Tonzillofaringit

Description:

Tonzillofaringit - it is an acute infection of a throat and palatine tonsils. Symptoms include a pharyngalgia, a dysphagy, a cervical lymphadenopathy and fever. The diagnosis is exposed clinically, confirmed by means of crops or a rapid test for antigens. Treatment depends on symptoms and in case of hemolitic streptococci of group. And includes antibiotics.

Reasons of a tonzillofaringit:

Almonds participate in system immune supervision. Besides, local protection of almonds is presented by the cells of a flat epithelium capable to processing of antigens and participating in V-and T-cellular answers.
Tonzillofaringit, as a rule, has a virus etiology. The most widespread activators are viruses of acute respiratory infections
(adenovirus, a rhinovirus, an influenza virus, a coronavirus, a respiratory and syncytial virus), but sometimes — a virus of Epshtey - on - Epstein-Barr virus, a herpes simplex virus, a cytomegalovirus and HIV. Approximately in 30% of cases an etiology bacterial. The most widespread bacterial activators are - hemolitic streptococci of group A, sometimes — S. aurous, Streptococcus pneumonia, Mycoplasma pneumonia and Chlamydia pneumonia. Whooping cough, Fusobacterium, diphtheria, syphilis and gonorrhea belong to the rare reasons.
Tonzillofaringita make about 15% of out-patient visits to the doctor. Most often tonzillofaringit, caused - a hemolitic streptococcus of group A, meets at the age of 5-15 years and it is rare at children up to 3 years.

Symptoms of a tonzillofaringit:

Pain when swallowing is a symptom of this disease. It often irradiates in ears. Small children who cannot complain of a pharyngalgia often refuse food. High fever, an indisposition, a headache and gastrointestinal frustration, and also an unpleasant smell from a mouth and a snuffling voice are characteristic. Also there can be scarlatiniform or nonspecific rash. Almonds are edematous and hyperemic, often covered purulent for a short while. The painful cervical lymphadenopathy is characteristic. Fever, an adenopathy, petechias in the sky and a plaque — all this is more characteristic for - hemolitic streptococci of group A, than of a virus tonzillofaringit, but in many respects they are similar. Tonzillofaringit, caused by a hemolitic streptococcus of group A, usually passes within 7 days. And in the absence of treatment leads to local purulent complications (for example, peritonsillar abscess or cellulitis), and sometimes to rheumatic fever or a glomerulonephritis.

Diagnosis:

It is easy to distinguish pharyngitis clinically, and its reason — no. The rhinorrhea and cough are typical symptoms of a viral infection. The infectious mononucleosis is assumed at a zadnesheyny or generalized adenopathy, a gepatosplenomegaliya, fatigue and an indisposition over 1 week; at a full neck with petechias on a soft palate; and at a dense plaque on almonds. The dirty-gray, dense, hardly deleted plaque at which removal the bleeding surface is bared is a symptom of diphtheria (seldom meets in Great Britain).
As at the tonzillofaringit caused - a hemolitic streptococcus of group A, antibiotics are required, it needs to be diagnosed timely. Criteria for diagnosis are contradictory. Many authors recommend to carry out a rapid test for antigens or crops at all children. The rapid test for antigens is specific, but not sensitive and therefore after it it is necessary to make crops, the possessing about 90% specificity and 90% sensitivity. At adults many authors recommend to use 4 criteria: fever in the anamnesis, a plaque on almonds, absence of cough and a painful perednesheyny lymphadenopathy. At the patients having 1 criterion or not having any, low probability - a hemolitic streptococcus of group A, and it is not necessary to inspect them. The patients having 2 criteria are inspected. The patients having 3 or 4 criteria are inspected on a hemolitic streptococcus of group A or treated empirically.

Treatment of a tonzillofaringit:

The maintenance therapy includes an analgesia, hydration and a bed rest. Penicillin V is considered choice drug in treatment of Tonzillofaringit caused by a hemolitic streptococcus of group A; the dose makes 250 mg in 2 times a day within 10 days for patients with the body weight< 27 кг и 500 мг при массе тела > of 27 kg. If the liquid form is required, amoxicillin (Amoxicillin) is effective and more nice to the taste. If комплайнс is a problem,  effectively single  intramuscular administration of benzylpenicillin (benzathine penicillin) in a dose 1,2 million units (600,000 units for children with the body weight of 27 kg). Other peroral drugs include macroleads for patients with an allergy to penicillin, cephalosporins of the 1st generation and clindamycin.
Treatment is begun immediately or postponed until obtaining results of crops. If treatment is begun hypothetically, it should be stopped at negative takes of crops. Repeated crops from a throat usually do not carry out. They are used at patients with a frequent recurrence of the tonzillofaringit caused by a hemolitic streptococcus of group A or at a disease of pharyngitis of close house or school contacts.
The question of a tonsilectomy is considered at a frequent recurrence of the tonsillitis caused by a hemolitic streptococcus of group A (> 6 episodes a year,> 4 episodes a year for 2 years,> 3 episodes a year for 3 years), or at a heavy and persistent acute infection, despite an antibioticotherapia. Other indications for a tonsilectomy include obstructive night the apnoea recuring peritonsillar abscess and suspicion of cancer.
Various effective surgical methods are used for performance of a tonsilectomy, including electrocaustic, a mikrodebrider with single-step high-frequency ablation and acute dissection (sharp dissection). Severe intraoperative or postoperative bleeding arises less than at 2% of patients, usually within 24 hours after operation or 7 days when the scab exfoliates later. Patients with bleeding should be taken to hospital. If on arrival bleeding proceeds, patients are usually inspected in the operating room and carry out a hemostasis. If blood clot is in a mindalikovy pole, patients are observed within 24 hours. Postoperative intravenous rehydration therapy is necessary at 3% of patients, and it is possible at the smaller number of patients when performing optimum preoperative infusional therapy, preoperative introduction of antibiotics, analgetics and glucocorticoids. Postoperative obstruction of respiratory tracts most often arises at children 2 years with the previous obstructive night apnoea and at patients with pathological obesity, neurologic diseases, craniofacial pathology and with a heavy preoperative obstructive night apnoea are younger. Adults of a complication have much more often also usually heavier.