Pharyngomycosis: symptoms and treatment. Candidal pharyngitis in children treatment Hardware washing of the tonsils

Pharyngomycosis- damage to the mucous membrane of the pharynx by the fungus Leptotrix buccalis.

Causes of pharyngomycosis.

The occurrence of pharyngomycosis contributes to the long-term irrational use of antibiotics, chronic tonsillitis, lack of vitamins. Often, pharyngomycosis accompanies oncological diseases, such as liver cancer.

Symptoms of pharyngomycosis.

On the surface of the mucous membrane of the posterior pharyngeal wall, on the palatine tonsils, whitish dense formations in the form of spikes appear. The course of the disease is chronic, not disturbing the patient, often detected by chance when examining the pharynx. Only sometimes the patient indicates an unpleasant sensation of something foreign in the throat.

Treatment of pharyngomycosis at home.

Lubrication of the mucous membrane and tonsils with disinfectant and aseptic solutions.

Folk remedies for the treatment of pharyngomycosis

Apply frequent gargling with a weak solution of potassium permanganate or onion infusion. To strengthen the immune system, vitamin folk remedies are used.

Pharyngomycosis can be a symptom of a general decrease in immunity due to a disease that a doctor should diagnose. In this case, treatment with folk remedies will bring only a temporary result.

Medicines for the treatment of pharyngomycosis as prescribed by an ENT doctor

Disinfectant and aseptic solutions: Lugol's solution Oxyquinoline (Idril, Kryptonol, Mikantin, Octofen, Salkinat, Soloxin, Sunoxol, Superol, Quinozol, Hinrok sizol) Furacilin

Pharyngomycosis is an acute or chronic disease of the pharyngeal mucosa, caused by opportunistic fungi. Pharyngomycosis is very common - it makes up about 30-40% of all infectious diseases of the pharynx, and the number of cases of incidence is steadily growing. The disease is common among all segments of the population - it affects both men and women, both adults and children. Pharyngomycosis rarely occurs in isolation, more often it is accompanied by fungal lesions of other organs of the oral cavity (mucosa - stomatitis, gums - gingivitis, tongue - glossitis). About what is pharyngomycosis, why and how it develops, what are the principles of diagnosis, treatment and prevention of it, we will talk in the article. So…

Reasons for the development of pharyngomycosis

Fungi are the main etiological factor of this disease, more than 90% of cases are caused by yeast-like fungi of the genus Candida (more often C. albicans and C. stellatoidea), and in 5–7% of cases mold fungi - Aspergillus, Penicillium, Geotrichum - become the cause of the disease.

In healthy people, pharyngomycosis develops extremely rarely. The primary role in its occurrence is played by congenital or acquired immunodeficiencies or pathology of the human endocrine system. More often the disease develops against the background of:

• tuberculosis;
• frequent SARS;
• obesity;
• hypothyroidism;
• diabetes;
• due to frequent prolonged unreasonable use of antibiotics;
• after chemotherapy or glucocorticoids.

In addition, the risk factor is the wearing of removable dentures.

Mechanisms of development of pharyngomycosis

Like most infectious diseases, pharyngomycosis develops against the background of a decrease in the function of local and general immunity. Fungi, which are a causative factor, usually live in the oral cavity of a healthy person, without harming him and not manifesting themselves in any way.

Classification of pharyngomycosis

According to the nature of the course, acute and chronic pharyngomycosis are distinguished. Unfortunately, due to late diagnosis and inadequate treatment, acute forms often become chronic.

Depending on the nature of local changes in the pharynx, the following forms of the disease are distinguished:

• pseudomembranous pharyngomycosis - on the surface of the pharynx, raids are visualized more often white, less often with a yellow tint, having a curdled appearance, easily removed with a mucous spatula; sometimes bleeding areas of hyperemia are found under them;
• catarrhal, or erythematous, pharyngomycosis - in the region of the posterior pharyngeal wall there are areas of hyperemia with a smooth, as if varnished, surface;
• hyperplastic pharyngomycosis - characterized by the formation of white spots and plaques on the pharyngeal mucosa, which are difficult to remove from it;
• erosive and ulcerative pharyngomycosis - in the places where the fungus is introduced, there are superficial ulcerations, erosions, which often bleed.

Signs of pharyngomycosis

The acute form of pharyngomycosis is characterized by rather bright clinical symptoms, while the chronic one proceeds more smoothly, but periods of remission are replaced by exacerbations up to 10 times during the year.

Patients suffering from this disease may complain of a variety of intense discomfort in the throat:

• dryness;
• burning;
• rawness;
• scratch;
• pain, aggravated by swallowing and during meals, radiating to the ear, lower jaw, to the front surface of the neck.

In addition to these symptoms, patients are also concerned about:

• enlargement and soreness of the cervical lymph nodes;
• headache;
• general weakness;
• fatigue;
• irritability;
• loss of appetite;
• increase in body temperature to subfebrile numbers.

Diagnosis of pharyngomycosis

The specialist will suspect a disease of the pharynx based on the characteristic complaints of the patient. When clarifying the anamnesis of the disease and the patient's lifestyle in favor of pharyngomycosis, there will be data on concomitant pathology and drugs taken by the patient shortly before the disease (antibiotics, cytostatics, glucocorticoid hormones), as well as on the conditions of his life and work. After questioning the patient, the doctor will examine the oral cavity and pharynx, where he will find changes specific to pharyngomycosis:

• edema, infiltration, hyperemia of the mucosa;
• injection of its dilated vessels;
• desquamation (detachment) of the epithelium;
• an increase in lateral ridges against the background of subatrophy of the mucosa;
• white or yellowish cheesy layers on the mucosa, easily removed with a spatula, leaving behind a hyperemic bleeding mucosa;
• the spread of raids on the palatine arches, hard and soft palate, bleeding erosions, ulcers in their place indicate the development of an ulcerative-necrotic form of pharyngomycosis.

