Simanovsky-Plaut-Vincent angina: photo, treatment, causes and symptoms

Varieties and atypical forms

There are not so many classic forms of unilateral sore throat. Distribution occurs according to the pharyngoscopy picture.

The identification looks like this:

Diphtheroid (fibrinous-membranous) form. Progression occurs against the background of bacterial pathology caused by staphylococci. The defining sign is the formation of a compacted film of a gray-yellow hue on the tonsils. This is an atypical manifestation of angina, diagnosed in isolated cases.
Ulcerative form. It is expressed by unilateral inflammation of the tonsil. Necrotic formations are covered with a dirty yellow pasty layer.

Reactions that occur in the body when exposed to a pathogenic factor can be localized not only on the tonsils; pathological processes are also recorded on the muscle tissue covering the roots of the teeth, the inner surface of the cheeks, and in some cases can affect the genitals.

Causes

The development of the disease is facilitated by the fusospirallary symbiosis of the coexistence of two types of microorganisms - fusobacteria and Vincent's spirochete. These microbes are present in the oral cavity, namely, in the periodontal pockets of the gums and lacunar openings of the tonsils, of every healthy person. However, in small quantities they do not have pathogenic properties.

When the protective properties of the body are weakened, saprophytes begin to actively reproduce, which leads to ulcerative necrotic sore throat.

There are other reasons for the virulence of these microorganisms:

nutritional dystrophy, as a result of insufficient consumption of complete protein foods in the daily diet;
avitaminosis;
late complication, which is differentiated from the outcome of influenza;
regular intoxication of the body in small doses (harmful working conditions, smoking, unfavorable environmental factors, consumption of alcoholic beverages);
insufficient personal hygiene of the oropharynx;
carious spots, gum inflammation, periodontitis, etc.

Due to the fact that the main triggering mechanism for ulcerative membranous tonsillitis is a cold, that is why an increase in diagnosed cases is recorded during the cold period.

The differential characteristic of necrotizing tonsillitis is a relatively narrow category of people at risk. This category includes men aged 18-35 years!

Triggers that cause disease

We found out that Vincent's ulcerative stomatitis appears against the background of the activation of two bacteria - Vincent's spirochete and spindle-shaped rod. But why do these microbes begin to multiply in the body with a vengeance?

The main reason is weakened immunity. If a person constantly suffers from colds, has a poor and unhealthy diet, has problems with the kidneys and liver, gastrointestinal tract, leukemia, syphilis, HIV, oncology, disorders of the endocrine system, he has recently undergone surgery, and also experiences constant stress and overexertion, then you are not immune from this disease.

Also, the risk of infection arises in those who periodically violate oral hygiene and do not treat diseased teeth in a timely manner. Soft and hard plaque, carious bacteria contribute to the proliferation of anaerobic microflora. And when plaque is localized not only on the enamel, but also under the gums, it irritates the mucous membrane and is another prerequisite for an outbreak of infection.

Another common reason why pathology develops is considered to be a traumatic factor, which leads to damage to the upper layers of the mucosa. Its integrity can be impaired by an incorrect bite, wearing uncomfortable orthodontic devices and prosthetic structures, the presence of decayed teeth with sharp edges, as well as the period of teething. Most often, wisdom teeth become the culprits of infection, because... Eights take a very long time to come out of the gums.

Symptoms

Based on the degree of dysfunction, characteristic symptoms are identified, expressed in mild, moderate or severe form. Distinctive features are the extent of the spread of pathology in the tonsils, as well as temperature indicators.

The mild (latent) stage of infection is described as similar to pharyngitis. This stage has the following features:

low-grade fever (often small jumps in temperature do not last long or are within normal limits);
a feeling of moderate pain and dry mouth;
visible processes of inflammation (redness) are localized exclusively on lymphoid tissue;
painless palpation of the cervical lymph nodes, possibly slightly enlarged.

More complex processes appear with moderate severity of ulcerative tonsillitis. This form has the following characteristics:

temperature indicators are fixed at 37.5-38°C;
sore throat becomes intense during swallowing, but remains tolerable;
examination of the tonsils indicates their swelling and slight redness of the outer layer;
The superficial membrane of the tonsils is covered with so-called “stones”, with dirty white contents.

