Lacunar angina in adults - what is it and why does it occur? This disease is a clinical form of acute tonsillitis, in most cases of bacterial etiology. Lacunar tonsillitis is the type of tonsillitis in which there is a lot of plaque on the tonsils, it accumulates in the mouths of the tonsils lacunae or covers them with a continuous film. Compared with catarrhal and follicular forms of angina, lacunar is the most difficult - the patient suffers from severe sore throat, fever and other unpleasant symptoms.
How to quickly improve the well-being of a patient with lacunar angina? How many days does it need to be treated in adults? We will answer these and other questions in this article.
Signs of a lacunar form of tonsillitis
Lacunar angina in adults can be moderate or severe. In almost every case, the patient develops a feverish state, symptoms of intoxication appear. Intoxication with angina is the poisoning of the body with the waste products of bacteria (or other infectious agents), as well as the products of degradation of spent leukocytes and dead cells of the mucous membrane. It is as a result of intoxication that the patient suffers from headache, nausea, etc.
Symptoms of inflammation of the tonsils are also pronounced - there is hyperemia, profuse plaque, soreness.
In general, the clinical picture of the lacunar form of tonsillitis includes symptoms such as:
- yellowish-white plaque in the lacunae (depressions) of the tonsils, or in the form of a continuous film;
- loose plaque, loosely adhering to the tonsils, can be easily removed with a spoon;
- the tissue of the tonsils under the plaque is reddened, edematous, but without areas of necrosis and damaged blood vessels;
- sore throat is acute, constant, aggravated by swallowing, opening the mouth, etc.;
- the lymph nodes of the neck are enlarged and painful when touched;
- body temperature increased to 38-39C from the first day of illness;
- headache worried;
- decreased appetite, often nausea.
The disease always develops acutely - the patient's body temperature rises sharply, swelling of the tonsils rapidly develops, and plaque accumulates in the throat during the day. This condition lasts from 3 to 5 days.
Why does the disease develop? Causes and pathogens
The causative agent of purulent forms of angina (lacunar and follicular) in most cases is streptococcus. Much less often, inflammation of the tonsils is caused by staphylococcus. In this case, angina may appear as a complication of ARVI.
Streptococcal sore throat develops as a result of infection. A healthy person can become infected with streptococcus during close conversation, shaking hands, sharing utensils, etc. with a sick person or carrier of the infection (who has no symptoms of the disease). The likelihood of streptococcal infection increases in certain conditions - with hypothermia,
during ARVI, with a decrease in immunity.
Despite the fact that streptococcal lacunar angina often develops with hypothermia, it is not caused by cold, but by a bacterial infection.
Staphylococcal angina, unlike streptococcal, can occur in the absence of contact with an infected person. The reason for this is the fact that staphylococcus is a representative of opportunistic microflora. This means that a small amount of staphylococcus is constantly present on the skin and mucous membranes of healthy people. In people with a normally functioning immune system, the activity of staphylococcus is constantly inhibited, and it cannot cause illness. If the immune system is weakened, staphylococcus begins to multiply uncontrollably. It can cause an infection of the tonsils (tonsillitis), as well as other diseases - inflammation of the ear (otitis media), pharynx (pharyngitis), etc.
The diagnosis of "staphylococcal angina" is made only on the basis of the results of laboratory tests. Outwardly, it is impossible to distinguish staphylococcal sore throat from streptococcal.
Treatment of streptococcal sore throat
Lacunar angina caused by streptococcal infection requires timely full treatment. This type of tonsillitis is dangerous not only during the acute period of the disease, but also after recovery - often it is purulent streptococcal tonsillitis that leads to the development of various complications.
Among the complications of lacunar sore throat, one can distinguish purulent (otitis media, paratonsillitis, pharyngitis, etc.), and non-purulent (rheumatic heart disease, joints, kidneys).
The provocateur of the development of rheumatism in most cases is the usual streptococcal tonsillitis not cured in time.
An integrated approach, which includes 3 main directions, plays an important role in the successful treatment of angina:
- First, it is necessary to destroy the infection - the cause of the disease. For this, antibacterial drugs of systemic action are used (antibiotics in the form of tablets).
- Secondly, to accelerate recovery, it is necessary to act directly on the site of infection. For this purpose, antiseptic agents are used in the form of throat sprays, rinsing solutions, etc.