It is noteworthy that a typical sign of pharyngomycosis is uneven hyperemia of the pharyngeal mucosa and a unilateral inflammatory process.

The most accurate methods to make a reliable diagnosis are mycological research methods. The material for the study is raids from the surface of the tonsils and the posterior pharyngeal wall. The laboratory assistant, using a special tool, removes them on a glass slide and, without smearing, covers them with another glass. After that, the resulting material is stained according to a special technique and studied under a microscope. In a smear with pharyngomycosis, fungal cells, their spores or pseudomycelial filaments will definitely be detected. It is important to know that the detection of single fungi under a microscope is not always a sign of a disease - they are present in smears and are normal. In addition, if a negative result is obtained in the first study, this does not indicate the absence of pharyngomycosis - in such a situation, it is necessary to conduct a study again.

A cultural study of the material can also be carried out - sowing it on a nutrient medium. This study takes a lot of time, but it allows you to find out which type of fungus caused the disease and to which drugs this pathogen is sensitive.

In order to search for conditions that have reduced immunity, the following diagnostic methods can be prescribed to the patient:

• detailed blood test (signs of inflammation will be revealed);
• general urine analysis;
• blood sugar test;
• blood test for hepatitis B, C;
• blood test for HIV;
• immunogram;
• syphilis test;
• consultation with an endocrinologist;
• consultation with an immunologist.

Differential diagnosis of pharyngomycosis should be carried out with the following diseases:

• acute tonsillitis;
• acute pharyngitis;
• diphtheria;
• syphilis;
• scarlet fever;
• tuberculosis;
• Simanovsky-Vincent's angina;
• infectious mononucleosis (its anginal form);
• oncological neoplasms.

Treatment of pharyngomycosis

Acute pharyngomycosis and exacerbations of its chronic form are, as a rule, subject to outpatient treatment for 7–10–14 days. If the disease is severe, there are signs of severe intoxication, or complications have developed, the patient should be hospitalized.

To achieve the effect of the treatment as soon as possible, it is necessary to take antifungal drugs both systemically (in the form of tablets or injections) and locally. In pharmacology, there are 3 groups of antifungal drugs used for this disease:

• azoles - Ketoconazole, Fluconazole, Intraconazole;
• polyenes - Nystatin, Levorin, Amphotericin;
• allylamines - Terbinafine.

The optimal prescription of drugs based on the results of a cultural study of the scraping of the affected mucosa: in this case, the causative agent of the disease and the drugs to which it is sensitive are known exactly. However, in the vast majority of cases, treatment must be started before the results of the analysis become known - in this case, the drug is selected empirically (it should act on the maximum pathogens for which the patient is being treated).

Fluconazole is often the drug of choice for candidal pharyngomycosis. Its dose directly depends on the severity of the course of the disease and averages 50–200 mg per day. If after 3-5 days there is no improvement from treatment with Fluconazole, it is necessary to replace it with a drug of another group of antifungal agents.

In some cases, when the patient does not respond to any of the drugs prescribed orally (for oral administration), intravenous injections of Amphotericin are prescribed.

With pharyngomycosis caused by mold fungi, the appointment of Terbinafine (250 mg 1 time per day for 8–16 days) and Itraconazole (100 mg 1 time per day for 14 days) is indicated.

As for local therapy, the main drugs used for this purpose are borax in glycerin (sodium tetraborate), Natamycin suspension, Miramistin, Oxyquinoline, Clotrimazole. Medicines are applied directly to the affected mucosa by lubrication, washing the lacunae of the tonsils, endopharyngeal instillations, irrigation of the posterior pharyngeal wall, gargling.

In addition to antifungal drugs, the patient should be prescribed medications to correct disorders that have become the background for the development of pharyngomycosis (vitamins, immunomodulators, drugs for the treatment of hormonal disorders).

Prevention and prognosis of pharyngomycosis

Subject to timely diagnosis and adequately prescribed treatment, the prognosis is favorable - the patient is completely cured of pharyngomycosis.

In the case of a chronic inflammatory process, a complete cure for this disease is unlikely; only its introduction into the remission phase is possible.

To prevent the development of pharyngomycosis, it is necessary:

• monitor the state of the immune system;
• take antibiotics and glucocorticoids strictly according to indications and in sufficient dosages;
• control blood sugar levels;
• do not let the disease of the endocrine system take its course.

Remember that it is better to pay attention to prevention and prevent the development of the disease than to treat it later. Do not be ill!

The main causes of the disease

By pharyngomycosis, doctors mean the manifestation of an inflammatory process on the mucous membrane of the throat, which is provoked by certain types of fungi. Most often, the diagnosis reveals:

• yeast-like mycoses of the Candida type (more than 90%);
• moldy types Penicillium, Geotrichum.

All these types of fungi belong to the conditionally pathogenic part of the microflora. They are ubiquitous, and spores settle on household items, clothing or furniture. Therefore, the disease is quite contagious and often coincides with a wave of colds and SARS. Diseases are susceptible to people of different ages and sexes, children often suffer from pharyngomycosis.

The main reason is the decrease in the overall defenses of the body under the influence of various factors. At increased risk are people who have the following chronic diseases or health conditions:

• injuries of the pharyngeal mucosa (scratches, burns with hot tea);
• allergies;
• frequent colds or viral diseases;
• HIV or tuberculosis;
• dysfunction of the thyroid gland;
• diabetes;
• chronic thrush;
• obesity.

