Purulent sore throat in adults: symptoms, what it looks like, what it means

• Etiology and pathogenesis
• Classification of tonsillitis Clinical forms of vulgar tonsillitis

Complications of sore throat

Treatment of sore throats

Treatment of vulgar tonsillitis.

Antibacterial therapy for acute streptococcal tonsillitis

Prevention of sore throat

As a disease of the pharynx, sore throat has been known since ancient times.
Sore throat is described in the works of Hippocrates (IV–V century BC), Celsus (I century AD), and also in the manuscripts of the Tajik physician Abu Ali Ibn Sina (Avicenna, 11th century) mention of intubation and tracheotomy for asphyxia due to tonsillitis, etc. Sore throat is a common acute infectious disease in which local inflammation affects the lymphadenoid tissue of various tonsils of the pharynx. In the vast majority of cases, tonsillitis occurs in the palatine tonsils, while other tonsils are involved in the process much less frequently. Angina is not a homogeneous disease; it differs in etiology, pathogenesis and form of clinical course.

Causes of acute tonsillitis

Most often, an infectious inflammatory process develops in the palatine tonsils1,4,5, located on both sides of the root of the tongue on the lateral walls of the pharynx.

The causative agents of sore throat in most cases are:

• Viruses - most often adenoviruses that cause acute respiratory diseases, less often Epstein-Barr, Coxsackie viruses1,2,3.
• Bacteria - beta-hemolytic streptococcus of group A, streptococci of other groups, Neisseria, Corynebacterium and others3.

Sometimes acute tonsillitis accompanies common infectious diseases such as diphtheria, tularemia, gonorrhea2,3.

The infection most often enters the body through airborne droplets, nutritional and contact routes1.

The source of infection is a sick person5. The causative agents of the disease can remain in the body for a long time without causing any symptoms, and when the immune system is weakened, they can trigger pathological processes in the tonsils. This often happens when you carry group A beta-hemolytic streptococcus, which causes exacerbations of chronic tonsillitis1.

The development of acute tonsillitis is promoted by:

• hypothermia;
• sudden change in weather conditions;
• tonsil injuries;
• chronic inflammatory processes in the oral cavity and upper respiratory tract;
• disturbances in the functioning of the nervous system;
• malnutrition and lack of vitamins1.

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Kinds

Based on the nature of structural changes and involvement of the palatine tonsils in the process, the following types of sore throats are distinguished:

• catarrhal - without pus, the mildest form;
• follicular - with the formation of pus;
• lacunar - also a purulent form of tonsillitis;

Depending on the pathogen that caused the infectious process in the tonsils, tonsillitis can be streptococcal, staphylococcal, or mixed etiology.

According to the course of the disease, angina can be mild, moderate and severe.

How to recognize a sore throat

Manifestations of any acute tonsillitis are represented by three main symptoms2,5,6:

• fever;
• sore throat;
• enlargement and tenderness of the submandibular and cervical lymph nodes.

Body temperature always rises during acute angina, regardless of the type of causative agent of the disease. With catarrh, it may remain subfebrile. With follicular and lacunar tonsillitis, the heat increases quickly, the fever can reach 39-400 C, accompanied by chills, general malaise, weakness, drowsiness, and body aches1,2.

Sore throat with sore throat can be of varying intensity: from mild discomfort and pain when swallowing to a feeling of constriction, the presence of a foreign body in the throat and the inability to even take a sip of water. Stiffness in the neck muscles and increased pain may occur when you try to open your mouth wide. Some patients note that they have hoarseness or have lost their voice.1,3

The degree of enlargement, hardening and tenderness of the lymph nodes with angina helps differentiate different types of the disease. This symptom is most striking in infectious mononucleosis, when all the lymph nodes are enlarged. In other cases, the process is often limited to submandibular lymphoid formations2.

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What do tonsils look like with a sore throat?

• Catarrhal inflammation is limited mainly to the mucous membrane of the pharynx. The palatine arches, uvula and tonsils are red, slightly swollen7.

