And whether you know...
May 21, 2011
As a disease quinsy is known since antique medicine. The term comes from the Latin word angere – to squeeze to squeeze. Connect many pathological changes of a stomatopharynx with this disease. And though they differ on an etiology, they are integrated by the general symptoms, and they get under the term – quinsy.
Quinsy – the general infectious disease of which the acute inflammation of components of a lymphadenoid pharyngeal ring is characteristic. Most often such local display of a disease concerns palatine tonsils. On the standard classification of quinsy divide into three types: primary, secondary and specific. Carry usual, simple or banal quinsies which are the acute inflammatory diseases having signs of defeat only of a lymphadenoid ring of a throat to primary quinsies. Secondary it is symptomatic quinsies. Refer defeats of almonds at scarlet fever, diphtheria, an infectious mononucleosis and other acute infectious diseases to them. Defeats belong to secondary quinsies also at blood diseases – a leukosis, an agranulocytosis and others. Carry the diseases caused by specific infections to the third look – fungal quinsy, quinsy of Simanovskogo-Plauta-Vensana.
Primary quinsy one of the most frequent diseases of upper respiratory tracts. Most often the disease affects children and people of young age mainly till 35 flyings, can have character of seasonal epidemics. Epidemics are more often observed in the cities as a source of a disease is the infected person, big population density promotes distribution of a disease.
As virus by which primary quinsy in most cases is caused ß - a hemolitic streptococcus of group A acts. Also golden staphylococcus or a pneumococcus can be activators. But in 85% the illness arises at infection with streptococci. Carriers of these infections allocate in external environment quite large number of activators which are transferred airborne, as well as household, contact and alimentary ways. To group of streptococci of people it is most susceptible, especially at children's age.
Disease and diagnosis of quinsy
Primary center of an inflammation forms in an adenoid tissue of a stomatopharynx. Local and general overcooling, the dusty and gas-polluted atmosphere, the increased dryness of rooms, decrease in immunity, etc. can be the reasons contributing to a disease. In most cases quinsy develops after the postponed SARS which reduce protective functions of an epithelium in respiratory tracts, opening for that a way of an infection.
The first almonds because of a srodnenny adenoid tissue with a number of antigenic structures of a streptococcus are damaged. Toxins which are waste product of microbes come to blood, causing thereby damages to nervous and cardiovascular systems. Therefore quinsy is characterized not only local damage of fabrics of a stomatopharynx, and and deterioration in the general condition of the patient.
The incubation interval of a disease makes from 10-12 hours to 2-3 days., the acute onset of the illness, temperature increase, emergence of a fever and pain when swallowing is characteristic. All this together with increase in regional lymph nodes also makes the main symptoms of quinsy.
At suspicion on streptococcal quinsy, the exact diagnosis is established according to a clinical picture, a faringoskopiya and laboratory researches. For specification of the activator additional diagnosis of quinsy, namely bacteriological and serological laboratory researches of crops of slime from a stomatopharynx is carried out. All these data are necessary for definition of a class of a disease and purpose of effective treatment.
Classification of quinsies
Depending on extent of damage of quinsy divide into several types. Definition of a disease also depends, and from nature of defeats so allocate catarral, follicular, lacunary and purulent or necrotic quinsy. On the general manifestations allocate also easy, medium-weight and severe forms of an illness. The Faringoskopichesky picture and expressiveness of some symptoms depend on what classification of quinsy. In certain cases weight of a course of a disease also depends on a class.
Catarral quinsy is characterized by superficial defeat of almonds. At a faringoskopiya it is observed a bright diffuse hyperemia, puffiness of almonds. The patient has subfebrile temperature (37,0-37,5" C), minor changes of blood and poorly expressed symptoms of intoxication. Catarral quinsy of a disease proceeds 1-2 days then symptoms of quinsy disappear, or the illness passes into other form.
Lacunary quinsy is characterized by defeat of almonds in the field of lacunas. Faringoskopiya shows the expressed hyperemia, hypostasis of almonds and expansion of lacunas. On palatine tonsils the purulent plaque is found. It is formed of fibropurulent contents of lacunas, can be in the form of the small centers or a film. This yellow-white plaque easily is removed without leaving the bleeding marks and is localized only on almonds without extending out of their limits. In this form catarral quinsy passes more often than into others.
The angina follicularis has a pronounced picture of "star sky" — raying through an epithelial cover, nagnoivshikhsya follicles. Defeat of the follicular device of almonds is characteristic of this form. At inspection deep defeat of almonds is found, they are hypertrophied, edematous, covered nagnoivshimisya with follicles which have an appearance of whitish-yellow small educations.
If at the patient follicular and lacunary to quinsy, then intoxication is stronger expressed, body temperature increases till 39-40" C. Therefore the main symptoms of quinsy are supplemented with the general weakness, a headache, heartaches, muscles and joints. At laboratory researches in blood the leukocytosis, and in urine protein traces, erythrocytes comes to light.
Necrotic quinsy differs from other forms of a disease of heavier current and more expressed symptoms. At this form of a disease the faringoskopiya finds the affected areas covered leaving deep into a mucous membrane for a short while on almonds. It has the uneven pitted surface of chartreuse or gray color. Such sites become firm, and after their removal the surface bleeds. After rejection of such nekrotizirovany sites there are deep defects on fabrics of almonds. Often necroses extend to a uvula, a back wall of a throat further.
Symptoms of quinsy of a necrotic form worsen the general condition of the patient, it is persistent fever, often repeating vomiting, confusion of consciousness, high temperature. Laboratory blood tests find the expressed leukocytosis, a sharp deviation to the left, neyrofilez. This form of a disease is more often than others leads to complications.