The danger is also the use of removable dentures, more precisely, their storage without observing hygiene standards. In preschool children, candidal pharyngitis can occur after a foreign body enters the throat, which scratches the delicate mucous membrane, carries spores of the fungus. Often this form of mycosis occurs in people who are constantly taking hormonal drugs, who have been treated with antibiotics.

Otolaryngologists associate fungal pharyngitis with some diseases of the stomach (ulcer, chronic gastritis), intestines, in which its contents and bile can injure the mucous membrane of the upper esophagus. The risk of mycosis increases the wrong way of life, frequent smoking, constant hypothermia.

The main symptoms of pharyngomycosis

The observed clinical picture at the initial stage may resemble the symptoms of inflammation in angina:

• perspiration and burning sensation in the throat;
• feeling of drying out of the mucous membrane;
• pain when eating or drinking;
• pain that radiates to the lower jaw;
• marked enlargement of some lymph nodes.

With further development, patients note a significant increase in body temperature, severe malaise and weakness, headaches. A dense whitish coating appears on the surface of the mucous membrane and tonsils, resembling the manifestation of thrush. It is a consequence of the active reproduction of fungi and the formation of colonies.

Many patients have aching pain in the ears, on the front of the neck, which increases with any sudden movements. Due to the accumulation of pathogenic mucus, a feeling of the presence of a foreign body appears and swallowing is difficult.

There are two main forms of fungal pharyngitis:

• Acute: characterized by a strong inflammatory process that affects overall well-being. A severe runny nose, inflammation of the entire nasopharynx, and a dry debilitating cough are added to the main mycosis.
• Chronic: less pronounced, but dangerous for its consequences. When neglected, the fungus affects the vessels or joints, causes rheumatism or heart disease.

The hardest thing to distinguish fungal pharyngitis from viral diseases in babies. Symptoms at this age are blurred and not expressed. In most cases, the course of the disease resembles the usual rhinitis after SARS. The child becomes restless and more capricious, refuses favorite foods. Only a thorough diagnosis helps to correctly establish the cause and prescribe treatment.

Forms of the disease

Experts identify several typical forms of fungal pharyngitis, which differ in course and symptoms:

1. Pseudomembranous: characterized by a white, sometimes yellowish coating.
2. Catarrhal: a smooth red crust forms on the inner surface of the pharynx.
3. Hyperplastic: large white plaques appear that attach to the mucosa.
4. Erosive and ulcerative: open inflamed areas (erosion) form on the surface of the throat or nasopharynx.

Method for diagnosing mycosis

When referring to an otolaryngologist, it becomes necessary to correctly identify the disease. Many symptoms coincide with bacterial pharyngitis, some types of tonsillitis, throat cancer, scarlet fever. Therefore, the patient is assigned a range of different procedures:

• determination of sugar and hormone levels;
• tests for HIV, hepatitis and syphilis;
• culture swabs from the nose and throat;
• microscopic examination of scrapings from the tonsils.

In addition, the specialist conducts a survey of the patient to find out what antibiotics and hormonal drugs have been taken recently, whether there was a cold, SARS. In some difficult situations, an examination by a mycologist, endocrinologist and infectious disease specialist may be required.

Fungal pharyngitis treatment

The basis of therapy for pharyngomycosis is a systematic approach aimed at increasing immunity and destroying the causative agent of the disease. With a high degree of intoxication and swelling of the throat, the patient is placed in a hospital under constant supervision.

The following systemic drugs are prescribed as antimycotics:

• Ketoconazole;
• Fluconazole;
• Terbinafine;
• Nystatin (for yeast fungi).

The course of treatment depends on the form of fungal pharyngitis and can last up to 14 days. Additionally, the inflamed mucosa is treated with Miramistin, a suspension of Natamycin, which have an antifungal effect. Several times a day, it is recommended to rinse the larynx with a glycerin solution of sodium or Lugol.

You can soften the throat and mucous membranes by inhalation with disinfectants, decoctions of herbs: chamomile, calendula or sage. The main treatment of fungal pharyngitis is supplemented by drinking plenty of fluids, wholesome food and a complex of vitamins. This helps to increase immunity and stimulates the patient's body to fight mycosis.

Classification of pharyngomycosis

According to the course of pharyngomycosis, it is divided into: acute and chronic. The acute form of pharyngomycosis with delayed or incorrect treatment often quickly becomes chronic. The classification of pharyngomycosis is represented by four groups - these are pseudomembranous pharyngomycosis, erythematous pharyngomycosis, hyperplastic or erosive-ulcerative factor.

Pseudomembranous pharyngomycosis is determined by the presence of white plaque on the surface of the pharynx. Erythematous pharyngomycosis is characterized by red areas on the pharynx that have a smooth, shiny surface. The hyperplastic form has the appearance of white dots, almost not separated from the epithelium of the pharynx. The erosive-ulcerative group accrues a lot of erosions and ulcers on the mucous surface of the pharynx.

Causes of pharyngomycosis

The reasons for the development of pharyngomycosis can be different factors. In most cases, the disease provokes a long course of antibiotics, during which there is a decrease in immunity. Since in the oral cavity of a healthy person there are many different bacteria and fungi that do not cause any harm in a healthy body, when the protective function of the body decreases, the fungi penetrate into the cells of the mucous membrane of the oral cavity and pharynx and multiply. As a result, the particles of their vital activity and the toxins that are released cause damage to the cells. In the process, inflammation of the mucosa occurs, which manifests itself in puffiness, a loose structure and a rich pink color. Fungi, damaging the walls of the vessel, enter the bloodstream and release toxins into the blood. With untimely treatment, fungi affect the internal organs and cause inflammation. Also, a metabolic disorder that occurs in the course of diseases such as diabetes and obesity can be a factor in the development of the disease.

