signs of general intoxication of the body.

Angina always begins acutely. First, there is a sore throat, usually sharp and severe. Sometimes it is impossible for a sick person to swallow even saliva, or even open his mouth. The body temperature rises sharply to 39-40 ° C, swelling and pain appear in the region of the submandibular lymph nodes². Unlike respiratory viral infections, there is no runny nose with angina, but there are signs of general intoxication in the form of a headache, aches in the joints and throughout the body, severe chills are disturbing. In the future, the course of angina, as well as the degree of damage to the palatine tonsils, depend on its form.

Useful information about angina

Types of angina in adults

According to the modern classification, depending on the severity of the purulent-inflammatory process, angina can be:

• light form;
• moderate severity;
• severe, with complications.

According to their clinical form, angina are:

• primary – arise as independent, separate pathologies, usually of a bacterial nature (the second name of this form is banal or simple tonsillitis);
• secondary tonsillitis – occur against the background of infectious (scarlet fever, diphtheria) or systemic diseases (agranulocytosis, leukemia)¹.

By the nature of the inflammatory process in the tonsils, angina can be:

• Catarrhal – this is the easiest type of sore throat with the fastest recovery;
• Follicular – this type of angina is characterized by the appearance of purulent vesicles 3-4 mm in size on the surface of the tonsils;
• Lacunar – in this case, a whitish coating appears on the edematous and hyperemic tonsils, and purulent contents accumulate in the lacunae or depressions of the tonsils;
• Necrotic or ulcerative necrotic – is considered the most severe form of angina. With this disease, areas of dead tissue of a dirty gray color up to 20 mm in size appear on the tonsils.².

Catarrhal angina

For this form of angina, the presence of a low temperature is typical (subfebrile, within 37,2 – 37,6 ° C). When examining the pharynx, redness is determined along the back of the throat, redness and swelling in the soft and hard palate. Tonsils are red, edematous, without raids. This stage lasts about 2 days and can turn into more severe options or recovery occurs.

Follicular sore throat

With follicular tonsillitis, follicles on the surface of the tonsils are involved in the infectious and inflammatory process. At the same time, yellow, pus-filled vesicles can be seen on the surface of the tonsils.³. Follicular angina is one of the severe forms and usually occurs with severe symptoms of intoxication (chills, severe weakness, fever up to 40 ° C). Antibiotics are prescribed for the treatment of follicular angina.

Lacunar angina

This form of angina is characterized by severe intoxication, with severe headache, severe malaise and weakness, sore throat when swallowing, pain in the muscles and joints. It is often difficult for the patient to open his mouth and speak. The temperature reaches 39,0 – 39,5 ° C.

When examining the pharynx, a pronounced redness is visible along the back wall, swelling of the tonsils, their sharp reddening, the region of lacunae (depressions) is greatly expanded, filled with pus. The plaque spreads around the gaps, loose films of plaque form on the surface of the tonsils. Pus does not go beyond the boundaries of the tonsils, it can be easily removed with a spatula. The tissue under the raids does not bleed.

Necrotic angina

The disease develops gradually, while the symptoms of general intoxication are mild, and the temperature does not rise. There is a unilateral sore throat, bad breath appears³.

When examining the pharynx, a dense plaque is detected over the entire surface of the tonsils, which is gray or yellow-green in color, has uneven surfaces. When trying to remove plaque, the surface of the tonsils bleeds. It is possible to spread plaque and tissue necrosis to neighboring areas – the pharyngeal wall, palatine arches or uvula of the soft palate.

Purulent sore throat

Purulent tonsillitis in colloquial speech is usually called tonsillitis, which occurs with the accumulation of pus in the tonsils. These tonsillitis include follicular and lacunar tonsillitis. On examination, the tonsils are covered with yellow blisters, which, when pressed, exude pus. Purulent tonsillitis is always accompanied by fever up to 40 ° C, headache, severe weakness, and the patient may also complain of nausea and vomiting. In this case, the cervical lymph nodes are usually enlarged in size. For the treatment of purulent tonsillitis, local antiseptics and antibiotics are usually prescribed.

bacterial sore throat

Most often, bacterial (purulent) tonsillitis is provoked by streptococci, pneumococci, staphylococci. Less commonly, this is the influence of opportunistic flora of the oral cavity (usually against the background of reduced immunity, with exacerbation of chronic pathologies). It is possible to develop tonsillitis due to trauma to the tonsils, with the addition of a secondary microbial infection.

Inflammation affects the tonsils and the region of the arches, the back wall of the pharynx is not very inflamed. The affected tissues turn red sharply, swell, then after a day or two small purulent dots appear. Fabrics are covered with a white-yellow coating. Local manifestations are combined with muscle pain, aching joints, malaise, fever and headache.

Streptococcal angina

Streptococcal angina is a bacterial type of inflammation, but with a specific type of pathogen – beta-hemolytic streptococcus. The tonsils are affected, purulent raids are formed. Streptococcus is quite stable in the external environment, it usually causes angina against the background of a decrease in immune defense (hypothermia, stress, aggressive environmental factors, hypovitaminosis).

The main manifestations are a sharp pain in the throat, fever, swollen lymph nodes, an increase in the size of the tonsils, the appearance of purulent deposits on them, nausea, and general malaise. The disease is dangerous for its complications. Possible development of glomerulonephritis, damage to the heart valves, inflammatory diseases of the joints.

Viral angina

Unlike bacterial, viral sore throats are usually a manifestation of systemic infections. Inflammation of the tonsils is caused by viruses – adenovirus, enterovirus. There is a sore throat, which increases when swallowing, an increase in the size of the tonsils, their redness, low temperature and signs of infection from other organs and tissues (rash, runny nose, digestive disorders).

