Purulent tonsillitis in adults - symptoms and treatment, photo. Follicular (purulent) tonsillitis

Purulent tonsillitis is an acute inflammation of the lymphoid apparatus of the pharynx, mainly the palatine glands, with the presence of a characteristic plaque on their surface, or liquid pus in the lacunae of the tonsils.

This is the nature of the pathological process, and not an independent disease.

The term "purulent" means catarrhal, lacunar, follicular and ulcerative-necrotic tonsillitis, according to the classification of Soldatenk I. B.

The key causes of a purulent sore throat are the following factors:

• Bacteria: group A β-hemolytic streptococcus (in 80% of cases), less often pneumococci, meningococci, etc. The cause of atypical purulent processes is often intracellular bacteria: chlamydia, etc. In addition, a special type of tonsillitis (Simanovsky-Vincent's tonsillitis) causes a combined effect fusiform rods and spirochetes of the oral cavity.
• Viruses. The following are distinguished: herpes (5 types), Epstein-Barr virus, Coxsackie, influenza strains, as well as adeno and rhinoviruses.
• Symbiosis of viral-bacterial microflora. Such combinations cause aggressive types of angina, which may be resistant to standard treatment regimens.
• Fungi (candida, actinomycetes). Fungal infection of the throat and tonsils develops against the background of the constant use of antibacterial agents or in patients with weakened immune systems.

In addition to the inflammatory process in the development of tonsillitis, the state of immunity, the influence of low temperatures, beriberi, tonsil injuries and the presence of chronic foci of infection in the body play an important role.

Incubation stage

The causative agents of angina are transmitted by airborne droplets from a sick person to a healthy one. Moreover, you can get infected both in the acute period of the disease, and during the recovery of the patient.

A person who has had a sore throat remains contagious for another week. An alimentary route of infection transmission is possible, through common objects (towel, cup, spoon).

The cause of the development of angina can be microbes from their own foci of persistent infection (carious teeth, sinusitis, pharyngitis, adenoids, etc.).

The incubation period depends on the type of bacteria, virus and averages from 12 hours to 3 days.

The disease begins acutely, it may be preceded by small prodromal signs in the form of discomfort and sore throat.

Stages of development of the disease

The onset of the disease is sudden. 12-24 hours after contact with the pathogen, there are signs of perspiration and sore throat. After a day, the pain intensifies, and the inflammatory reaction increases.

Interesting:

Angina can be abortive. This means that the throat bothers for 1-2 days and after that it goes away on its own.

On the 2-3rd day, the height of the disease sets in: the tonsils are covered with raids, the patient has difficulty swallowing, and the temperature rises.

With adequate treatment for 5-6 days, these symptoms disappear, and the body begins to recover.

Within 2 weeks after the illness, a person may experience weakness, loss of appetite, and mild malaise. Then, as a rule, there is a complete recovery, if the disease does not go into a chronic stage.

Forms of purulent tonsillitis

There are several forms of purulent tonsillitis: lacunar, follicular and catarrhal. It is not entirely correct to call it forms of angina, rather, these are stages that can pass one into another or develop in parallel.

So, the patient begins a catarrhal type of angina, which after a few days turns into lacunar.

Often there is such a picture, when on one tonsil there are signs of lacunar tonsillitis, and on the other follicular.

Let's consider them in more detail:

This is the mildest form of acute tonsillitis. There is a slight or moderate intoxication of the body, the temperature rises to subfebrile values ​​(rarely up to 38 ° C).

The tonsils are swollen and reddened, there are no pronounced raids on them yet. With normal immunity and effective therapy, such a sore throat disappears in 3-4 days.

Otherwise, it transforms into a follicular or lacunar form.

Lacunas (anatomical depressions) of the tonsils are affected. The patient complains of symptoms of severe inflammation: weakness, fever, joint pain.

The tonsils are enlarged, edematous and almost completely covered with white merging plaques (see photo).

The inflammatory process affects the follicles of the tonsils (special lymphoid formations in the thickness of the dermal layer).

The patient is concerned about intoxication, fever, sore throat. The tonsils are covered with single whitish plaques that look like large dots.

