The appearance of a purulent discharge is observed against the background of an inflammatory process in the tissues and indicates the presence of bacterial pathogenic pathogens. If abscesses in the throat without fever are diagnosed, this may indicate a pronounced immunodeficiency. In addition, the appearance of hyperthermia is due to the pathogenicity of pathogens.
Among all diseases, unexpressed hyperthermia or its absence at all can be observed with pharyngomycosis, aphthous stomatitis, chronic tonsillitis or Simanovsky-Vincent tonsillitis.
In these diseases, the inflammatory process is not so active, so the temperature in a person can be normal.
Chronic tonsillitis
Purulent plugs in the tonsils are recorded in chronic tonsillitis. Its development is due to:
- decreased immunity against the background of tuberculosis, oncopathology or concomitant decompensated somatic pathology;
- condition after a severe infectious disease (scarlet fever, diphtheria, flu);
- strong general hypothermia (getting wet in the rain, the influence of a frosty wind);
- taking large doses of antibacterial, hormonal and chemotherapy drugs for a long time;
- defective nasal breathing (hay fever, traumatic or congenital curvature of the septum, adenoiditis, tumors);
- chronic diseases of the nasopharynx (sinusitis, frontal sinusitis);
- caries, gingivitis, the presence of removable dentures, which increases the risk of maintaining chronic infection.
Often, in the process of diagnosis, a bacterial pathogen of the staphylococcal or streptococcal group is detected.
The severity of clinical signs depends on the aggressiveness of pathogens and the resistance of the immune system against infection. There are several forms of chronic angina:
- simple, in which only local manifestations are recorded. They are represented by edema, hypertrophy of the arches, there are abscesses on the tonsils, especially in the lacunae. The preservation of the infectious and inflammatory process is supported by the presence of bacterial pathogens and purulent plugs. On palpation of closely located lymph nodes, their sensitivity, swelling and increased size are noted. The absence of general symptoms indicates a localized inflammatory focus without the spread of bacteria throughout the body;
toxic-allergic 1 degree - manifested by local and systemic clinical signs. They are caused by the generalization of infectious microorganisms. In addition to local symptoms, a person is worried about joint, chest pain and severe malaise. During the examination, the electrocardiogram does not register any violations of cardiac work and myocardial damage. Each subsequent exacerbation of chronic tonsillitis is characterized by a longer recovery period. Other infectious diseases, for example, ARVI, diphtheria, influenza, also occur in a more severe form;- toxic-allergic grade 2, when the spread of infectious pathogens leads to the appearance of organ dysfunction. So, there is renal, hepatic failure, disruption of the heart. With the help of electrocardiography, it is possible to identify changes in the cardiac rhythm due to myocardial damage. With ultrasound, X-ray and endoscopic examination, organ pathology is diagnosed. In the course of laboratory diagnostics (blood, urine analysis), the severity of damage to internal organs is established.
toxic-allergic 1 degree - manifested by local and systemic clinical signs. They are caused by the generalization of infectious microorganisms. In addition to local symptoms, a person is worried about joint, chest pain and severe malaise. During the examination, the electrocardiogram does not register any violations of cardiac work and myocardial damage. Each subsequent exacerbation of chronic tonsillitis is characterized by a longer recovery period. Other infectious diseases, for example, ARVI, diphtheria, influenza, also occur in a more severe form;Pus in the throat with prolonged preservation and frequent exacerbations of chronic tonsillitis is complicated by a paratonsillar abscess. Of the systemic complications, it is worth highlighting:
- sepsis, when pathogenic microorganisms form infectious foci in internal organs, causing their dysfunction;
- rheumatic fever, in which cardiac valvular defects, myocarditis, endocarditis, polyarthritis, renal dysfunction are diagnosed;
- defeat of the glands.
Symptomatically, chronic tonsillitis is manifested by:
- a lump in the oropharynx;
- tickling, discomfort;
- dryness, scratching;
- unpleasant odor.
During periods of remission, there are practically no symptoms, however, after hypothermia, decreased immunity against the background of acute respiratory viral infections or somatic pathology, an exacerbation develops. It is characterized by increased clinical symptoms (sore throat), the temperature rises to 37.5 degrees, headache, drowsiness, fatigue and body aches appear.
For diagnosis, a pharyngoscopy is prescribed, with the help of which the glands and pharyngeal wall are examined. During the examination, redness, thickening of the uvula, arches and loosening of the tissue of the glands are found. On the surface, white dots on the tonsils (suppurative follicles) are visualized, with the breakthrough of which the purulent discharge spreads through the glands.
Treatment is carried out with conservative methods or with the help of surgery.
For drug therapy, systemic antibacterial agents are used (Amoxiclav, Zinnat, Sumamed). Antiseptic, anti-inflammatory and analgesic solutions are prescribed locally to rinse the oropharynx, irrigate or lubricate the surface of the tonsils. For this, Miramistin, Chrorhexidine, Chlorophyllipt, Rotokan and Givalex are used.