It is most difficult to tolerate the symptoms of severe Simanovsky tonsillitis. It is at this stage that the disease can rapidly worsen.

Clinical manifestations of exacerbation of Simanovsky development tonsillitis are based on the following indicators:

moderate fever (up to 39°C) sometimes developing into a life-threatening hyperpyretic stage;
redness and swelling of the mucous membranes are already localized not only on the tonsils, but also rapidly spreads to other areas of the oropharynx: gums, soft and hard palate, lymphadenoid tissue of the posterior wall of the pharynx, the vestibular part of the respiratory tube;
ulcerative formations are subsequently formed on the fibers of the musculoskeletal, vascular and muscular systems.

If we take the general symptoms, there is an additional set of symptoms characteristic of any of the stages:

putrid odor from the mouth;
increase in temperature indicators;
hypersalivation (increased salivation).

What other diseases are named after Vincent?

When only the gums are affected by the bacteria discussed above, they say that Vincent's ulcerative-necrotizing gingivitis occurs. When an extensive surface of the entire mucous membrane is also involved in the inflammatory process, then we are talking about stomatitis, and when the tonsils are also affected, then Botkin-Simanovsky-Plaut-Vincent sore throat is diagnosed.

“Acute ulcerative gingivitis of Vincent is very dangerous because it can degenerate into chronic. And if initially the process affects only the gums in the area of 1-3 teeth, then later it can become generalized, i.e. capture all teeth. This disease poses a direct threat not only to the gums, but also to periodontal tissues - it can develop into periodontitis, disrupt the safety and stability of teeth, and their basic chewing function. To avoid this, come to the dentist on time and certainly do not try to be treated with traditional methods, as some people now do,” warns O.P. Vasilevsky, a dentist with 30 years of experience.

Photo of Simanovsky-Vincent's angina: what it looks like

Often the only manifestation of the disease at the primary stage is characterized by an unpleasant sensation at the time of swallowing.

Pharyngoscopy during the moderate and severe stages of Simanovsky's angina reveals enlargement and hyperemia of the glands. They are covered with a dirty white coating, clearly visible in the presented photo, which can be easily scraped off with a spatula. In this case, a bleeding erosion remains, at the bottom of which there is a loose fibrin overlay.

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Diagnostics

At the initial examination by an ENT doctor, after collecting an anamnesis, the oropharynx is examined and the cervical lymph nodes are palpated.

To determine the ratio of leukocytes, lymphocytes and macrophages in the blood composition, as well as to identify the speed and intensity of red blood cell adhesion, a general detailed blood test is prescribed.

The justification for making a microbiological diagnosis of Simanovsky's angina is the combined clinical picture and the result of bacterial culture, during which a large coefficient of fusiform rods and Vincent's spirochetes was isolated in the studied material (scrapings from the pharynx and nose).

In addition to culturing the pathogen, tests are done to determine the sensitivity of the infectious agent to antibacterial drugs.

It is also taken into account that in some cases, fusospirochetal symbiosis is also characteristic of other pathologies of the larynx.

Fusospirochetosis is differentiated from such similar pathologies as: diphtheria of the larynx, venereal diseases, malignant tumors of the tonsils with ulcerations and tuberculosis!

Treatment of Simanovsky-Vincent's angina

The latent phase of gangrenous tonsillitis lasts longer than with the classic form of the disease, lasting about 7 days.

Similarly, a longer prodromal period is noted - 1-2 weeks. In acute clinical cases, the duration can reach 1 month.

Simanovsky-Plaut-Vincent angina is subject to treatment using antibacterial agents. This therapeutic method is typical for mild and moderate forms of gangrenous tonsillitis.

To quickly eliminate severe symptoms, drugs of the penicillin group are administered intravenously or intramuscularly.

Systemic complications may also develop in the form of sepsis, abscess and purulent phlegmon, which usually requires immediate hospitalization of the patient!

In addition to systemic antibiotic therapy, local treatment is also prescribed in the form of lubricating the tonsils at intervals of 2 hours, as well as gargling with antiseptics.

In addition, the doctor prescribes other drugs aimed at eliminating the general symptoms of the disease, namely, drugs with antipyretic and analgesic effects.

Vitamin therapy (vitamins C and B) is aimed at detoxifying the body. Patients are also advised to increase their drinking regime.