In addition to banal purulent tonsillitis, atypical forms are distinguished, such as Simanovsky-Vincent's tonsillitis, fungal tonsillitis, etc.

Characteristic symptoms

Purulent tonsillitis is manifested by general and local signs, which are expressed in each patient in their own way.

The main common symptoms are:

• Increased body temperature. It can be either subfebrile (37.1-37.4) or rise to high values ​​(40 degrees or more). The lack of temperature response is often observed in debilitated patients and the elderly.
• Chills, weakness.
• Decreased appetite.
• Aches in joints and bones.

Local signs of angina that disturb the patient to one degree or another:

• Sore throat. The pain is of varying intensity, some patients have difficulty opening their mouth due to severe pain.
• Feeling of suffocation, lack of air, difficulty in swallowing. There is swelling of the tonsils, which prevents the patient from fully breathing. Speech may change, the voice may acquire a nasal tone.
• Nearby lymph nodes increase in size and become painful: submandibular, cervical, etc.
• Increased salivation.
• On examination, the tonsils are reddened, edematous, partially or completely covered with a whitish, possibly yellowish or greenish coating.

Symptoms of purulent tonsillitis in children differ from the symptoms of an adult. For babies, the prevalence of general symptoms of intoxication is characteristic, which can occur with nausea, vomiting, convulsions against the background of high temperature.

Diagnostic measures

A general practitioner, an infectious disease specialist or an otorhinolaryngologist can identify a sore throat.

For diagnosis, the specialist interviews the patient for characteristic complaints and examines the oral cavity.

On visual inspection, the tonsils look loose, red, edematous and covered with blooms - such a typical picture makes it easy to diagnose purulent tonsillitis.

Differential diagnosis of angina is carried out with a number of similar pathologies:

• Diphtheria. An acute infectious disease that occurs with inflammation of the mucous membrane of the respiratory tract. The causative agent is corynebacterium diphtheria. It is characterized by an extremely toxic course and often gives complications to the musculoskeletal system and the heart muscle.
• Infectious mononucleosis. Viral pathology (Epstein-Barr virus), which often affects children. It is characterized by inflammatory changes in the oropharynx, swelling of the lymph nodes, a rash, an increase in the size of the liver and spleen.
• Scarlet fever. Infectious disease, which is manifested by a rash, intoxication and sore throat-like changes in the pharynx.
• Specific pathologies(syphilis, tuberculosis, HIV infection).

Additionally, with angina, a general and biochemical blood test, urinalysis and ECG are prescribed. These studies help confirm the process of inflammation and monitor the condition of the kidneys and heart.

Bacteriological sowing of a throat swab on nutrient media is necessary to identify the type of pathogen and its sensitivity to antibiotics.

Pathogen elimination

Treatment of purulent tonsillitis takes place at home and always requires the use of antibacterial drugs.

The antibiotic is prescribed according to the results of the tank. sowing, i.e. choose the remedy that has a wide range of activity and acts on most of the known pathogens of tonsillitis.

What antibiotics are used:

• penicillin series. With catarrhal uncomplicated tonsillitis, Amoxicillin, Flemoxin-Solutab are prescribed. If beta-lactamase bacteria are found in the smear, protected penicillins become the drugs of choice: amoxicillin + clavulanic acid (, "Amoclave"). These are relatively safe drugs with a wide spectrum of antimicrobial activity, which are used to treat bacterial pathology of the upper respiratory tract. Among the side effects, problems with the digestive tract (nausea, diarrhea) are often mentioned, and allergies (rash, swelling) often develop.
• Cephalosporins. There are several generations of them. For treatment, tablet (Cefuroxime) or injectable forms () are prescribed.
• Macrolides. With allergies to the two classes of antibiotics listed above, as well as tonsillitis caused by intracellular pathogens (mycoplasmas, chlamydia), this group of drugs is used. The most famous representative is Azithromycin. The drug is prescribed once a day, a course of 3-5 days. Due to the cumulative effect, it continues to work in the affected area even after you stop taking it.

In addition to these main groups of antibiotics, which are used most often, there are reserve drugs (carbapenems). They are prescribed to patients with atypical resistant microflora and severe complications, specific names are chosen according to the situation.