In the presence of complications, pronounced clinical signs during periods of remission, as well as in the toxic-allergic form of grade 2, an operation in the volume of tonsillectomy (removal of tonsils) is indicated.
Angina Simanovsky-Vincent
The difference between this type of sore throat and typical forms of tonsillitis is the absence of fever or a slight increase in temperature. The development of angina is due to the activation of opportunistic microorganisms, which include the spindle-shaped bacillus, as well as the spirochete. Under certain factors, they acquire disease-causing properties and lead to the development of the disease. Predisposing factors include:
- decreased immunity due to frequent acute respiratory viral infections, chronic tonsillitis, sinusitis, exacerbation of severe somatic illness, tuberculosis or cancer;
- blood diseases;
- improper diet, which leads to hypovitaminosis;
- poor oral hygiene.
Symptomatically, the disease is manifested by pronounced salivation, putrid odor, edema, enlargement of regional lymph nodes and soreness in the oropharynx.
For diagnosis, pharyngoscopy is used, in which an abscess on the tonsil without fever, swelling and loosening of the tonsils is revealed. With the breakthrough of abscesses, purulent discharge spreads over the surface of the tonsils, forming yellowish films. They are easily removed, leaving an uneven ulceration.
To establish the type of pathogenic microorganisms, microscopy and a culture method are prescribed. This makes it possible not only to identify pathogens, but also to assess their resistance to antibacterial drugs. In some cases, PCR is used. To reduce the risk of recurrence, hygiene rules, strengthening of immunity and regular sanitation of chronic infectious foci (caries, sinusitis, tonsillitis) are required.
Pharyngomycosis
Due to the activation of fungal pathogens, an inflammatory process occurs in the oropharynx. In otolaryngology in our time, 30% of all infectious pathology is represented by fungal infection.In most cases, the pathology is combined with cheilitis, stomatitis or gingivitis.
The course of pharyngomycosis is often of a chronic type, since the pathology does not respond well to therapy.
Candida fungi are conditionally pathogenic flora, which, under certain conditions, has a damaging effect on the mucous membrane, skin and genitals. In 5% of cases, molds are detected, which cause a more severe clinic. Among the predisposing factors, it should be noted:
- decreased immunity with influenza, acute respiratory viral infections, oncopathology, tuberculosis or exacerbation of severe somatic diseases;
- a long course of taking antibacterial, chemotherapeutic agents and glucocorticosteroids;
- the presence of removable dentures, which increases the risk of infection.
Given the variety of clinical symptoms, there are several forms of pharyngomycosis:
- pseudomembranous, characterized by the appearance of a white coating on the tonsils;
- erythematous, when zones of hyperemia with a smooth surface are noted;
- hyperplastic, in which a speck is visualized in the form of a white plaque. Such a stain is difficult to remove from the surface of the mucous membrane;
- erosive-ulcerative - manifested by ulcerative defects of a superficial nature.
Of the clinical signs, we single out:
- perspiration, scratching, discomfort, dryness in the throat area;
- pain in the oropharynx, aggravated by eating food with spices;
- cephalalgia;
- malaise;
- drowsiness;
- lymphadenitis.
In the process of diagnosis, the doctor analyzes the patient's complaints, the peculiarities of their appearance, after which an additional examination is prescribed. In the process of pharyngoscopy, tissue edema and plaque on the tonsils without temperature are visualized, which also covers the tongue and the pharyngeal wall. The films have a curdled consistency.
The diagnosis is confirmed by bacteriological examination, for which material is collected from the surface of the tonsils. It allows you to establish the type of pathogenic microorganisms and their sensitivity to medicines.
For treatment, antimycotic drugs are used, for example, Intraconazole or Flucanozole.
Aphthous stomatitis
The occurrence of aphthous stomatitis in most cases is due to a decrease in immune defense. There are several forms of pathology (fibrinous, necrotic, granular, scarring and deforming stomatitis).
The disease is characterized by the appearance of aft with a whitish bloom. Sometimes necrotic areas of the mucous membrane in the oropharynx are visualized. The temperature does not rise in this case. Ulcerations, depending on the depth, can epithelize within 2-4 weeks. In the presence of deep ulcerative defects, the formation of scars is possible.
Therapeutic taxics for stomatitis consists in strengthening the immune system and using local techniques. For this, antiseptic, anti-inflammatory and analgesic drugs are used to rinse, lubricate aft and affected tonsils. Thanks to the anesthetic component in the drugs, pain is reduced. Also, medications with hormonal, vascular components are used, which accelerate tissue regeneration and healing of aft.
Due to the fact that diseases are not always accompanied by fever, one should pay attention to such clinical symptoms as pain, dryness in the oropharynx, as well as a deterioration in the general condition (loss of appetite, drowsiness or weakness).
