Acute Inflammatory Diseases of the Pharynx: Classification, Clinical Manifestations, Treatment

Acute inflammatory diseases of the pharynx – a pathological condition caused by the activation of pathogenic microflora on the surface of the pharyngeal mucosa and manifested by local and general symptoms.

These include:

• Acute tonsillitis (sore throat) is inflammation of the palatine tonsils;
• Acute pharyngitis is an inflammation of the mucous membrane of the pharynx.

Classification of acute inflammatory diseases of the pharynx

1. Acute tonsillitis (non-specific):

• Catarrhal form;
• Lacunar form;
• Follicular form.

2. Acute tonsillitis in blood diseases:

• With leukemia;
• Agranulocytosis.

3. Acute catarrhal pharyngitis

Acute tonsillitis (sore throat)

Etiology of acute tonsillitis

Acute tonsillitis (sore throat) in most cases is caused by pathogenic bacteria, in particular about 80% beta-hemolytic group A streptococcus (BHSA). In addition, the source of infection can be streptococci, staphylococci, pneumococci, enterococci, hemophilus bacillus, a large number of viruses, especially adenoviruses, herpesviruses. When local immunity is weakened, opportunistic microflora living in the oral cavity(Streptococcus viridans, Leptothrix, fusobacteria, fungi) can also cause inflammation.

Anatomy of acute tonsillitis

In acute inflammation of the palatine tonsils is determined by their swelling and hyperemia, in the same way change and nearby structures (uvula, soft palate, back wall of the pharynx), the tongue covered with white plaque, these signs are characteristic of catarrhal tonsillitis.

In the follicular form, in addition to the above picture, small millet dots of white-yellow color appear in the follicles.

In lacunar tonsillitis on hyperemic and edematous tonsils spread large foci of plaque coming from the lacunae, which in some cases may merge. The plaques are microabscesses of tonsil parenchyma.

Clinical picture of acute tonsillitis

Acute tonsillitis is characterized by a sudden acute onset. Patients notice a pronounced pain in the throat, intensified by swallowing, which may irradiate to the ear or neck. Because of the swelling and painful palatine tonsils there is difficulty in opening the mouth, nasality, bad breath. Plaque on the tonsils is easily removed with a spatula, the surface does not bleed. General symptoms appear: fever to febrile values(38-40°C), chills, headache, regional lymph nodes are enlarged and sharply painful. The disease lasts 5-7 days.

Frequent complications are characteristic, local complications include: paratonsillitis, paratonsillar abscess, cervical lymphadenitis; general complications include: rheumatism, glomerulonephritis, arthritis, sepsis, endocarditis.

Diagnosis of acute tonsillitis

Diagnosis is established on the basis of a characteristic clinical picture, the results of pharyngoscopy. Determination of leukocytes and C-reactive protein, rheumatoid factor in blood, urinalysis, bacteriological examination of the detachment or strepto-test (for diagnostics of BHSA) is performed.

If it is not possible to perform a bacterial examination or strepto-test, the Centor-McAzek scale is used. If the sum of scores is 3 or higher, a bacterial pathogen is suspected and antibiotic therapy is prescribed.

The Centor-McAzek Scale:

Treatment of acute tonsillitis

For the treatment of acute bacterial tonsillitis, antibacterial drugs of the penicillin series are used for 10 days, in case of allergy – cephalosporins or macrolides. In addition to antibiotics, non-steroidal anti-inflammatory drugs are prescribed. For a speedy recovery prescribe a sparing high-calorie diet, it is also recommended to observe bed rest.

Acute tonsillitis in blood diseases

In leukemia.

Etiology

Leukemia is a malignant blood disease in which immature or atypical blood cells are formed. Tonsillitis in leukemia is not an independent disease, but only a symptom, from which, as a rule, this blood pathology manifests. It is more often observed in acute le ukemia (in persons of young age), but also occurs in chronic forms of leukemia (in the elderly).

In leukemia, the formation of immune system cells in the bone marrow is impaired, and immature and undifferentiated cells – blasts – are released into the blood. These forms are not able to fully repel the infection. For the development of an infectious process in the oropharynx, a slight violation of the integrity of the mucosa, through which the pathogenic microflora enters, is sufficient.