- In addition, in the treatment of lacunar sore throat, symptomatic drugs are actively used - antipyretic and pain relievers, which can significantly improve the patient's well-being.
From the first day of illness and until the symptoms disappear, it is necessary to observe bed rest and refrain from contact with others.
Antibiotic therapy
Purulent lacunar angina caused by streptococcus is treated with antibiotics. Streptococcus is sensitive to most penicillin antibiotics. The drugs of the first choice are Amoxicillin, Amoxiclav, Ospen, Phenoxymethylpenicillin. The selected drug is taken three times a day, one hour before eating. The dosage is calculated individually, based on the age and weight of the patient. The duration of treatment should be 10 days.
In some cases, streptococcus is resistant to the selected antibiotic. How to understand that a drug does not work on an infection? Normally, an effective antibiotic helps to normalize the temperature and reduce sore throat as early as 2-3 days of treatment.
Improving the patient's well-being on the 2-3 day of treatment is not a reason to prematurely end the course of taking antibiotics.
Remember that the course is designed in such a way that the complete destruction of the infection is achieved with three times the use of a certain dose of the antibiotic for 10 days. You should not violate the prescribed course of treatment - this can lead to complications.
When streptococcus is resistant to penicillins, other antibiotics are prescribed - cephalosporins or macrolides. For example, the macrolide antibiotic azithromycin (sumamed) is highly effective. The indisputable advantage of azithromycin is that the duration of the course of treatment with this antibiotic is only 5 days.
Treatment of staphylococcal lacunar sore throat
Lacunar angina can be caused by both streptococcal and staphylococcal infections. If sore throat does not respond well to standard treatment (antibiotic + antiseptics and anti-inflammatory), you should suspect the presence of staphylococcal tonsil infection. To confirm the diagnosis, it is necessary to pass some tests, first of all, bacteriological culture of a smear from the pharynx, which allows detecting staphylococcal cells in the plaque on the tonsils.
Treatment of staphylococcal lacunar sore throat differs significantly from streptococcal.First, antibiotics that are effective against streptococcus may be useless in the fight against staphylococcus.
Staphylococcal lacunar sore throat should be treated not with antibiotics, but with special anti-staphylococcal drugs of biological origin.
Among anti-staphylococcal drugs, one can distinguish "Staphylococcal bacteriophage". This drug contains viruses that are active against bacteria only (they do not pose a threat to humans). "Staphylococcal bacteriophage" - a local drug. It is used to irrigate the tonsils.
"Anti-staphylococcal plasma" is another drug actively used to treat staphylococcal infections. "Anti-staphylococcal plasma" contains antibodies to staphylococcus. Once in the blood, antibodies activate the immune system, accelerating the detection and destruction of staphylococcal cells.
Antibiotics for staphylococcal tonsillitis are prescribed in exceptional cases when angina proceeds in a severe purulent-necrotic form.
When choosing an antibiotic, it must be borne in mind that staphylococcus is resistant to the influence of many antibacterial drugs. To select an effective antibiotic, it is recommended to determine the sensitivity of staphylococcus to various antibiotics using bacteriological culture.
Adjunctive therapy
Procedures that facilitate the patient's well-being are actively used in the treatment of both streptococcal and staphylococcal lacunar tonsillitis. Much attention is paid to rinsing the throat - this procedure cleans the tonsils from food debris, pus, bacterial mass, accelerating recovery. For rinsing, you can use:
- salt solution (a teaspoon of table salt per glass
warm water); - soda solution (a teaspoon in a glass of water);
- warm water with the addition of propolis or chlorphilipt tincture;
- infusions of medicinal herbs with antiseptic properties (chamomile, pine stands, calendula, eucalyptus, etc.).
warm water);You can gargle your throat 4-5 times a day. Be sure to gargle before going to bed, after waking up and after every meal. After rinsing, do not eat, drink or talk for 20 minutes.
Irrigation of the tonsils with throat sprays has an antiseptic and analgesic effect. Many throat lozenges also have a similar effect - Strepsils, Septolete, Faringosept. Some lozenges have an immunomodulatory effect, for example, Tonsillotren, Imudon.
Topical treatments complement, but cannot replace, systemic antibiotic treatment.