Symptoms of pharyngomycosis

Symptoms of pharyngomycosis are discomfort in the mouth and larynx, a feeling of the presence of a foreign body, a sensation of perspiration and dryness in the oral cavity. Pain is aggravated by eating food that irritates the mucous membrane, for example, salty and spicy foods. With the disease, a headache and a decrease in general well-being are diagnosed, the body temperature also rises to thirty-eight to thirty-nine degrees Celsius, painful sensations of the lymph nodes increase, irritability and fatigue of the body appear. When examining the pharynx in sick patients, there is swelling of the mucosa and a white coating on it, which extends to the tongue and the inner surface of the cheeks, the mucosa of the esophagus. When affected by yeast fungi, the plaque on the pharynx has a whitish appearance and is easily removed; if the infection is provoked by moldy fungi, then the plaque has a yellowish appearance and is difficult to remove. Worse, if this plaque resembles a diphtheria plaque, then it is necessary to carry out a bacteriological study and, based on its results, either confirm or refute the presence of such a disease as diphtheria - an infectious disease of a bacterial breed, which is characterized by the development of fibrous inflammation, in which the upper respiratory tract and the mucous surface of the oropharynx are affected . This disease is transmitted by airborne droplets, as a result of which the trachea, larynx, bronchi, eyes, nose and genital organs are affected.

How is pharyngomycosis diagnosed?

Diagnosis of pharyngomycosis begins with a patient survey, according to the results of which the otolaryngologist can find out what diseases were previously in the pharynx and what treatment was carried out. In the presence of periodic exacerbations of diseases, any inflammatory processes that cannot be treated, the doctor questions the presence of such a disease as pharyngomycosis. Next, an examination of the pharynx and oral cavity is carried out, and according to the results of pharyngoscopy, the presence of swelling of the mucous surface of the pharynx, the presence of raids are revealed. Characteristic of pharyngomycosis is uneven coverage of redness of the cavity of the posterior pharyngeal wall, the presence of hypertrophy of the lateral ridges. But since with the help of visual examinations and studies, the otolaryngologist cannot give a 100% definition of the disease, a laboratory analysis is carried out to detect fungi in smears. With the help of a special tool, plaque is removed from the glass slide and covered, without smearing the contents, with another glass. Next, the resulting material is stained using a special technique and examined under a microscope. With the help of microscopic magnification, it is possible to identify fungal spores, cells and threads of pseudomycelium. However, the detection of single fungi is not always a sign of the disease. Another important action is to re-examine if the first one is negative. Studies by the culotural method of smears make it possible to establish the type of fungi.

To analyze the background state of the body, they are examined by an immunologist and an endocrinologist, who in turn conduct tests for the presence of syphilis, diabetes mellitus or hepatitis B and C.

At the moment, the treatment and diagnosis of fungal disease remains an urgent problem. In the last few years, the incidence of pharyngomycosis has increased several times. A high percentage of patients is due to an increase in risk factors for its development; immunodeficiency states remain in the leading positions, which occur as a result of long-term treatment with antibiotics, immunosuppressive drugs for cancer, AIDS and blood diseases. The problem is the identification and prescription of the correct treatment, since due to the massive and widespread distribution of fungal chronic pharyngitis and tonsillitis are tolerated and develop more difficult than other inflammatory processes, they can be the beginning of the development of disseminated visceral mycosis or fungal sepsis.

Treatment of pharyngomycosis

A big problem remains the appointment of treatment, since the complexity is due to the resistance of some types of fungi to antifungal drugs. Nina has developed a new effective drug from the group of azoles mycoflucan, which is a representative of the class of triazoles. Mycoflucan has a disinfecting effect on all types of fungi that were the causative agents of pharyngomycosis, which leads to their death. The drug is well tolerated by patients, no side effects or allergic reactions have been identified. Treatment of pharyngomycosis is combined with general and local use of antimycotic drugs. The groups of antimycotic drugs include polyenes, azoles, allylamines. In the local treatment of pharyngomycosis, a suspension of natamycin or miramistin is used, they treat the walls of the pharynx and palatine tonsils. Also, chewing of nystatin tablets, which envelop the surface of the pharynx, is prescribed for all manipulations. The affected areas are lubricated with a solution of Lugol or gentian violet, and a solution of sodium tetrathorate in glycerin also has a positive effect on the surface of the damaged areas. Apply itraconazole, which kills yeast-like and mold fungi. With exacerbations, treatment lasts about two weeks. If the disease recurs, anti-relapse therapy is prescribed.

According to the results of the immunogram, the infected patient is given immunomodulatory treatment. Good results and a favorable prognosis are given by timely and correct treatment, after which there is a complete cure for pharyngomycosis.

Preventive measures

Prevention of pharyngomycosis can be considered a timely visit to the doctor and correct, correct treatment. In no case should you self-medicate. The most basic actions to prevent pharyngomycosis are professional and correct therapy, the use of antibiotics, and maintaining a high percentage of immunity performance. In the presence of a disease such as diabetes mellitus, it is necessary to maintain the sugar level at acceptable levels, not to let endocrine diseases take their course. It is important not to forget about a healthy diet and vitamins in adequate doses. You should lead a healthy lifestyle and exercise.