Anatomy

Due to a sharp decline in local and general immunity develop pathological processes in the tonsils. Pathogenic microflora begins to spread uncontrollably in the oropharynx, causing inflammation of the tonsils. Tonsillitis quickly passes all stages (catarrhal, lacunar, follicular) and eventually necrotic changes in the tonsils occur. The oropharyngeal mucosa is infiltrated, palatine tonsils hypertrophied, covered with fibrinous hard to separate plaque. Subsequent necrosis may spread to the mucosa of gums, soft palate.

Clinical picture

The first signs of leukemia include general weakness, subfebrile temperature, body aches. Hemorrhagic syndrome is characteristic: there is a widespread small hemorrhagic rash on the skin and mucous membranes, epistaxis, from a small wound there is prolonged bleeding, which can end fatally. Local changes in the oropharynx develop in 3-5 days from the onset of the disease. There is a sequential development of all stages of tonsillitis, which ends with the development of ulcerative-necrotic sore throat. There is a pronounced pain in the throat, intensified by swallowing, irradiating to the ear. Against the background of pathological changes in the amygdalas, pyretic fever (increase in body temperature to 39-40°C), sweating, chills are characteristic. Regional lymph nodes are enlarged, but sometimes generalized lymphadenopathy is observed, the liver and spleen are also enlarged. With the development of the necrotic form, there is a putrid odor from the mouth, the general condition rapidly deteriorates, the course becomes malignant. With the progression of the process may develop sepsis and multi-organ failure with lethal outcome.

Diagnosis

Initially , a general examination and otorhinopharyngoscopy are performed. However, it is difficult to clinically suspect leukemia. It is obligatory to perform a general blood test, which reveals a decrease in all formational elements, in addition to leukocytes, which increase several times due to immature cells (blasts). In some cases, a pronounced decrease in leukocytes is observed in the leukopenic form. To definitively establish the diagnosis, a bone marrow puncture is performed. Leukemia is characterized by suppression of all sprouts of hematopoiesis and the presence of a large number of blasts. Consultation with an oncohematologist is recommended.

Treatment

Initially, broad-spectrum antibiotic therapy is initially prescribed to prevent a severe course of leukemia. Specific therapy is carried out by doctors of oncohematology profile, which includes chemotherapy and radiation therapy, bone marrow transplantation. Hemotransfusion is prescribed to compensate for the deficiency of blood form elements.

In agranulocytosis.

Etiology

Agranulocytosis is not an independent diagnosis, but is a clinical and hematologic syndrome. In this pathology, the number of neutrophil granulocytes (< 0.5*109/L) is sharply reduced, up to their complete absence. More often occurs in women over 40 years old. Depending on the causative factors distinguish myelotoxic, immune and autoimmune agranulocytosis:

• In the myelotoxic form (acute radiation sickness) , the process develops when the body is exposed to ionizing radiation, cytostatic drugs or some drugs (levomycetin, streptomycin, gentamicin, penicillin).
• Immune agranulocytosis also occurs through the interaction of the body with drugs (sulfonamides, NSAIDs, drugs for the treatment of diabetes mellitus, tuberculosis) or in some infectious diseases (influenza, infectious mononucleosis, poliomyelitis, viral hepatitis).
• Various autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, autoimmune thyroiditis) contribute to the development of autoimmune agranulocytosis.

Against the background of any of the above forms of the disease, infectious processes occur in places of traumatization or contact with a large number of pathogens, including the development of acute tonsillitis. Lesions of tonsils with agranulocytosis is a characteristic symptom.

Anatomy

Myelotoxic form of agranulocytosis occurs due to suppression of myelopoiesis progenitor cells production in the bone marrow, while the level of lymphocytes, reticulocytes, and platelets also decreases.

Immune agranulocytosis is characterized by the formation of antibodies (a complex composed of drugs and blood proteins) that are directed against white blood cells.

Autoimmune agranulocytosis triggers the independent production of antineutrophil antibodies, which cause their death.

With a decrease in leukocytes, the penetration of any microorganism through the damaged mucosa of the tonsils causes a pathological process that leads to the development of acute tonsillitis. In mild forms, the process is limited to catarrhal sore throat, which is characterized by infiltration and hyperemia on the palatine tonsils. However, with a severe course develops ulcerative-necrotic sore throat, affecting the mucosa and underlying structures, spreading down to the bone tissue. After rejection of necrotic masses, deep ulcers remain . Microscopically, there are no neutrophils in places of necrosis.

Clinical picture

The disease begins with pyretic fever (a rise in body temperature to 40°C), chills, sweating, and body aches.