The tongue with catarrhal sore throat is coated and dry. If the process does not worsen, inflammation in the tonsils persists for 3-5 days1.

• With follicular angina, the infection penetrates deep into the lymphoid formations and captures their functionally active tissue - the follicles. The surface of the enlarged tonsils takes on the appearance of a “starry sky” - follicles filled with light pus appear through the red mucous membrane1,7.
• With lacunar angina, the tonsils are enlarged, red, and a purulent coating appears on their surface. Initially, pus appears only in the area of ​​the mouths of the lacunae, then it spreads and covers almost all the tonsils1,7.

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How many suffer from simple sore throat?

Typically, the entire process from the appearance of the first signs of catarrhal inflammation to the clearing of pus from the tonsils takes 5-7 days1.5.

Atypical variants of the disease have their own characteristics.

• With fibrinous tonsillitis, plaque completely covers the entire tonsil. The general condition worsens, a putrid odor from the mouth appears, abdominal pain and stool disorders may occur1.
• With herpetic tonsillitis, the “culprit” of which is the Coxsackie virus, the tonsils become covered with small red dots and blisters, which in appearance resemble herpes2.
• Phlegmonous inflammation of the tonsils is accompanied by purulent melting of tissues and the formation of an abscess (peritonsillar abscess) in their place. More often this happens with advanced sore throat, when the infection spreads beyond the tonsils into the surrounding tissue1.

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How to distinguish a sore throat from ARVI?

Despite the fact that inflammation of the tonsils can accompany respiratory infections, sore throat and ARVI are different diseases. In the first case, the inflammatory process is mainly limited to the tonsils; in the second, in addition to sore throat, fever and swollen lymph nodes, there are always symptoms of damage to the upper respiratory tract, such as a runny nose, sore throat, cough with or without phlegm, and hoarseness. With adenovirus infection, there may also be signs of conjunctivitis: lacrimation, redness and pain in the eyes2.

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How dangerous is a sore throat?

Tonsillitis is dangerous if complications develop. If your throat hurts with a sore throat for more than 7 days, you should think about possible inflammation of the tissues surrounding the tonsils (peritonsillitis), their suppuration and the formation of a peritonsillar abscess. If your ear begins to hurt and your hearing decreases, it means that otitis media has developed.1

Late complications of acute tonsillitis include:

• rheumatism;
• glomerulonephritis;
• infectious-allergic myocarditis;
• polyarthritis;
• cholecystocholangitis1,2.

Timely and competent treatment can prevent these complications of angina.

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Possible complications and prevention

Severe herpes sore throat can lead to the spread of infection throughout the body and damage to internal organs - so-called complications arise. The most common complication after suffering herpes sore throat is serous meningitis, or inflammation of the brain. The disease can lead to disturbances in the functioning of the heart and cause myocarditis, which is diagnosed by an electrocardiogram. Kidney diseases (pyelonephritis), liver, hemorrhagic conjunctivitis - this is just an incomplete list of complications with late diagnosis of the disease and delayed treatment. If you have the slightest suspicion of a disease, do not delay visiting a doctor!

To date, no vaccines have been developed to prevent herpangina disease. During an epidemic, if possible, do not take your child to kindergarten or school. Adults should try to avoid places with a lot of people and remember the rules of hygiene. Both children and adults need to strengthen their immune system in general, eat healthy and balanced, take vitamins and harden themselves.

If there is a sick person at home, it is necessary to ventilate the room frequently, and provide the sick person with individual dishes, linen and a towel.

What helps with sore throat

It all depends on its cause.

For bacterial inflammation of the tonsils, doctors prescribe antibiotics. Only they can relieve a sore throat and reduce the risk of complications1,2,3,4,5. For a viral infection, antibiotics are useless.

To determine the type of sore throat, the doctor conducts a bacteriological study and analysis for beta-hemolytic streptococcus2, since it is the most dangerous representative of the bacterial pathogens of sore throat.