Pharyngomycosis is considered a fairly serious disorder that is difficult to treat. To cope with the pathology, you need to consult a doctor in a timely manner. The specialist will conduct a detailed diagnosis and select appropriate methods of treatment. Thanks to this, complications can be avoided.

Pharyngomycosis ICD 10

Pharyngomycosis is an inflammatory lesion of the pharynx, which is a consequence of the increased activity of fungal microorganisms.

According to ICD-10, pathology is coded under the following codes:

• Q37.0. ;
• J02.8. caused by other specified pathogens.

Usually, the disease develops when the immune system is weakened, for example, with. It is in this situation that fungal microorganisms begin to manifest themselves. In the process of their vital activity, they release many toxic substances that lead to cell poisoning and the appearance.

As a result, the mucous membranes of the oral cavity acquire a bright pink hue and a loose structure. If toxins enter the blood, manifestations of intoxication are observed.

During the period of therapy must be observed. Pickles, spicy foods, hot foods, sour foods should be removed from the diet. All this leads to irritation of the pharynx. Dishes should have a soft texture. It is best to give preference to mashed soups, mashed potatoes, liquid cereals.

In order to prevent exacerbations of the disease, it is very important to control the state of your health, treat diseases of the nasopharynx and.

Medically

To eliminate pharyngomycosis, systemic and local antifungal agents are prescribed. Such drugs can be divided into several categories:

• allylamines -;
• polyenes - levorin, nystatin;
• azoles - itraconazole,.

The course of therapy is selected depending on the severity of the disease. Usually treatment lasts 7-14 days. After normalization, the condition is prescribed fixing therapy. It helps to avoid relapses.

An obligatory component of therapy is the use of local funds. To eliminate the symptoms of pathology, antifungal drugs and antiseptics are used. For such purposes, it is shown to use streptocide, natamycin in the form of a suspension. First, the oral cavity is washed with disinfectants, after which it is treated with a spray or ointment.

Simple and effective recipes for the treatment of fungus:

Physiotherapy

The means of physiotherapy include laser exposure and ultraviolet radiation. Such treatment works when rays hit the affected areas. In addition, it is worth using vitamins and hyposensitization.

Possible Complications

With the spread of the abnormal process, the fungi enter the oral cavity, leading to local complications. The most common include the following:

1. Candidomytic angulitis is a lesion of the oral cavity and skin in the corners of the lips.
2. Cervical lymphadenitis - purulent.
3. Candidal cheilitis is a lesion of the dermis in the corners of the mouth, which is characterized by the appearance of cracks.

Prevention

To prevent the development of pathology, it is necessary:

• strengthen immunity;
• control glucose levels;
• use antibiotics as prescribed by a doctor;
• engage in the treatment of endocrine pathologies.

Forecast

If you make the correct diagnosis in time and start, the prognosis will be favorable. During the process, therapy will not lead to a complete recovery, but will allow you to achieve a stable remission.

Pharyngomycosis is a serious pathology that can lead to dangerous consequences. To avoid this, you need to strictly follow medical recommendations.

Fungal infections are a very common problem in our time, and their danger lies in the ease of infection and difficult and long treatment. Many patients do not immediately pay attention to unpleasant symptoms, and the disease eventually becomes chronic. Fungal is one of the manifestations of mycosis of the oral cavity, which is caused by some fungi when they enter a weakened body.

What is fungal (pharyngomycosis) pharyngitis

Pharyngomycosis refers to a fungal infection of the pharyngeal mucosa in acute or chronic form. This disease can be caused by opportunistic fungi of different species and occurs among almost all segments of the population. Young children, including newborns, are most susceptible to fungal pharyngitis. Many mothers have met with such a pathology in a baby as thrush caused by a fungal infection.

NOTE: The most striking sign indicating the presence of pharyngomycosis is the presence of plaque on the mucous membrane of the throat, tonsils, palate.

The danger of this disease is that, as a rule, it is accompanied by other mycoses that affect neighboring organs and tissues: tongue, gums, and mucous membranes.

In the last decade, according to statistics, there has been a significant increase in the cases of diagnosis of pharyngomycosis. Among infectious diseases of the tonsils and pharynx, fungal pharyngitis occupies about a third (from 30 to 45%). The reason for the increase in the incidence of pharyngomycosis is an increase in the frequency and number of provoking factors.

One of the main factors can be called mass antibiotic therapy, long-term use of immunosuppressive and glucocorticoid drugs for cancer, HIV, diseases of the circulatory system, endocrinopathies, which leads to iatrogenic immunodeficiency in patients. As a result, their body becomes unable to cope with infection by opportunistic fungi on its own.

NOTE: Compared with other diseases of the oropharynx, the defeat of a fungal infection leads to a more severe condition of the patient, fungal pharyngitis and tonsillitis are more difficult to treat.

Pharyngomycosis can turn into a focus of disseminated visceral mycosis or lead to fungal sepsis. And since mycotic pharyngitis is becoming more widespread over time, it can be called an acute social problem.

Most often, pharyngomycosis is diagnosed in children. Fungal pharyngitis in newborns is a well-known thrush that affects the oral cavity. In this case, the cause of the focus of the disease is not fully formed immunity, which cannot cope with a fungal infection. Children of preschool and school age also often suffer from fungal pharyngitis. In these cases, the manifestation of the disease is usually associated with the fact that in infancy the child was infected, and the pathogen remained in the body.

Candidal pharyngitis is also diagnosed in adults, as a rule, patients in different age groups after 16 years of age are approximately the same number. In rare cases, patients older than 70 years are observed.