Complications of quinsy can be early or late. In the first case it the diseases arising during an illness, they the inflammations caused by distribution on nearby bodies. Such complications are the peritonsillitis, sinusitis, otitis, paratonsillar abscess, etc. Late complications of quinsy are the diseases which arose in 3-4 weeks, they have an infectious and allergic origin - it is joint rheumatism, a rheumatic carditis, a post-streptococcal glomerulonephritis.
Treatment of quinsy of primary form
Treatment of quinsy is carried out on an outpatient basis at easy stages and at uncomplicated forms of a disease. In case of heavy disease of the patient surely hospitalize in infectious department. Medicamentous therapy, topical treatment, a sparing diet, plentiful drink is appointed. The main drugs used at treatment it is antibacterial drugs which are appointed a course to 5-7 days. Antibacterial therapy includes fenoksimetilpenitsilin or amoxicillin with clavulanic acid, cephalosporins, macroleads, for example, erythromycin, and streptocides can be also appointed.
Topical treatment of quinsy is carried out by rinsings using solutions of antiseptic agents, it can be Furacilin, and also broths of the medicinal herbs having the same properties – a camomile, a calendula, a St. John's Wort. Also apply an irrigation of almonds such drugs as Cametonum, Inhalyptum, Sebidinum. For topical administration use and fuzafunzhin, Ambazonum, Gramicidin and others. Rinsings are effective for removal of purulent plaques in which the angina follicularis differs.
Very important at treatment to observe prevention measures, isolation of the patient is obligatory in order that not to give an infection will extend between the people contacting to the patient. For the prevention of a disease the organism hardening, elimination of such irritants as dust, a smoke, excessive dryness of air is recommended. It is necessary to eliminate the centers of persistent infection, for example, caries, sinusitis in time.
As for the forecast of treatment that at catarral quinsies the forecast of treatment favorable in all cases. Especially quickly the disease passes at timely begun treatment. The favorable forecast and at treatment of follicular and lacunary quinsy. But after all they can lead to development of an adenoid disease. Heavy complications are caused by the postponed necrotic quinsy of any form of complexity. Most often such complications will melt rheumatism and a glomerulonephritis.
Secondary and specific quinsies
Secondary quinsies develop as an associated disease at other infectious defeats. As well as primary quinsies, this acute inflammation of a lymphatic pharyngeal ring, or its separate elements, most often almonds.
Quinsies arise at such diseases as measles, scarlet fever, diphtheria, an adenoviral and herpes infection, syphilis and others. To secondary also carry group of quinsies arising at an agranulocytosis and leukoses. Quinsy symptoms in a secondary form and its current almost does not differ from primary quinsies, but against other diseases have more expressed symptoms and the form of weight.
Specific quinsies are caused not by streptococci, but other activators. Depending on it the clinical picture and treatment of a disease changes. Such diseases result from decrease in protective functions of an organism, frequent use of antibiotics, exhaustion.
Fungal quinsy arises against other diseases, especially after prolonged treatment by antibacterial drugs at an adenoid disease. Causative agents of quinsy drozhzhepodobny mushrooms of the sort Candida albicans, in many cases join them pathological cocci. More often the disease is observed at children of early age.
Symptoms of quinsy of a fungal origin are a little expressed. The general condition of the patient practically does not suffer as very weak intoxication is observed. In rare instances there can be subfebrile temperature and a moderate headache, weakness is sometimes felt. Local symptoms are limited to an insignificant hyperemia of a pharynx and a moderate pharyngalgia. But pains can not be at all. Slightly lymph nodes increase, at a palpation they are almost painful. Presence of a white or ochroleucous plaque on almonds, a mucous membrane of cheeks and language is characteristic of this disease. The plaque extends in the form of points or islands, he easily acts.
Ulcer and filmy quinsy or quinsy of Simanovskogo-Plauta-Vensana also belongs to specific quinsies. Infestants are a spindle-shaped stick of Plauta-Vensan Vensan's spirochete. Most often patients with immunodeficiencies, gipovitaminoza, chronic intoxications which weakened and exhausted organism has no sufficient protective functions are surprised. Hemilesion of almonds is characteristic of this disease.
For the first days of an agnin of Simanovskogo-Plauta-Vensana proves what on the struck almond is formed tvorozhist or a filmy plaque, grayish-white or greenish and dirty color. After its removal there is a bleeding surface which becomes covered by a plaque again. In 4-5 days on the struck place there is the crateriform ulcer which healing, does not leave defects. Palatal handles and a soft palate can strike ulcers.
The main symptoms of quinsy are practically absent. There are no symptoms of intoxication, fever, except local manifestations, only increase in regional lymph nodes is observed. The laboratory blood analysis reveals only an insignificant neutrophylic leukocytosis.
Treatment of quinsy of a specific form
Fungal quinsy, first of all, demands cancellation of antibacterial drugs which were appointed earlier. Treat with nystatin, levorinum in combination with washing of almonds the same drugs. Fortifying therapy and vitamins of group B and C is appointed, K. Zabolevaniye differs in a long current, frequent recurrence therefore operational removal of almonds is recommended are possible.
Simanovskogo-Plauta-Vensana carry out treatment of quinsy locally. Rinsings of 0,1% solutions of Aethacridinum of a lactate and potassium of permanganate, sometimes weak solution of peroxide of hydrogen are appointed. Mucous, affected with ulcers, grease 2% with solution of methylene blue or 1% — boric acid. At a long current appoint antibacterial therapy, generally penicillin.