To alleviate the condition of sore throat caused by viruses, symptomatic treatment is sufficient: antipyretics and local therapy aimed at combating inflammation and reducing sore throat1,2.

HEXORAL® preparations may be recommended as a symptomatic remedy.

To irrigate the throat with a sore throat, you can use HEXORAL®8 spray. The broad-spectrum antiseptic hexetidine, which is part of the drug, is active against most bacteria, herpes simplex viruses type 1, influenza A, PC virus that affects the respiratory tract, and fungi, and provides a mild analgesic effect.

HEXORAL® in the form of a spray is convenient to use because it allows you to evenly spray the drug onto the entire mucous membrane of the tonsils and pharynx8. HEXORAL® solution can be used for traditional gargling9.

Lozenges HEXORAL® TABS, HEXORAL® TABS CLASSIC and HEXORAL® TABS EXTRA10,11,12 also help fight infection and sore throat during sore throat.

• HEXORAL®TABS with a neutral mint taste, based on the antiseptic chlorhexidine and the anesthetic benzocaine, can be suitable for both adults and children over 4 years of age10.
• HEXORAL®TABS CLASSIC for adults and children over 6 years old, contains a combination of antiseptics (amylmetacresol and 2,4-dichlorobenzyl alcohol), available in orange, black currant, lemon and honey with lemon flavors11.
• HEXORAL®TABS EXTRA, in addition to the antiseptic component, contains the anesthetic lidocaine, which can relieve even severe sore throat. The drug can be used by adults and children from 12 years of age.

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The information in this article is for reference only and does not replace professional advice from a doctor. To make a diagnosis and prescribe treatment, consult a qualified specialist.

Literature

1. Kudryavtseva Yu. S., Kunelskaya N. L., Turovsky A. B. Sore throats: diagnosis and treatment // General Medicine - No. 3, 2010. - P. 4-9.
2. Zaitseva S.V., Zastrozhina A.K., Kulikova E.V. Acute tonsillitis in the practice of a pediatrician // Medical Council.2019; 2. - pp. 113-119.
3. Clinical recommendations Acute tonsillopharyngitis // National Medical Association of Otorhinolaryngologists / 2021. - P. 36.
4. S. A. Artyushkin, N. V. Eremina Acute and chronic tonsillitis, pharyngitis: terminology, etiology, diagnosis, treatment // Otorhinolaryngology Pulmonology No. 10 (98) / 2014 - P. 66-70.
5. A.V. Gurov, M.A. Yushkina Local therapy of inflammatory diseases of the pharynx // Breast cancer. 2021. No. 11. - pp. 792–796.
6. Clinical recommendations “Differential diagnosis and treatment of acute tonsillpharyngitis.” // National Medical Association of Otorhinolaryngologists / Moscow - 2014. - P. 22.
7. E.I. Krasnova. Differential diagnosis and therapeutic tactics for acute tonsillitis (tonsillitis) at the present stage // E. I. Krasnova, N. I. Khokhlova, V. P. Provorova, A. N. Evstropov // Attending physician No. 11, 2021. - C 58-63.
8. Instructions for use of the drug HEXORAL® AEROSOL: .
9. Instructions for use of the drug HEXORAL® SOLUTION: .
10. Instructions for use of the drug HEXORAL® TABS: .
11. Instructions for use of the drug HEXORAL® TABS CLASSIC: .
12. Instructions for use of the drug HEXORAL® TABS EXTRA: .

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Classification of the disease

Inflammatory pathology of the tonsils varies:

• by type of pathogen, can be bacterial, viral or fungal in nature;
• by the nature of the course - acute or chronic;
• according to the clinical picture - catarrhal, follicular or lacunar.

Sore throat can be primary (simple), which occurs when a bacterial infection penetrates, secondary, which occurs against the background of other diseases of the body, and also specific, caused by the action of a specific agent.