The main causative agent of fungal pharyngitis are yeast-like fungi of the genus Candida, they cause pharyngomycosis in about 93% of diseases. Among these mushrooms, the following types can be distinguished:

• Candida albicans;
• C. stellatoidea;
• C. krusei;
• C. tropicalis;
• C. parapsillosis;
• C. glabrata;
• C. brumpti;
• C. intermedia;
• C. sake and others;

NOTE: According to statistics, Candida albicans becomes the most common cause of pharyngomycosis among fungi of the genus Candida - this pathogen is found in half of the cases.

The next most common cause of fungal pharyngitis is Candida stellatoidea. In their morphology and biochemistry, these fungi are very similar.

In addition to Candida fungi, fungal infections of the oropharynx can also be caused by mold fungi of the following genera:

• Aspergillium;
• Geotrichum;
• Penicillium and others;

Due to the penetration of molds into the mucous membrane of the oropharynx, pharyngomycosis occurs in 5% of cases.

There are a number of factors, the presence of which acts depressingly on the immune system, as a result, fungal pharyngitis occurs more easily. Provoking factors include:

• pharynx injuries;
• inflammation of the pharyngeal mucosa;
• prolonged use of antibiotics;
• prolonged use of cytostatics;
• use of corticosteroids for a long time;
• tuberculosis;
• after chemotherapy;
• hypothyroidism;
• diabetes;
• HIV infection;
• excess weight;
• the presence of removable dentures;
• beriberi or hypovitaminosis;

Symptoms of fungal pharyngitis are felt by patients primarily as a feeling of discomfort, burning, itching, soreness, dryness in the throat. The symptoms of pharyngomycosis are very similar to those of bacterial pharyngitis, but more pronounced. As for the pain syndrome, its features in this disease will be the following:

• the intensity is moderate;
• increased during eating and swallowing;
• irridation in the ear, front of the neck, in the submandibular region;

Pharyngomycosis external symptoms gives the following:

• the mucous membrane of the pharynx is edematous;
• plaque on the mucous membrane;
• severe intoxication of the body;

NOTE: A characteristic feature of candidal pharyngitis is constant exacerbations of the disease, which can occur from 2 to 10 times a year.

According to its clinical course, the disease can be in the following forms:

• acute fungal pharyngitis;
• chronic pharyngomycosis;

In both cases, the localization of the pathological process is the posterior pharyngeal wall, palatine arches and tonsils. In addition, fungi can spread to the larynx, esophagus, and also lead to the formation of paratonsillar abscesses.

The acute form of the disease eventually turns into chronic fungal pharyngitis if the disease was not diagnosed in a timely manner or the treatment was chosen incorrectly.

Regardless of the causative agent, pharyngomycosis of the throat gives such general symptoms as:

• headache;
• weakness
• malaise;
• subfebrile body temperature;
• discomfort (in the form of burning, scratching) in the throat;

With different types of fungi, the symptoms may vary slightly:

• yeast-like - plaque has a whitish color, is removed easily, the mucous membrane under it is hyperemic, sometimes it can bleed;
• moldy - yellowish plaque, difficult to remove;

The disease can also be combined with other pathologies of the nasopharynx, respiratory tract and other internal organs, therefore, for example, pharyngomycosis and cough often coexist, while the cough will signal some other disease.

Pharyngomycosis can be divided into several varieties according to their clinical and morphological manifestations:

• pseudomembranous - in its manifestations it is very similar to fungal pharyngitis caused by yeast-like fungi, the plaque is white, curdled in consistency, when removed from the mucous membrane, a bright red base is visible, while the surface may bleed;
• catarrhal (erythematous) - the surface of erythema is smooth, as if “lacquered” in appearance, severe dryness, burning and pain are noted in the oral cavity;
• hyperplastic - on the epithelial layer of the oral cavity there are plaques and white spots, which can be separated from the surface only with great effort;
• erosive-ulcerative - characterized by the presence of an ulcerated surface;

When candidal pharyngitis is suspected, symptoms should be confirmed by a physician. To do this, you must visit a medical institution and undergo a diagnostic examination. It is carried out in the form:

• inspection;
• laboratory research;
• screening;

Diagnostic measures are required for differential diagnosis, since pharyngomycosis in many of its manifestations is very similar to diseases such as:

• tuberculosis;
• syphilis;
• acute bacterial tonsillitis;
• acute bacterial pharyngitis;
• diphtheria;
• angiogenic form of infectious mononucleosis;
• malignant tumors, etc.;

It should be remembered that pharyngomycosis is contagious, and can be transmitted from the carrier in various ways. Therefore, timely diagnosis and treatment is very important. Only in this case, the disease can be cured in a short time and it will not go into a chronic form.

Due to weak or incompletely formed immunity, pharyngomycosis often occurs in children. The causes of the disease are the ingestion of fungi such as Candida or mold. As a rule, when children get sick with fungal pharyngitis, they begin to complain of such unpleasant and painful symptoms as:

• constant sore throat;
• there is a lump in the throat that you want to swallow;
• pain when swallowing, during a conversation, when eating, especially if these are products that irritate the mucous membrane of the larynx;
• lethargy;
• lack of appetite;
• the oral mucosa swells;
• the mucosa is covered with a curdled coating of white or yellow (depending on the type of fungus) color;
• Strong headache;
• increased body temperature;

If at least part of the above symptoms are found, then the child should be shown to the doctor as soon as possible. In case of pharyngomycosis, treatment of children should be carried out strictly under the supervision of a specialist, self-medication is unacceptable and can only harm.

Only a doctor can in each specific case know the correct answer to the question: “If pharyngomycosis is found in a child, how to treat this disease?”.