Symptomatic medications

To eliminate fever and sore throat, it is recommended to take Ibuprofen or Paracetamol. These drugs effectively suppress inflammation, which reduces pain, including headache and joint pain, and normalizes body temperature.

To eliminate the allergic component of the disease and remove the pronounced edema, antihistamines are prescribed ("Loratadin", "Zirtek").

In addition to systemic therapy, topical preparations are widely used for angina. They effectively relieve the symptoms of the disease and help speed up the recovery time.

Throat sprays

Sprays for the laryngopharynx disinfect, cleanse and moisturize the mucosa. For treatment, different types of aerosols are used, let's recall the most effective:

• "Gexoral". As part of the antiseptic hexetidine. It has a strong antibacterial and antifungal effect, partially eliminates pain and symptoms of inflammation.
• "Lugol". An iodine-based drug that has an antiseptic and drying effect.
• "Tantum Verde". Spray with nastetic (benzydamine) and anti-inflammatory properties. Good for relieving sore throat.
• "Oracept". It contains a solution of phenol. The drug relieves the symptoms of inflammation and also relieves pain.
• "Ingalipt". One of the most famous products based on sulfanilamide and eucalyptus oil. Shows antimicrobial and antifungal effect.
• "Kameton". It includes several components: chlorobutanol, camphor, levomenthol and eucalyptus. The spray anesthetizes, disinfects the mucosa and relieves marked inflammation.

Any aerosols are approved for use in children over 3 years of age. Before this age, the use of sprays can cause the development of laryngospasm and suffocation.

Lozenges

The use of lozenges will not be able to defeat a sore throat at home, but as part of a complex treatment it will help moisturize the inflamed mucosa and relieve pain.

Gargle

Such procedures mechanically clean the surface of the tonsils and create an unfavorable environment for the reproduction of bacteria.

It is contraindicated to treat purulent sore throat with only rinses, but this procedure relieves symptoms and significantly reduces the recovery time.

How can you rinse your throat with purulent sore throat:

• Hydrogen peroxide at 3% concentration. It cleans the pharynx well from bacterial raids. An important detail: after rinsing with peroxide, the throat and mouth should be rinsed with plain water or a mild antiseptic, such as Miramistin.
• "Furacilin". A yellow antiseptic solution that cleans the mucosa well and destroys most of the known microorganisms on its surface.
• Miramistin. The safest antiseptic for adults and children with low allergenic properties. Effective against viruses, bacteria and fungi.
• Rotokan. A mixture of extracts of chamomile, yarrow and calendula. It has an anti-inflammatory effect, cleanses and promotes the restoration of the mucosa.
• "Alcohol solution of Chlorophyllipt". Eucalyptus leaf extract, which has an antiseptic effect. For rinsing, it must be diluted in warm water.

With angina with intense pus formation, it usually has two forms - local abscesses-follicles and free secretions on the surface of the tonsils. In order to answer the question of whether it is necessary and whether it is possible to remove pus with angina, it is necessary to very clearly distinguish between these two types of purulent discharge. The success of the treatment of the disease and the speed of recovery will directly depend on the correctness of actions and the choice of tactics of behavior.

Ulcers in the form of follicles

These formations on the surface of the tonsils are a kind of reservoirs in which the “results” of the struggle of the body and antibiotics with a bacterial infection accumulate. Pus is a mixture of destroyed bacterial agents, dead blood cells and the immune system, intracellular fluid, as well as a very large number of different components.

But it should also be understood that pain in angina, fever and other symptoms are caused not by abscesses, but by inflammation of the tonsils.

That is, even if you remove all the pus from the tonsils, you will not get any significant improvement in the patient's condition. And vice versa, if the correct antibacterial treatment is carried out with specially selected antibiotics, then even if the abscesses persist, the patient will quickly recover.

Ulcers do not have any effect on the patient's well-being and do not complicate the course of angina. It is not necessary to remove them from the tonsils with this pathology.

Purulent formations with adequate treatment will disappear on their own. This is due to the fact that correctly prescribed antibiotic therapy within a few days after the start of medication leads to the almost complete destruction of pathogens. Accordingly, pus ceases to form. And the contents of already existing abscesses will be washed out by blood flow and excreted from the body over the next 3-4 days.