Simultaneously with the general changes there are pathological processes in the oropharynx. Characterized by severe pain in the throat with difficulty swallowing, profuse salivation and bad breath, patients refuse to eat. Regional lymph nodes, liver and spleen are enlarged. High fever persists for a long time, later arthralgia appears.

In myelotoxic agranulocytosis is characterized by the presence of hemorrhagic syndrome, manifested by bleeding gums, nosebleeds, the formation of bruises and hematomas, hematuria.

Among the most frequent complications are perforation of the soft palate, sepsis, mediastinitis with fatal outcome.

Diagnosis

It is necessary to carefully collect an anamnesis, clarify what drugs the patient takes, the presence of concomitant diseases.

General examination and pharyngoscopy are performed. It is obligatory to perform a general blood test, which reveals leukopenia due to a decrease in neutrophil granulocytes (total leukocyte count less than 1.0×109 / L, neutropenia below 0.5×109 / L, relative lymphocytosis and monocytosis). In myelotoxic agranulocytosis , the number of erythrocytes and platelets is reduced . Then a bone marrow study is performed, where a violation of leukopoiesis is noted. If autoimmune agranulocytosis is suspected, a blood test for antineutrophil antibodies is performed. In all cases, it is necessary to consult a hematologist.

Treatment

Initially, it is necessary to cancel all drugs that could lead to the development of agranulocytosis. Patients are treated in the hematology department, where hemotransfusions are performed , drugs that stimulate leukopoiesis, antibacterial and antifungal therapy are prescribed .

It is necessary to regularly perform sanitation of oropharynx with removal of necrotic masses, treatment with antiseptic solutions. In the immune nature of the disease glucocorticoids are administered in high dosage, in the presence of a large number of circulating immune complexes plasmapheresis is indicated. A sparing high-calorie diet is prescribed, if necessary, the transition to parenteral nutrition. It is necessary to prevent infectious complications. The prognosis for this disease is severe.

Acute catarrhal pharyngitis

Etiology of acute catarrhal pharyngitis

Infectious inflammatory changes in the pharynx are most commonly caused by viruses (about 70%), less commonly by bacteria (30%).

Among the viruses are:

• Adenoviruses;
• Respiratory syncytial viruses (RS);
• Rhinoviruses;
• Herpes viruses;
• Influenza and parainfluenza viruses;
• Coxsackie viruses, coronaviruses.

Among bacterial pathogens, b-hemolytic streptococcus group A is predominant, pneumococci, mycoplasmas, hemophilus bacillus, Staphylococcus aureus are found less frequently.

Separately, mechanical factors should be singled out as a cause of acute pharyngitis, such as trauma, burns, irritation by caustic substances, allergens.

Anatomy of acute catarrhal pharyngitis

There is a bright hyperemia and edema of the posterior pharyngeal wall, uvula, palatine glands. Lymphoid granules on the posterior pharyngeal wall increase , acquiring the appearance of milky yellow tubercles in large numbers. In some cases, scanty mucous discharge is noted.

Clinical picture of acute catarrhal pharyngitis

Acute pharyngitis is characterized by the prevalence of local complaints over the general symptomatology. Patients are bothered by dryness, dryness, persistence in the throat, which can cause a painful cough. There is a pronounced tearing pain in the throat, a sensation of a foreign body. The general condition changes slightly, body temperature may rise to 37-37.5°C for 2-3 days, body aches, weakness. Regional lymph nodes may enlarge, becoming moderately painful. A distinctive feature of bacterial infection is the prolonged persistence of fever, up to 5-7 days.

Diagnosis of acute catarrhal pharyngitis

When the patient goes to the doctor , a general examination is performed , pharyngoscopy is performed . To clarify the nature of inflammation , a general blood test is prescribed , microscopy of a smear from the surface of the posterior pharyngeal wall to determine the causative agent in case of suspected bacterial infection (especially streptococcus).

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Treatment of acute catarrhal pharyngitis

With viral etiology (more often), only symptomatic therapy is used . It is recommended to rinse the oral cavity with antiseptic solutions, chew lozenges with a combined composition.

If a bacterial infection is suspected, broad-spectrum antibacterial drugs are prescribed systemically.

In both cases, the use of anti-inflammatory drugs is indicated . Absorbent preparations with lidocaine, menthol, essential oils have proved to be good for pain symptom relief. It is recommended to moisturize the air in the room, drink plenty of fluids.