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Primary tonsillitis
The most common bacterial cause is
Group A -hemolytic streptococcus (
GABHS), which causes strep throat.
Less common bacterial causes include:
Staphylococcus aureus (including
methicillin resistant Staphylococcus
aureus or MRSA ),
Secondary tonsillitis
(symptomatic)
The most common causes of tonsillitis
are adenovirus, rhinovirus, influenza,
coronavirus, and respiratory syncytial
virus. It can also be caused by
Epstein-Barr virus, herpes simplex virus
, cytomegalovirus.
Specific tonsillitis
Sometimes, tonsillitis is caused by an
infection of spirochaeta and treponema,
in this case called Vincent's angina or
Plaut-Vincent angina.
Sometimes by fungi.
Sometimes - by Corynebacterium
diphtheriae
Etiology
Corynebacterium
diphtheriae
Grampositive, nonmotile
(Leffler rod)
Epidemiology
Source sick person or carrier (convalescent
or health) of toxicogenic strains
Ways of transmission - airborne, contact household (occasionally)
Sensibility is high, adults more often become
sick (80 %)
Case rate sporadic, outbreaks are possible
Immunodefence antitoxic, postvaccine
Seasonal character - autumn - winter
Pathogenesis
Penetration of the agent through entrance
gate (mucous of upper respiratory tract,
sometimes conjunctivas, skin)
Production of exotoxin
Local and systemic effects of the toxin:
Dermonecrotoxin - necrosis of a surface
epithelium, retardation of blood stream,
rising of a permeability of vessels, their
fragility, transuding of plasma in ambient
tissues, formation of a fibrinous film,
edema of tissues; downstroke of pain
sensitivity
Pathogenesis
Neuraminidase - replacement of
cytochrome, blockage of cellular
respiration, destruction of a cell,
violation of a function of organs and
tissues (central and peripheric nervous
system, cardiovascular system, kidneys)
Hyaluronidase - destruction of a stroma
of a connecting tissue (rising of
permeability of vessels, edema of
tissues)
Hemolysin - hemorrhagic set of
symptoms
Classification
Localization - otopharynx, nose, larynx,
trachea and bronchi; rare localizations (skin,
eye)
Degree of severity - mild, moderate, severy,
hemorrhagic, hypertoxic
Form - localized, wide-spread, combined
Nature of process - catarrhal, island-like,
paleaceous
Complications - myocarditis, neuritis,
nephritis (early and late)
Subclinical (carriering)
Clinical manifestation
Incubation period 2-10 days
Phenomena of intoxication (high fever,
malaise, general weakness, headache)
Pharyngalgia - moderate
Changes of a throat mucous - soft hyperemia,
edema of tonsills, covers on their surface
(grey colour, dense, hard to remove with
bleeding, slime), spread out of tonsills limits
(palatopharyngeal arches, uvula, soft palate)
Augmentation and moderate morbidness of
regional lymph nodes
Edema of a hypodermic fat of a neck
Diphtheria of larynx
Real croup (stenosis of a larynx)
degree (catarrhal) - labored inspiration,
retraction of intercostal spaces, rasping dog
barking" cough, horse voice
degree (stenosis) - noisy respiration,
inspiratory dyspnea with an elongated
inspiration, participation in respiration of
auxiliary muscles, aphonia
degree (asphyxia) - acute oxygen
insufficiency, sleepiness, cyanosis, cold
sweat, cramps, paradoxical sphygmus
Complications
Infectious-toxic shock
Intra vessels disseminated
syndrome
Myocarditis (early, late)
Polyradiculoneuritis (early, late)
Nephrosonephritis etc.
LABORATORY DIAGNOSTIC
Detection of the agent in smears from a
throat and nose (taking of material on border
between effected area and normal mucous)
Microscopy (colouring by Neisser) typical
locating of rods, grains of volutin in bacterias
Sowing on convolute serum or telluric blood
agar for allocation of clean culture and
recognizing of toxigenisity
Serological tests mirror a condition of immune
defence (efficiency of vaccination)
Treatment
Immediate hospitalization
Bed regimen (at localized forms - 10 days, at toxic not less than 35-45 days)
Specific treatment - introducing of antitoxic
antidiphtherial Serum (from 30-50 thousand IU at the
localized forms up to 100-120 thousand IU at toxic,
by Bezredka method)
Glucocorticoids (in toxic forms and croup)
Antibiotics (penicilini, tetracyclini, erythromycini)
Strychninum (in toxic forms)
In case of croup - inhalations, broncholitics, diuretics,
glucocorticoids, antibiotics, antihistamine, lytic
admixture; under the indications - intubation,
tracheotomy
Conditions of
discharging from a
hospital
Clinical convalescence
2 negative results of bacteriological
research of smears from a throat and a
nose with two-day interval
For decret group - additional double
bacteriological examination in polyclinic
Prophylaxis
Plan immunization (vaccination in 3, 4,
5 months. With PT vaccine,
revaccination in 18 months; 6, 11,
14, 18 years and adults every 10
years with T- vaccine)
In the focus
7 days medical observation after contact persons
Bacteriological examination
Sanation of detected carriers
Final disinfection
Revaccination
Desinfection
Aeration and ultra-violet lighting of puttings,
wet cleaning with usage of 2/3-basic salt of
perchloron, calcium of hypochlorite, 3 % of
solution of chloraminum, 1 % of solution
amfolan
Sputum, the outwashes from a nasopharynx
hash with double quantity of solutions,
exposition 2 hours. The tableware is boiled in
2 % potassium solution 30 mines. Bedclothes and clothes if necessary to
decontaminate in desinfection camera
Differential diagnosis
Tonsillitis, including Plaut-Vincent-Simanovsky
Herpetic tonsillitis
ARVI (adenoviral infection, false croup)
Paratonsillar abscess
Infectious mononucleosis
Scarlet fever
Pseudotuberculosis
Tonsillo-bubonic form of tularemia
Mycotic affection of tonsills
Epidemic parotitis
Typhoid fever
Lues
Hematological diseases (acute leukosis,
agranulocytosis)
Common symptoms of
tonsillitis
sore throat
red, swollen tonsils
pain when swallowing
high temperature (fever)
coughing
headache
tiredness
chills
a general sense of feeling unwell
white pus-filled spots on the tonsils
swollen lymph nodes (glands) in the neck
pain in the ears or neck
changes to the voice or loss of voice
Complications
Complications may rarely include dehydration and kidney failure due to