Complications with improper removal

Self-removal of abscesses with angina is not only pointless from the point of view of clinical effectiveness, but also poses a rather serious danger. Even if you manage to open a purulent follicle and more or less qualitatively clear the contents, then an unprotected wound surface is formed at this place. In addition to the fact that it will deliver additional pain to the patient, it also represents the entrance gate for the penetration of any infection. And this is a direct path to the formation of abscesses in the throat, which will have to be treated by surgery.

In addition, the removal of abscesses at home is almost always a rather rough process associated with extensive damage to the mucous membrane. Even if it seems to the patient that such manipulations are performed very carefully, in fact this is not the case.

Intense mechanical trauma leads to the development of additional foci of inflammation, prolongation of the disease and deterioration of the patient's condition.

Finally, severe damage to the mucous membrane caused by attempts to remove purulent follicles on the tonsils usually heals very poorly. In this case, rough scars and scars are formed. These elements significantly impede the normal outflow of fluid from the lacunae on the surface of the tonsils, which often leads to chronic tonsillitis, and sometimes even becomes a reason for surgical intervention.

Removal of abscesses can only be carried out by a doctor, guided by serious indications. In a hospital setting, special tools are used and careful processing of the tonsils at the end of the procedure.

Superficial deposits of pus

This pus, in principle, can be removed from the surface of the tonsils. This procedure will not bring much benefit in the treatment of purulent tonsillitis, but if performed correctly, it will slightly speed up the final recovery.

The criterion for which pus can be removed, and which one should not be touched, is the possibility of washing it off with rinses. What can be removed using throat lavage is the superficial deposits of pus. And what remains on the tonsils is already purulent follicles that should not be touched.

It should also be noted that rinsing indirectly can affect the follicles. They stimulate the development of these formations with angina, the accumulation of pus in them and, accordingly, the fastest breakthrough. Such a breakthrough, if it occurred naturally, will actually completely close the resulting wound with surrounding tissues. And this means that scars will not form during healing.

Rinsing to remove pus

In order to remove superficial deposits of pus from the tonsils, it is not so important what exactly to gargle with. After all, this effect is exerted by the liquid itself. Washing technique is much more important:

Although almost any neutral liquid can be used to remove purulent plaque from the tonsils, it is most convenient to use solutions that have additional healing properties. Thanks to this, you will immediately receive several therapeutic effects that will help with sore throat. Commonly used liquid compounds that have anti-inflammatory, analgesic and disinfectant effects:

• sodium chloride solution, including 1 teaspoon of common salt dissolved in half a liter of water;
• a solution of baking soda (1 tsp of soda per 1 liter of water);
• a mixture of 1 tsp. soda and 1 tsp. salt in 1 glass of water with the addition of 2-3 drops of iodine;
• infusions and decoctions of medicinal herbs and plants - calendula, wild rose, St. John's wort, chamomile, oak bark, yarrow, sage, oregano, coltsfoot, etc .;
• a solution of potassium permanganate, including 5-6 granules of dry potassium permanganate, diluted in 1 glass of water;
• solutions of boric acid, furacilin, chlorophyllipt, chlorhexidine, stopangin and other pharmaceutical preparations.

With angina with a purulent component, Lugol's solution or Ingalipt should not be used. These substances are characterized by increased viscosity due to the presence of glycerol and for this reason, on the contrary, make it difficult to remove pus from the surface of the tonsils.

How not to remove pus?

The methods described below can often be found in the form of all sorts of "useful tips". But their use from a medical point of view carries a huge risk of complications and only aggravates the course of the disease.

This is a fairly common pathology in our region, according to statistics, annually purulent tonsillitis accounts for almost 15% of all diseases of the upper respiratory tract. The peak incidence occurs in the autumn and spring months, this is due to a seasonal decrease in immunity and the development of beriberi.

Causes and mechanism of the development of the disease

The main cause of the development of purulent tonsillitis are pathogenic microorganisms, which include:

• streptococci - a particularly dangerous disease caused by hemolytic streptococcus;
• staphylococci;
• pneumococci;
• the combined effect of the fusiform rod and the oral spirochete causes the development of an acute form of the disease.