NOTE: Usually complex antimycotic, anti-inflammatory, antipyretic drugs are used, which are suitable for children.

Treatment

In the case of pharyngomycosis, treatment should comply with the following important principles:

• a combination of local and systemic antifungal drugs is required;
• antifungal agents should be selected in accordance with the results of laboratory tests.

Drug therapy for fungal pharyngitis includes drugs such as:

• nystatin, dekamin or levorin (if nystatin is ineffective) - in tablets;
• gentian violet solution 1%, Lugol's solution, glycerin solution of sodium tetraborate 10%, natamycin in suspension - lubrication of lesions;
• fluconazole, ketonazole, or itraconazole (if fluconazole has failed);
• amphotericin B (if the fungus turned out to be resistant to other antimycotic agents used) - intravenously at a dose depending on the weight of the patient.

NOTE: It must be remembered that some drugs, for example, ketoconazole and amphotericin B, have a pronounced toxic effect on the kidneys and liver; in case of fungal pharyngitis, treatment with such drugs must be carried out with constant monitoring of the functioning of these organs by analyzing biochemical parameters.

When candidal pharyngitis is diagnosed, treatment should be systemic and include the following groups of antimycotic drugs:

• polyenes: natamycin, nystatin, amphotericin B, levorin;
• azoles: itraconazole, fluconazole, ketoconazole;
• allylamines: terbinafine;

Very often, a doctor, having discovered symptoms of fungal pharyngitis in a patient, prescribes treatment in the form of a course of fluconazole. This drug is used once a day, the dose is prescribed depending on the severity of pharyngomycosis. The duration of the course of treatment is from one to two weeks.

As a preventive measure in relation to pharyngomycosis, first of all, attention should be paid to actions aimed at eliminating disease-provoking factors. Namely: it is necessary to eliminate the conditions that could cause or contribute to the occurrence of fungal pharyngitis.

If necessary, you should:

• stop antibiotics;
• stop taking glucocorticoids;
• adjust the glycemic profile;
• take general strengthening drugs;
• observe the correct daily routine;

NOTE: A very important place in the prevention of pharyngomycosis is occupied by measures aimed at strengthening the immune system. You need to eat right, take vitamin complexes, walk in the fresh air, get enough sleep, move.

Such measures will help to avoid not only fungal infections of the pharynx, but also other health problems, since a strong immune system will be able to cope with many problems.

Pharyngomycosis (tonsillomycosis) - pharyngitis (tonsillitis) caused by fungi.

Classification: According to the clinical course, the following forms of pharyngomycosis are distinguished: acute; chronic.

Clinical and morphological variants of pharyngomycosis:

Pseudomembranous. It is characterized by raids of white color, cheesy appearance, removed with exposure of a bright red base, sometimes with a bleeding surface;

Erythematous (catarrhal). Characterized by erythema with a smooth "varnished" surface, while patients note soreness, burning, dryness in the oral cavity;

Hyperplastic. In the oral cavity, white spots and plaques are found that are difficult to separate from the underlying epithelium;

Erosive and ulcerative.

Etiology: to The main causative agents of pharyngomycosis include various types of yeast-like fungi of the genus Candida. C. albicans (50%) is considered the main causative agent, C. stellatoidea is in second place in terms of frequency of occurrence. In 5% of cases, fungal infections of the oropharynx are caused by fungi of the genus Geotrichum, Aspergillus, Penicillium, etc.

Pathogenesis: In the pathogenesis of fungal pharyngitis and tonsillitis, the main role is played by a decrease in the body's immune defense, which accompanies long-term treatment with antibiotics, glucocorticoids and chemotherapy drugs, blood diseases, HIV infection, endocrinopathies, diseases of the gastrointestinal tract. With the development of mycotic lesions, adhesion of saprophyte fungi occurs on the mucous membrane of the pharynx, followed by invasion. Inflammation is chronic and is accompanied by frequent exacerbations. The risk group includes patients using removable dentures.

Clinic: With pharyngomycosis, patients complain of discomfort in the throat, burning sensation, dryness, soreness, perspiration, which are more pronounced than with a bacterial lesion of the pharynx. The pain is moderate in intensity, with swallowing and eating irritating food intensifies. Patients note the irradiation of pain in the submandibular region, on the front surface of the neck and in the ear. The specific signs of pharyngomycosis are raids, swelling of the mucous membrane and pronounced phenomena of intoxication. Pharyngomycosis is also characterized by frequent exacerbations (2-10 times a year).

Diagnostics: When interviewing, it is imperative to find out whether the patient was treated with antibiotics, glucocorticoids, cytostatics (duration and intensity of treatment), to clarify the characteristics of production and living conditions, previous diseases, and an allergological history.

Physical examination. On examination, edema and infiltration of the mucous membrane, expansion and injection of blood vessels, desquamation of the epithelium are detected. A characteristic clinical sign of chronic pharyngitis of fungal etiology is uneven hyperemia and infiltration of the mucous membrane of the posterior pharyngeal wall. Against the background of subatrophy, an increase in lateral ridges is noted. Often, against the background of the described pathological changes, whitish cheesy, easily removable raids are detected, under which areas of erosion of the mucous membrane are found. With ulcerative-necrotic form of fungal tonsillitis, raids spread beyond the palatine tonsils to the palatine arches and soft, and sometimes hard palate. Raids and unilateral lesions are considered pathognomonic diagnostic signs of pharyngomycosis.

