ANGINE ACUTE

- inflamatii faringiene + a ariei periamigdaliene cauzate de virusuri, bacterii - expresia clinica febra, odinofagie, disfagie

+ modificari obiective (eritem, inflamatie, adenopatie)

ANGINE BACTERIENE ETIOLOGIE:

S.pyogenes (30%)
Stafilococ aureu Mycoplasma sp. H.Influenzae

Corynebacterium diphteriae
EPIEDEMIOLOGIE Copii, tineri, rar < 3 ani

Sursa omul bolnav, purtator

Transmitere directa saliva, picaturi secretii respiratorii

PATOGENEZA:
- aderare (fibronectina), multiplicare locala, invazia mucoasei faringiene - inflamatie faringe, amigdale, lueta, + hiprplazie ganglionara CLINIC: - Incubatie 2-3 zile - debut brusc febra , cefalee, odinofagie, disfagie, - adenopatie submandibulara adenita

- amigdale tumefiate, eritematoase + depozit opalin, pultaceu

FORME CLINICE: - Angina eritematoasa - angina pultacee - angina flegmonoasa (flegmon periamigdalian) - angina pseudomembranoasa - angina ulcero-necrotica

- angina Ludwig, angina Henoch (scarlatia), angina Vincent

LABORATOR:
- VSH, CRP, fibrinogen crescute - leucocitoza, neutrofilie - SF streptococ bet-hem. Gr.A; - antibiograma pentru macrolide, clindamicina - SF - Staphylococcus aureus ! etio- - incerta, context clinic DIAGNOSTIC: - clinic - microbiologic DIAGNOSTIC DIFERENTIAL: - mononucleoza infectioasa - angina Ludwig de cauza odontogena - angine neinfectioase (agranulocitoza, leucemii) - TU faringiene

- angina difterica

TRATAMENT:

Penicilina G 4-6 mil.UI/zi - 10mil.UI/zi - 7 zile

Penicilina V 4x500mg/zi 10zile Macrolide 10-14 zile Cefalosporine gen.I Amoxicilina 3x500mg/zi 10 zile Profilactic:

Moldamin 1.200.000 UI i.m. la 7-10 zile, timp de 1 luna

Copil >4 ani 600.000UI i.m la 7-10 zile Tratament antiinflamator

ANGINA DIFTERICA Bacil Gram-pozitiv Corynebacterium diphteriae Vizualizare pe frotiu (bastonase, litere hinezesti) Tulpini producatoare de toxina - Angina eritematoasa necrotica + pseudomembrane greu detasabile (sangerare locala), cenusii, albe care se refac rapid - edem important local obstructia cailor respiratorii - gat proconsular - toxina circulanta produce modificari multiorganice (cord, SNC, rinichi) Diagnostic: Epidemiologic Clinic Laborator!!! Tratament: Ser antidifteric (in primele 24-72h) Eritromicina 40-50mg/kg/zi, penicilina G 10 mi.UI/zi 10 zile

ANGINE VIRALE - faringian: eritem difuz, microvezicule - febra inalta - disfagie, odinofagie

- cefalee, mialgii - catar nazal, traheobransic, ocular - +/- alte manifestari: exantem, diaree, hepato-splenomegalie (MNI) - laborator: normal sau leucopenie
- tratament: antiinflamator, simptomatic

VIRALA

STREPTOCOCICA