Normally, getting a small number of these microorganisms on the mucous membranes of the glands is not scary, with a weakened immune system, the body cannot cope with the pathogenic microflora and the first signs of purulent pharyngitis appear.

Factors contributing to the development of the disease are:

• sharp hypothermia;
• a cold or an acute viral infection (ARVI);
• chronic long-term illnesses that significantly weaken the immune system;
• in women, the activity of the immune system is significantly reduced during pregnancy;
• in adults, one of the provoking factors is smoking.

In order to prevent the development of complications, it is necessary to accurately determine the causes of purulent tonsillitis before treatment (to identify the pathogen and determine its sensitivity to antibiotic therapy). Lugol provides acceleration of treatment due to the impact on the coccal flora.

Development mechanism

Is purulent tonsillitis contagious - definitely yes.

The disease is transmitted from person to person:

1. Airborne when talking, close communication, kissing, sharing dishes, towels or personal hygiene items.
2. It can also be the result of autoinfection, when, with weakened immunity, microorganisms located in the foci of chronic infection become the cause of the development of pathology, which include teeth destroyed by caries, chronic sinusitis and rhinitis.

Upon contact with the mucous membrane of the tonsils and the posterior pharyngeal wall, microorganisms begin to actively multiply causing the development of inflammation, swelling, pain and the formation of purulent discharge in the crypts (folds) and on the surface of the tonsils. Lugol or another local remedy will help reduce the activity of manifestations.

Clinical manifestations of the disease

The period from the moment of infection until the first symptoms of purulent tonsillitis appear lasts from 2 to 5 days (in children it is somewhat shorter than in adults). The first sign is the development of severe chills, which is replaced by a sharp increase in body temperature to 38.5-39.9 degrees.

There are two forms of the disease acute and chronic, the first is more common in children with primary infection. The second is equally common in children and adults.

Acute purulent tonsillitis is manifested by the following symptoms:

• sore throat from mild discomfort to a pronounced syndrome that makes swallowing and talking difficult;
• the temperature rise lasts until the inflammation of the tonsils passes;
• signs of intoxication - headache against the background of fever, pain in the joints, bones and muscles, weakness, irritability, increased fatigue;
• manifestations from the gastrointestinal tract - lack of appetite, in children, against the background of high temperature, nausea and vomiting may develop (in adults, this symptom practically does not occur);
• an increase in regional lymph nodes (occipital, submandibular, behind the ear);
• on the surface of the tonsils, you can see a yellowish-white, easily detachable plaque.

The chronic form is characterized by dense microbial seeding of crypts and glandular lacunae. Due to the closed system and insufficient excretion of pus, the chronic process often gives relapses, which proceed in the same way as the acute form and also begin with a sharp increase in temperature and a slight sore throat.

Types of pathology

What does purulent tonsillitis look like, depending on its type:

1. Follicular - pus is localized in the follicles of the tonsils and shines through the thin mucous membrane, which causes the tonsils to become covered with whitish spots. This is the most dangerous form, since the intraparenchymal location of purulent exudate causes an increased risk of its penetration into the bloodstream and the development of distant abscesses and sepsis. It is manifested by a significant increase in temperature and acute pain radiating to the ear.
2. Lacunar - lacunae (folds) of the tonsils are filled with dense pus, this form proceeds much easier, lasts less, does not cause extremely high temperature and often becomes chronic.
3. Phlegmonous - the course of the disease is accompanied by purulent fusion of one of the tonsils, in addition to high temperature, there is significant swelling and a forced posture in which the head is turned in the opposite direction to inflammation, accompanied by a sharp pain in the eye and ear. Requires immediate hospitalization and urgent surgical treatment, which will help remove the manifestations of sore throat.

During pregnancy, any form of purulent tonsillitis (acute or relapse) requires treatment in a hospital, you will have to spend as much time there as it takes to remove all manifestations of the disease.

Features of the course of purulent tonsillitis in children

In children, fever and other vivid manifestations of the disease do not last as long as in adults, the children's body returns to active life much faster. But this fact is not a reason to cancel the medicine prescribed by the doctor and continue the treatment of purulent tonsillitis using only folk remedies. Cancellation of antibiotic therapy can cause the development of special resistant forms of microorganisms that will accompany the baby throughout his life.