With timely consultation with a doctor and proper therapy, the disease goes away without serious deterioration with further regeneration of all functions of the tonsillar tonsils.

Physiotherapeutic treatment

To obtain maximum results, a course of physiotherapy may be prescribed in parallel with drug therapy.

The following methods of influence are used:

ultrasonic waves,
microwave therapy,
ultraviolet irradiation,
magnetotherapy,
ion therapy, etc.

Each type of physiotherapy has its own recommended course, if not followed, the therapy may not have the desired effect. The number of sessions is determined by the attending physician. For ulcerative tonsillitis, you must undergo at least 10 physiotherapy procedures. In some cases, for the purpose of prevention, the course can be resumed a month after complete recovery.

Rinsing and irrigation

In order to cleanse and disinfect the oral cavity, “oral baths” are used.

The following products can be used to rinse the pharynx:

2-5% solution of potassium permanganate;
hydrogen peroxide.

Such procedures must be repeated daily throughout the entire treatment period.

Lubricating the mucous membranes of the tonsils

During local therapy, lubrication of focal segments is involved through the following tinctures:

aqueous (8%) or alcoholic (2-10%) solution of potassium iodide;
potassium chloride;
3% and 5% silver nitrate solution;
copper sulfate;
10% solution of Novarsenol in glycerin.

To heal the ulcerated layer, powdering with Osarsol powder is prescribed.

Tablets and injections

Membranous tonsillitis is considered an atypical and rare pathology. The main method of treatment is the use of antibiotic therapy.

The most effective drugs include:

azalides (Hemomycin, Zitrolide, Sumamed);
cephalosporins (Cefuroxime axetil, Cefaclor, Zefter);
penicillins (Benzylpenicillin, Amoxiclav, Ampiox).

However, greater preference is given to the azalide series of antibiotics, because they have the least amount of side effects on the patient’s gastrointestinal tract. In addition, azalides, in comparison with other antibacterial drugs, are less toxic.

That is why the azalide series of drugs can be used in the treatment of pediatric patients, as well as for pregnant women. For this group, Gramicidin, Bioparox or Fusafungin can be used.

Medicines are prescribed orally or for intramuscular administration. When calculating the dosage, the doctor takes into account the age, weight and degree of infection of the patient.

In the case when the sore throat is quite severe, analgesic drugs are prescribed: Aspirin, Akofin, Metindol. Also during this period, the patient’s appetite worsens, which often provokes constipation. They are eliminated through laxatives (Bisacodyl, Senade, Slabilen) or enemas.

In addition to local and general therapy, a course of general strengthening measures is prescribed - a vitamin complex (drugs of groups B and C). Therefore, nicotinic and ascorbic acids, as well as riboflavin, are prescribed.

Antibiotic therapy for necrotizing tonsillitis shows noticeable results after 3-4 days of taking medications, but for absolute recovery the course lasts 7-10 days!

Tonsil removal

If the therapeutic course chosen by a specialist is not effective and a relapse occurs, the need for tonsillectomy (laser ablation, electrocoagulation) may be considered. The surgical procedure involves complete removal of the tonsils.

Diet

During drug treatment, a special dietary program is also used. Strict adherence to the rules of rational nutrition includes the exclusion of hot and spicy foods. For patients with severe ulcerative sore throat, prepared dishes are served in ground form. Food should be of moderate temperature - not hot or cold.

It is recommended to enrich the food complex with protein ingredients as much as possible:

chicken eggs,
yellow cheese,
butter,
meat,
all dairy products,
offal.

Vegetable dishes must be present on the menu. You can steam them or eat them fresh in crushed form.

Particular attention is paid to the presence of berries and fruits in the patient’s diet that contain vitamin C:

lemon,
cranberry juice,
tinctures or tea with rose hips.

If the patient neglects the diet, this can significantly delay the process of restoring impaired functions in the body.

Treatment with folk remedies at home

The doctor may recommend treating the ulcers with saturated sugar syrup (60%) or dusting the lesions with powdered sugar. This method helps to change the habitat of infectious agents, as a result of which microbes stop multiplying.