Laboratory research. Single negative results do not indicate the absence of a fungal disease, therefore, in such a situation, several repeated studies of the pathological discharge are necessary. At the same time, a single growth of fungi in a crop does not always indicate a fungal infection. Plaques from the surface of the tonsils are usually easily removed. Large, dense plaques are removed on a glass slide with ear tweezers and, without smearing, are covered with another glass slide.

In addition, it is imperative to do clinical blood tests (including for HIV infection, markers of hepatitis, syphilis), urine, it is necessary to determine the level of glucose in the blood, immunogram indicators.

Thus, the diagnosis of fungal infection of the pharynx is made on the basis of: clinical data; detection of fungi by microscopy of smears from the mucous membrane; positive results when planting on elective nutrient media.

Differential Diagnosis pharyngomycosis should be carried out with acute bacterial pharyngitis and tonsillitis, scarlet fever, diphtheria, tuberculosis, syphilis, anginal form of infectious mononucleosis, Simanovsky-Plaut-Vincent's angina, malignant neoplasms.

Treatment:Medical treatment: the use of systemic antifungal drugs must be combined with a local effect on the focus of infection; antifungal drug therapy should be based on the results of a laboratory study that reveals the sensitivity of the fungus to the drug used.

Fluconazole is most effective in pharyngomycosis, which is prescribed once a day at a dose of 50 or 100 mg, in severe cases - 200 mg. The course of treatment is 7-14 days.

Alternative treatment regimens for pharyngomycosis, also lasting 7-14 days, consider the following suspensions:

Levorin (20,000 IU / ml) 10-20 ml 3-4 times a day:

Natamycin (2.5%) 1 ml 4-6 times a day;

Nystatin (100,000 units / ml) 5-10 ml 4 times a day.

With pharyngomycosis resistant to other antimycotics, intravenous amphotericin B is prescribed at 0.3 mg/kg per day for 3-7 days. For mold mycoses, itraconazole and terbinafine are considered the most effective. The course of treatment with itraconazole is 14 days, 100 mg once a day, the course of treatment with terbinafine is 8-16 days, 250 mg once a day.

In local treatment, antiseptics and antimycotics are used (miramistin *, oxyquinoline, clotrimazole, borax in glycerin, natamycin suspension) for lubrication, rinsing, irrigation, washing the tonsil lacunae. Further management

With exacerbation of pharyngomycosis, azoles are prescribed orally or topically for 7-14 days, taking into account the drug sensitivity of the pathogen. Risk factors need to be eliminated. Upon reaching remission, anti-relapse treatment is carried out with systemic antimycotics or antifungal drugs for topical use.

80+83. Chronic tonsillitis as a common cause of recurrent tonsillitis in children.

Chronic tonsillitis is an active, with periodic exacerbations, chronic inflammatory focus of infection in the palatine tonsils with a general infectious-allergic reaction. According to modern concepts, chronic tonsillitis is a common infectious-allergic disease with local manifestations in the form of a predominant lesion of the lymphoid tissue of the tonsils of the pharynx (often palatine, less often pharyngeal or lingual) and their persistent inflammatory reaction. Despite the fact that the tonsils are the first barrier that prevents the penetration of bacteria and viruses into the upper respiratory tract, with prolonged damage and untimely treatment, they become a source of infection and cause diseases of other organs and systems. The problem of chronic tonsillitis is one of the most urgent in modern clinical medicine. At present, we can say with confidence that this topic has gone beyond the limits of otorhinolaryngology and is extremely important in the clinic of childhood diseases. This is due to the significant prevalence of the disease, the frequency of which is especially high in children and young people. The incidence of chronic tonsillitis in children aged 3 years is 2–3%, and by the age of 12 it reaches 12–15%. Especially often chronic tonsillitis is observed in the group of frequently and long-term ill children: every second of them suffers from this disease]. The upward trend in the incidence of chronic tonsillitis in various age groups of the population continues to this day. It has been established that the share of chronic tonsillitis accounts for 24.8–35.0% of diseases of the ENT organs in both adults and children. The main causative agents of chronic tonsillitis are various representatives of pathogenic microflora, some viruses and fungi; it can also be caused by allergic inflammation. Dysbiosis of the upper respiratory tract and morphological restructuring of the lymphoid tissue as a result of a violation of the process of self-purification of the lacunae of the tonsils contribute to the multiplication of microorganisms and the development of a chronic inflammatory process. Chronic tonsillitis- not just inflammation of the palatine tonsils, it is a pathology manifested by the inhibition of nonspecific factors of the body's natural resistance, a violation of the humoral and cellular immunity, local protection factors and is accompanied by an infectious-allergic attack on the child's body with the development of a number of serious complications. Some of them, for example, paratonsillar and pharyngeal abscesses, tonsillogenic sepsis, often cause the death of the patient, others, primarily autoimmune processes (rheumatism, infectious arthritis, glomerulonephritis, vasculitis), lead to the disability of the child. Sensitization of the body can occur already in the early stages diseases of chronic tonsillitis. The chronic focus of infection in the tonsils is considered as a constant factor in the general sensitization of the body, which can cause metatonsillar diseases and additionally disrupt the already altered reactivity of the body. tonsils, changes in general reactivity and sensitization of the child's body.

In chronic tonsillitis, the accumulations of "moving" lymphocytes are more extensive and numerous than normal. This is also evidenced by the frequency of positive skin-allergic reactions to streptococcus and staphylococcus antigens in children suffering from this disease. With the onset of involution of the thymus, which regulates delayed-type hypersensitivity reactions, the number of children with chronic tonsillitis also decreases. In chronic tonsillitis, such tonsils serve as a source of tonsillocardial, tonsillorenal and other pathological reflexes.