Quinsy (Acute tonsillitis)

Description:

Quinsy is the infectious inflammatory disease which is characterized by local symptoms with interest of a limfoadenoidny pharyngeal ring.
On localization distinguish palatal, pharyngeal, lingual and guttural quinsies, depending on in what almond there is an inflammatory process. The Opastnost of quinsy consists in its complications which can affect heart, joints, respiratory system, etc.
For the first time the description of a disease belongs to Hippocrates who paid attention to symptomatology still 5-4th century BC.
In 75% of cases quinsy is diagnosed for children. The statistics saying about bigger prevalence of quinsy among children's urban population is well-known.

Quinsy reasons:

Various etiological agents – bacteria, viruses, fungi, etc. can cause quinsy.
Among the bacteria which are most often found at quinsy diplococcuses, pneumococci are staphylococcus. Viral quinsy most likely is caused enteroviral infections.
Infection can occurs in the airborne way, is more rare enteral (through digestive tract) at the use of dairy products. So-called traumatic quinsy arises after operative measures in a nose and a nasopharynx.
Due to the dominance of an airborne way infection of one family member is frequent or it is collective leads incidence of the people surrounding it.
The endogenous (internal) way of infection is possible at autoinfection. In this sense an important role is played by an adenoid disease, caries, diseases of bodies of digestive tract. Cases of hematogenous infection with quinsy are known.
Allocate also the factors contributing to development of quinsy: sharp fluctuations of weather conditions, cold snap, overcooling, bacterial air pollution, irrational food, insufficient insolation, unfavorable conditions of the environment. At emergence of the contributing factors there is a disturbance of microflora of a stomatopharynx, at the same time the saprophytic flora inhabiting normal a cavity, can cause the beginning of a disease. Favorable conditions for pathogenic and saprophytic microflora are created at disturbance of nasal breath – under the influence of smoke, dust, increase in adenoides.

Pathogeny:

In a human body I take place the general and local mechanisms of protection which have a znachushchy role in resistance of an organism. Normal these mechanisms do not allow to get infections and to develop to an inflammation. However under the influence of various factors, protective mechanisms can be insolvent in fight against an infection. In a pathogeny of quinsies a part is played by decrease in adaptation abilities of an organism to cold, sharp seasonal fluctuations of environmental conditions (temperature, humidity, a gas contamination, etc.). At a uniform diet with dominance of proteinaceous food, a vitamin deficiency With, In developing of quinsy quite possibly. The Limfatiko-giperplastichesky constitution at children also assumes to development of tonsillitis.
Due to the underdevelopment of a limfoadenoidny ring of a throat, quinsy seldom happens at children of chest and early age, however if it arose, then at this age proceeds hard, with the expressed general manifestations. Much more often quinsy is observed at children of preschool and school age, and also at adults up to 30-35 years. At advanced age quinsy arises seldom and usually proceeds is erased. It is explained by age involute changes of lymphadenoid tissue of throat.
Development of quinsy happens as allergic-giperergichesky reaction. Assume that rich microflora of lacunas of almonds and products of proteinaceous disintegration can work as the substances promoting an organism sensitization. In a sensibilized organism various factors of the exogenous or endogenous nature play a releaser role in development of quinsies. Besides, the allergic factor can serve as premises for emergence of such complications as rheumatism, acute nephrite, nonspecific infectious polyarthritis and other diseases having the infectious and allergic nature. Beta and hemolitic streptococci of group A have the greatest pathogenicity. They bear capsules (M-protein) for an attachment to mucous membranes (adhesion), are steady against phagocytosis, emit numerous exotoxins, cause a strong immune response, and also contain the antigens which are cross reacting with a cardiac muscle. Besides, the cell-bound immune complexes including them participate in damage of kidneys.
With a streptococcal etiology of quinsy the high probability of development of late complications is connected with damage of internals. The post-streptococcal glomerulonephritis, toxic shock, and in 2-3 weeks after stopping of symptoms of tonsillitis - rheumatic fever can develop in reconvalescence stages (for the 8-10th day from an onset of the illness).
Staphylococcal quinsy also has a number of the characteristic signs connected with features of the activator. Stafilokokki are very aggressive microorganisms, can cause abscesses, cosecrete a set of toxins, including antiphagocytic factors, including enzyme a coagualase and the protein A blocking opsonization. Usually staphylococcus gets into an organism through a mucous membrane of a nasal cavity, a mouth and a throat. In the place of implementation of the activator primary pyoinflammatory center in which restriction mechanism reaction of regional lymph nodes has great value develops. The enzymes emitted by stafilokokka promote reproduction of microbes in the inflammatory center and to their distribution to fabrics lymphogenous and hematogenous in the ways. In the place of implementation of the activator inflammatory process of which the zone of a necrosis surrounded with leukocytic infiltration and accumulation of stafilokokkov and hemorrhagic exudate are characteristic develops. It is possible formation of microabscesses with the subsequent merge in the large centers.