During an exacerbation, after preliminary consultation with the attending physician, a collection of herbs is used:

The following is taken in equal proportions: thyme, sage, lavender and dried juniper berries.
1 tbsp. The mixture must be poured with 1 cup of boiling water.
The ingredients are placed in a water bath and left for 15 minutes, stirring constantly.
After preparation, steam inhalations are performed. The collection should cool slightly, and the clouds of steam should be moderately warm.
Cover yourself with a towel and inhale the vapors for 5 minutes.

The session must be repeated daily throughout the course of treatment.

Recommendations

In most cases, the onset of pathological processes in necrotizing tonsillitis is provoked by a weakened immune system, therefore, in the initial stages, immunomodulatory therapy is an important aspect in treatment. The effect of medications should be supplemented with products containing an abundance of microelements and vitamins, crushed to a mushy state. It is worth emphasizing that constant irritation of ulcerated lacunae can slow down the healing process.

Despite the fact that this form of purulent tonsillitis does not always occur with elevated temperature, the patient is recommended to remain in bed.

Under no circumstances should you use independent thermal procedures for the pharynx. All manipulations must be agreed upon with the attending physician.

Treatment options

In most cases, necrotizing tonsillitis resolves without complications with subsequent complete restoration of tonsil function. To cleanse and disinfect the mucous membrane of the throat, rinse with a solution of hydrogen peroxide. A good effect is also achieved by using a solution of potassium permanganate.

If Simanovsky's angina is accompanied by chills and fever, a severe general condition, or has a protracted course, antibiotic therapy is prescribed, mainly with penicillin derivatives.

If possible, in case of Simanovsky’s angina, the patient is isolated and given separate dishes. They give plenty of fluids and bland food rich in proteins and vitamins. Additionally, sore throat requires the prescription of vitamin preparations and restoratives.

Prevention

There are no specific preventive measures for Vincent's angina.

However, proper oral care is an important aspect:

repetition of hygienic brushing of teeth in the morning and evening;
rinse after every meal.

To avoid advanced caries, you need to visit the dental office twice a year. Based on the patient’s predisposition to the formation of tartar, as well as lifestyle and diet, it is periodically necessary to carry out professional teeth cleaning.

Maintaining the immune system is also important. This factor can be affected not only by lifestyle, but also by strict diets and overwork. Therefore, taking a multivitamin complex during vitamin deficiency will help avoid serious infections.

What stages of treatment will you have to go through?

Treatment of Vincent's stomatitis is possible only with a doctor. After therapy in the dental office, the specialist will give recommendations that you will need to carry out independently, at home. But under the strict supervision of a doctor. Let's take a closer look at what manipulations a specialist performs.

Stage 1: sanitation of the oral cavity from rashes in dentistry

The main task at this stage is to clean necrotic mucous membranes from rashes and decay products. After all, they are the source of poor health, pain, and malaise. First of all, the doctor applies anesthesia, because any touch to the mucous membrane causes severe pain reactions in the patient. Most often, anesthesin in glycerin is used for this, which does not irritate inflamed gums and has a gentle effect. Less commonly, lidocaine.

To soften tissues affected by erosion, the doctor uses sterile applications soaked in medicinal enzymes. Then, using a surgical instrument, the specialist opens the crusts and treats the inflamed areas with antiseptics: trichopolum, chlorhexidine.

At this stage, it is also important to remove soft plaque and tartar that could be causing the spread of bacteria.

Complications and consequences

The presence of a secondary coccal infection can significantly change the clinical course of fusospirochetosis: pain when swallowing worsens, body temperature rises, even chills.

An exacerbation of the disease can provoke a retropharyngeal abscess. In some cases, when Vincent's angina spreads, it descends to the mediastinum and causes mediastinitis or sepsis.

The described conditions are not often diagnosed, but when they occur, the course of the disease is recorded as severe with extensive necrotic lesions of the oral cavity and pharynx.

In men, ulcerative tonsillitis causes nonspecific symptoms in the form of inflammation of the reproductive system (phimosis, balanoposthitis).

What to do when the health of your teeth and gums is threatened by spirochete bacteria

There are diseases that are localized in the mouth and are not so easy to define, for example, Vincent's stomatitis. A person who has this problem cannot independently suspect or recognize it, and therefore, accordingly, cannot do without the help of a specialist.

Let's try to find out what are the causes and symptoms of this disease. We will also reveal details of treatment that will help you take corrective and timely measures.