Features of the course of angina in pregnant women

Inflammation of the tonsils (tonsillitis) during pregnancy is not a rare disease, since the woman's immunity is greatly weakened. The disease has a bright symptomatology and a long course. During pregnancy, angina poses a danger not so much to the expectant mother as to the fetus. First of all, a sharp and persistent rise in temperature, an inflammatory process and infection with microorganisms are dangerous.

Unfortunately, it will not be possible to cure a sore throat using only folk remedies; antibiotic therapy is necessary. Using only means for rinsing or irrigation (lugol, for example), it will not be possible to achieve a positive result either. How quickly to cure purulent tonsillitis during pregnancy depends on how much harm it will cause to the unborn child. Modern pharmacology has in its arsenal powerful tools that can be used during pregnancy, in case of urgent need.

Complications and consequences

Purulent tonsillitis in itself is a serious disease that causes significant discomfort to the patient. But even more dangerous are the complications of purulent tonsillitis, which develop with incorrect or incomplete treatment of the disease.

Experts distinguish the following consequences of purulent tonsillitis:

• rheumatic affections of the joints;
• the development of rheumatism of the heart valves, more often develops in children;
• inflammation of the meninges - meningitis;
• chronic kidney disease with the possible development of acute renal failure;
• the formation of purulent abscesses (retropharyngeal or distant) - in most cases
• diagnosed in adults
• development of sepsis;
• during pregnancy, you should be extremely careful and try to prevent the development of the disease, since it can harm the fetus.

How long purulent tonsillitis lasts depends on how carefully the patient follows all the doctor's recommendations. Subject to bed rest, the dosage in which the medicine is prescribed and recommendations for taking it, recovery occurs in 7-10 days. If, however, only folk remedies are used for treatment without consulting a specialist, it is possible to achieve the transition of the disease into a chronic form or the development of severe complications.

Treatment of the disease

With purulent sore throat, mainly drug therapy is used, traditional medicine can be used as concomitants (only after consulting a doctor). Surgical methods (removal of tonsils, opening of an abscess) are used for medical reasons, and are rarely used during pregnancy.

Medical therapy

1. Antibiotics for purulent sore throat - in most cases, penicillin drugs (augmentin, amoxiclav) or a broad spectrum of action (ceftriaxone, cefotaxime) are used, cefazolin or erythromycin is prescribed during pregnancy. How much to take antibiotics? In adults, the course usually lasts 5-7 days, after which, if necessary, the remedy is replaced. For children, the duration of treatment and drugs are selected individually.
2. Local therapy - means for local exposure are used until the pain in the throat completely disappears, these include lugol, joks, inhalipt, oracept, cameton.
3. Antipyretic drugs - paracetamol, mefenamic acid, efferalgan, are used in the age dosage. They (like Lugol) can be used for as many days as necessary in order to stop the temperature rise.
4. With pronounced intoxication, intravenous detoxification therapy and the use of glucocorticoid drugs are prescribed.
5. To prevent the development of dysbacteriosis, probiotics (linex, bifidum bacterin) are used, they are taken as much as antibiotics.
6. To stop a possible allergy, hyposensitizing drugs are prescribed (in adults, this treatment is not used).

It is forbidden to have a mechanical effect on the inflamed tonsils, so it is better to use Lugol or another local remedy in the form of an aerosol or rinse.

Folk methods of treatment

From folk methods, infusions and decoctions of medicinal plants are used for gargling. It is better to buy herbs in a pharmacy or prepare them yourself. Chamomile and calendula flowers, eucalyptus and linden leaves, St. John's wort and sage herb, propolis and honey have a good effect.

Compresses with purulent sore throat can be done only in the absence of hyperthermia - vodka compress and rubbing with pharmaceutical products (eucabal, Dr. Mom) are popular.

Quite a long time ago, with purulent sore throat, they began to use Lugol, an iodine-based solution that has an excellent antiseptic effect. Recently, lugol is also available in the form of a spray.

To prevent the development of purulent tonsillitis, local and general hardening, a balanced diet and an active lifestyle are necessary. In order to reduce the risk of developing ENT pathologies, it is necessary to treat all diseases of the oral cavity, nose and ears in a timely manner.

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