Quinsy symptoms:

Despite existence  of various options of quinsy, all of them have the general clinical signs. The incubation interval, i.e. time which passed from the moment of infection before emergence of the first symptoms of a disease at quinsy makes up to 2 days. The acute beginning of a disease is characteristic. There is a fever, the general weakness, a headache, an arthralgia, a pharyngalgia when swallowing. The fever proceeds within 15 min.-1 the h, and then is replaced by feeling of heat, at severe forms of a disease the fever repeats. Body temperature within a day reaches 38,0-40,0os (febrile fever). With a condition of adequate treatment the increased temperature keeps about one week. The headache is stupid, has no certain localization and remains during 1-2 days. Appetite and a sleep is interrupted. At the same time there is a pharyngalgia, insignificant in the beginning, disturbs only when swallowing, then gradually amplifies and becomes a constant. Closer by 3rd day of a disease the pharyngalgia gains so expressed character, the patient cannot drink, eat and even to swallow saliva.
Exists clinical варинт courses of quinsy at which the disease begins with inflammatory changes in almonds, and all-toxic symptoms come a bit later. This option meets much less often. In these cases in the beginning patients are disturbed by pharyngalgias when swallowing which fever, the general weakness, a headache and others within a day join.
During the feverish period face skin is hyperemic, and with normalization of body temperature gets light pink coloring. Temperature can smoothly be normalized, within several days that lytic decrease in temperature is called. Vzmozhen critical option of stopping of fever when body temperature falls sharply within several hours, is followed profuse then.  Skin rash does not happen. At uncomplicated quinsy opening of a mouth free.

Complications:

Complications of quinsy are very various. also mention cardiovascular, musculoskeletal, respiratory and other systems of an organism. They include otitises, laryngitis, parafarengialny abscess, throat hypostasis, meningitis, lymphadenitis, neck phlegmons, abscesses. Owing to the postponed quinsy the organism sensitization even to usual saprfitny flora of a stomatopharynx is observed. After quinsies rheumatism, a pyelitis, a glomerulonephritis, a nephrosis, nephrite, cholecystitis, an orchitis, osteomyelitis is quite often diagnosed. Chances of generalization of an infection in the form of sepsis, septicopyemias.

Treatment of Quinsy:

The major aspect is timely begun therapy of quinsy since heavy complications after this disease are well-known.  Treatment in specialized anginous departments of infectious diseases hospitals is shown. In the first days of a disease before normalization of temperature appoint a bed rest. Various food, vitamin-rich, with an exception acute, hot, cold is shown. Plentiful drink is useful: freshly cooked fruit juice, tea with a lemon, milk, alkaline mineral water. It is necessary to monitor function of intestines.
Purpose of medicamentous therapy is pathogenetic treatment. Medicamentous means should be applied strictly individually depending on the nature of quinsy, a somatic state. At the easy course of quinsy without the expressed intoxication appoint according to indications sulfanamide drugs inside, the adult on 1 g pass 4 times. In hard cases, at considerable intoxication, appoint antibiotics. Apply penicillin in oil on 200 000 PIECES And more often - 6 times a day. If the patient does not transfer penicillin, purpose of erythromycin on 200 000 PIECES is shown inside during food 4 times a day within 10 days, or an opetetrin on 250 000 PIECES in 4 times a day within 10 days, or tetracycline inside on 250 000 PIECES 4 times a day within 10 days. Sick rheumatism and to persons with pathological changes in kidneys for the prevention of an exacerbation of a disease appoint antibiotics irrespective of quinsy form. Inside appoint also acetylsalicylic acid on 0,5 g 3-4 times a day, ascorbic acid on 0,1 g 4 times a day.
For rinsing use warm solutions of potassium permanganate, boric acid, gramicidin, Furacilin, a hydrocarbonate and sodium chloride, antibiotics, and also broths of a sage, a camomile (1 tablespoon on a glass of water). The children who are not able to rinse a throat are often given (in each 0,5 - 1 h) to have not hot tea with a lemon or fruit juice. Greasing of a throat can promote an exacerbation of a disease and therefore it is contraindicated. When involving regional the warming compresses for the night are shown (better spirit: 1/3 alcohols and 2/3 waters) and a warm bandage on a neck in the afternoon, steam inhalations. At prolonged lymphadenites topical administration of a sollyuks, UVCh currents is shown. In the course of treatment it is necessary to watch a condition of cardiovascular system, to repeat analyses of urine and blood that will allow to begin treatment of complications timely. At phlegmonous quinsy if process progresses and peritonsillar abscess was formed, its opening is shown. Sometimes instead of opening of abscess make operation - an abstsesstonzillektomiya (removal of almonds during which the abscess is emptied).