The diagnosis is made on the basis of examination, there are usually no raids on the tonsils, catarrhal tonsillitis. Treatment of this form is symptomatic, antibiotics are ineffective in this form of the disease.

herpes sore throat

Herpes sore throat is not quite the right term. It is more correct to call it herpetic sore throat, and its causative agent is not the herpes virus at all. It develops when the tonsils are affected by the Coxsackie virus, which belongs to the family of enteroviruses. The virus can enter the human body in the following ways:

• Contact, that is, during contact with another person carrying the virus. For example, kissing can transmit viruses through saliva;
• Airborne, when the virus enters the air during coughing and sneezing;
• Fecal-oral. In this case, infection occurs when using personal hygiene items of the infected person, as well as when personal hygiene rules are not followed (unwashed hands).

The most characteristic symptoms of herpetic sore throat are:

• Increased body temperature, headache, weakness;
• Rashes on the mucous membrane of the larynx in the form of vesicles, similar to herpes;
• Sore throat, especially when swallowing;
• Muscle pain.

Causes of angina in adults

Angina is most often provoked by an infection. The most common causative agent of angina is beta-hemolytic streptococcus, in second place is staphylococcus aureus. However, with the viral origin of tonsillitis, various viruses can be the causative agents of angina.¹:

• herpes virus;
• Epstein-Barr virus;
• Adenovirus;
• Enterovirus Coxsackie.

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Treatment of angina in adults

If inflammation of the tonsils is detected, treatment should not be delayed, especially if it is a bacterial lesion. Angina is insidious with its complications. In particular, streptococcus can provoke rheumatic lesions, in which an autoimmune reaction of the body is triggered, the heart, joints or kidneys are attacked.

Diagnostics

With severe sore throat, fever and general malaise, the appearance of raids in the throat, you need to call a doctor at home or contact a general practitioner, an ENT doctor for examination and analysis. The doctor makes a preliminary diagnosis on the basis of pharyngoscopy, examination of the pharynx and tonsils with the help of instruments.

To confirm the diagnosis and determine the nature of the pathogen, a number of tests are shown:

• a swab from the pharynx and tonsils for sowing, identifying the pathogen and determining sensitivity to antibiotics;
• general blood test (it evaluates the level of leukocytes, changes in ESR);
• general urinalysis (to exclude glomerulonephritis);
• biochemical blood test with the determination of the level of C-reactive protein, antistreptolysin-O and other indicators;
• ECG to exclude possible complications from the heart.

Modern treatments

Therapy is selected individually, depending on the type of angina (bacterial, viral or fungal) and the age and severity of the patient’s condition. All three approaches are used in therapy:

• impact on the cause (antibiotics, antiviral drugs);
• pathogenetic treatment (suppression of inflammation, fight against intoxication);
• symptomatic drugs (pain relief, elimination of malaise, antipyretics).

Antibiotics for angina

For the treatment of purulent tonsillitis of bacterial origin, as a rule, antibiotic therapy is prescribed. The most appropriate is the appointment of penicillin antibiotics (amoxicillin or amoxicillin in combination with clavulanic acid). Less common are cephalosporins and macrolides.

Antibacterial drugs are prescribed immediately after the diagnosis is established, without waiting for the results of a smear and culture, based on the suspected pathogen. If after 2-3 days treatment is ineffective, antibiotics are changed based on the sensitivity of the pathogen to them.

Rinsing with angina

In addition to antibiotics for angina, local antibacterial therapy is indicated in the form of gargling, irrigation of the tonsils with antiseptic solutions (Miramistin), injection of sprays and aerosols (Geksoral, Stopangin, Maxikold, etc.).

At high temperature, intoxication and a pronounced inflammatory process, symptomatic therapy is prescribed in the form of antipyretic and anti-inflammatory drugs, such as paracetamol, Nurofen, etc.

To strengthen the immune system, vitamin therapy is prescribed, in combination with the correct daily regimen and healthy food.

Surgical treatment or tonsillectomy is advisable with an increase in the size of the tonsils that interfere with breathing, frequent recurrences of tonsillitis, ineffective drug therapy, and the spread of a purulent process to neighboring tissues.

With inadequate, untimely treatment of angina, the transition of angina to a chronic course is possible, as well as the development of severe complications with damage to other organs and systems, for example, the development of rheumatoid arthritis, pyelonephritis, myocarditis, etc.

Prevention of angina in adults at home

Prevention of tonsillitis is to strengthen the immune system through hardening, maintaining a healthy lifestyle. Recommended physical activity, regular walks in the fresh air, a healthy diet containing the required amount of vitamins and minerals. It is important to observe oral hygiene, timely eliminate foci of infection in the oral cavity and nasopharynx, such as caries, sinusitis, otitis media.

Popular questions and answers

We discussed the most popular questions regarding the causes of angina, its treatment and possible complications with our expert general practitioner Mikhail Lystsov.

Sources of:

1. “Modern ideas about tonsillopharyngitis”. Kosyakov S.Ya., Angotoeva I.B., Muldasheva A.A. https://cyberleninka.ru/article/n/sovremennye-predstavleniya-o-tonzillofaringite/viewer
2. “Acute and chronic tonsillitis, pharyngitis: terminology, etiology, diagnosis, treatment”. S.A. Artyushkin, N.V. Eremin. https://therapyedu.su/wp-content/uploads/2018/10/Tonzilit.pdf
3. “Angina: diagnosis and treatment”: Kunelskaya N.L., Turovsky A.B., Kudryavtseva Yu.S. https://www.rmj.ru/articles/otorinolaringologiya/Anginy_diagnostika_i_lechenie/