The tonsils are collections of lymphoid tissue that are found in the mouth. These protective gates of the body are the first to meet disease-causing pathogens, which makes them especially vulnerable when the body's resistance decreases.
With the development of the disease, a purulent inflammatory process develops in the tonsils, which is called purulent tonsillitis. Follicular and lacunar angina are forms of the same disease, differing in the localization of inflammation.
The structure of the tonsils
The tonsils are the central organ of immunity, part of the pharyngeal lymphadenoid ring. They are located in the mucous membrane between the mouth and the pharynx. The main function is filtration of microbes entering with air, water, food. It is here that the body "gets acquainted" with pathogens in order to develop immunity against them. The pharyngeal ring consists of 6 tonsils:
- 4 paired (palatal, tubal in the auditory tube),
- 2 unpaired (pharyngeal, lingual).
The surface of the glands is covered with clusters of lymph nodes called follicles. They recognize and destroy foreign agents that can potentially lead to disease. It is here that lymphocytes, monocytes, macrophages and plasma cells are produced.
A distinctive feature of the structure of the tonsils is a porous structure. Hollow depressions that germs can enter are called lacunae. They penetrate the palatine glands. The amount varies from 10 to 20 in an adult. Like follicles, they produce white blood cells.
Features of the clinical picture
The external differences between the various forms of angina are in the severity and manifestations. With follicular angina, inflammation occurs on the surface, in the follicles of the tonsils. If purulent inflammation affects the lacunae, as well as a significant part of the surface of the tonsils, this is lacunar tonsillitis. Determining the form of angina can be difficult, due to the fact that one form can pass into another, forming a mixed type. There are rare cases when the amygdala is affected by lacunar sore throat on one side, and follicular on the other.
The main difference between follicular and lacunar tonsillitis is the location of acute inflammation in the tonsils.
Entogenesis
The uniting factor of all forms of purulent sore throat are pathogens, and also the conditions of occurrence. Diseases most often develop after hypothermia in the cold season, when the body's immunity is significantly reduced, in contact with the patient or his belongings. Lack of sleep, constant stress, vitamin deficiency and a polluted environment significantly reduce the protective function of the body.
The main causative agents of purulent tonsillitis are various microbes of the pyogenic group, namely:
- streptococci (in most cases);
- staphylococci;
- pneumococci;
- adeno-, rhinoviruses,
- spirochetes;
- yeast-like fungus.
Diseases of the teeth and gums significantly increase the risk of disease, especially caries. The affected tissues become a source of pathogen development, which can then lead to purulent sore throat.
Symptoms
Purulent tonsillitis is characterized by the rapid development of the inflammatory process. The period from the incubation period (up to 2 days) to complete recovery is from one to two weeks. The clinical picture is fully manifested during the first day. In addition, patients with follicular and lacunar angina are observed:
- fever, severe chills, body temperature up to 40 degrees;
- intoxication, which is manifested by weakness, lack of appetite, insomnia, nausea, and sometimes vomiting;
- pain syndrome: severe sore throat radiating to the ear, aching joints, muscles;
- inflammation of the submandibular lymph nodes, pain on palpation;
- gray coating on the tongue;
- hyperemia of the oral mucosa.
With follicular angina, the surface of the tonsils is covered with white-yellow blotches in the form of tubercles. The edges of the abscesses are separated from each other, pronounced.
Festering follicles shine through the surface, are not separated from the surface of the tonsils with a spatula or cotton swab.
Another picture is observed with lacunar angina. Purulent inflammation occurs both in the follicles and in the deeper layers of the tonsils - lacunae. A large amount of pus accumulates at the surface of the tonsils in the form of large white spots of irregular shape. Sometimes plaque covers the entire surface of the tonsils. For an otolaryngologist, the main feature when making a diagnosis is the fact that membranous formations are easily separated from the surface. A smooth, even surface with no visible damage is observed under them.
With follicular sore throat in a weakened body, individual pronounced purulent formations can merge as they mature, increasing the affected area. So purulent inflammation passes into the lacunae of the tonsils, the follicular course of angina passes into the lacunar stage. This process significantly aggravates the course of the disease.
Clinical examination and treatment
Determination of purulent tonsillitis usually does not cause difficulties, most often a history of the disease is sufficient. To clarify the form of the disease, an examination or pharyngoscopy, complete blood count and bacteriological analysis are performed. Laboratory examination of samples taken from the affected areas of the tonsils will determine the type of pathogen and adjust the choice of antibacterial agent.
The main drug is antimicrobial drugs.
When detecting the microbial etiology of lacunar and follicular tonsillitis, the ENT doctor prescribes antibiotics. The correct choice of antibiotic therapy ensures the rapid destruction of the pathogen and the prevention of complications. For treatment, the following antibiotics are prescribed:
- the penicillin group shows the highest efficiency against streptococci: amoxicillin, amoxiclav with clavulanic acid;
- macrolides are prescribed for intolerance to drugs of the penicillin group or resistance to bacteria, low toxicity, can be taken even by children and pregnant women: erythromycin, zitrolim, sumamed, chemomycin.
For a quick recovery, bed rest, regular gargling is required. For local treatment, antiseptic solutions (miramistin, chlorophyllipt), decoctions of herbs (chamomile, sage), various sprays (hexoral, inhalipt) are used. These funds will help remove purulent plaque and prevent further development of the inflammatory process.
