Non-necrotic angina (purulent necrotic tonsillitis) is a disease of the larynx, which is non-infectious nature and developing against the background of excessive reproduction of the conditionally pathogenic microflora - spirochetes and sprinkled sticks that dwell on the mucous membranes of the oral cavity and larynx. We will deal with what kind of necrotic angina, how its diagnosis and treatment is carried out.

The main symptoms of ulcerative-necrotic tonsillitis are:

• signs of general intoxication;
• increasing saliva generation;
• a slight pain in the throat when swallowing, amplifying after attaching to spirochetes and spindle-shaped sticks of staphylococci and streptococci;
• dehydration of the body;
• an increase in lymph nodes;
• feeling in the throat of the foreign body;
• the appearance of bad breath;
• the increase in the size of the tonsils and the appearance of a plaque having a pale yellow or light gray shade on them.

The pathological process is involved, as a rule, only one almond, a bilateral form of the disease is extremely rarely diagnosed.

Attention! Temperature of the body in necrosis does not exceed 37 C.

Causes of appearance

As a rule, the development of necrotic angina is carried out on the background:

• prolonged diseases that are infectious in nature;
• problems with the oral cavity (stomatitis and caries);
• general exhaustion of the body;
• avitaminosis;
• immunodeficiency;
• prolonged suppuration in the field of nasopharynx;
• insufficient oral hygiene.

However, occasionally the reasons for purulent-necrotic angina can also be other factors: difftheria, leukemia and other blood diseases, tularemia, scarladine.

Complications

The main complications of pathology are considered:

• necrosis of the oral cavity;
• abscesses;
• renal and heart disease;
• bleeding;
• solid skew;
• rheumatism and rheumatoid fever;
• sepsis.

Diagnostics

The diagnosis of pathology is made comprehensively and includes:

• careful inspection and patient poll;
• general blood analysis;
• the grinding stroke for bacteriological sowing (allows you to identify pathology pathogen and determine its sensitivity to those or other antibacterial drugs);
• PCR diagnostics;
• antigenic test on beta hemolytic streptococcus.

These activities make it possible to determine the course of further treatment and differentiate the disease from cancer diseases, tuberculosis, syphilis, lacunar and gangrenous phlegmosic angina, as well as other forms of tonsillitis.

See also: Clinical picture, causes and treatment of stomatite angina

Treatment of pathology is made comprehensively and includes the use of antibacterial and antiseptic agents.

Therapy of necrotic pathologies with antibiotics is appointed according to the results of bacterial sowing. In the overwhelming majority of cases, penicillins, cephalosporins and macrolides are used (most preferred due to the fact that they have a powerful therapeutic effect at low toxicity and minimal exposure to the gastrointestinal organs). These drugs are used in the form of injections in the dosage corresponding to the mass of the body and age of the patient.

Local treatment includes a set of measures aimed at the gradual purification of the fabrics involved in the pathological process from pus and mucus, their regeneration and recovery.

• processing of ulcerations with hydrogen peroxide solution;
• rinsing throats (as a rule, the following means for rinsing are used: solutions of permanganate and potassium chloride, furacilin, silver nitrate);
• irrigation of the oral cavity and larynx by antiseptic means;
• treatment of almonds Novarsenol, iodine, neosalvan.

Council. According to some specialists, sugar and syrup from it affect the acidic background, making it unfavorable for the growth and reproduction of pathogenic microflora in tissues of almonds, and therefore can be used for processing them.

Attention! Treatment of hydrogen peroxide with caution.

Mode and diet

Depending on the severity of the course of the disease, patients can be treated as an outpatient (in compliance with such precautions, both bedding, separate dishes and the highest possible isolation from healthy people) and stationary (in this case, the sicks are placed, as a rule, in the infectious compartment. ).

Special attention and in fact, and in another case, it is paid to meals. From the diet, dishes are excluded, the use of which negatively affects the affected mucous membranes. Patients are forbidden to use hard, hot, cold, sharp, salty and spicy food (it is recommended to replace it with nutritional and easily digestible broths and puree with neutral taste).

Attention! Meat (chicken, rabbit, turkey, beef, veal), dairy products (yogurts, kefir, cottage cheese and dishes from it), liver, eggs should be in a diet in sufficient quantities.

In addition to the described changes in the nutrition, the patients are recommended to be plentifully, which includes drinks rich in vitamins of the group B and C (rowness decoction, compotes, fruits, freshly swords, tea with lemon), as well as rubbish vegetables and fruits that fill the vitamin reserves of the body.

Non-necrotic alarg is an acute inflammatory disease of the tonsils, which is caused by the symbiosis of the spiruchite of the oral cavity and the spindle-shaped wand. The disease leads to the appearance on almonds (glades) of ulcers, tightened with a dense dying of dirty green color with an extremely unpleasant smell of rotten meat. Pathology is rare and more often amazing men aged 18 to 35 years. Necrotic angina lasts from 1 to 4 weeks. The second name is the Simanovsky-Platie-Wenzanna. The disease is recognized as increasingly infectious, since the transfer of illness from a person to a person is observed extremely rarely as a special exception.

Causes of occurrence

The disease often accompanies purulent necrotic stomatitis or is its complication. Anglary can develop, as well as independent illness, on the background of the contributing factors that are:

Non-necrotic districts often occurs in individuals with oncological diseases, leukose and radiation disease.

Views and symptoms

3 forms of the disease are distinguished, which differ in the severity of symptoms and the degree of lesion of the almonds. The clinic will be much varied.

1. Easy shape - the patient has a slight increase in temperature (not more than 37.5 ° C) or its absence, weak throat pain at the moment of swallowing, redness and tonsils swelling. The flight does not go beyond the limits. Lymph nodes are not changed.
2. Medium-heavy shape - temperature increase from 37 to 38 ° C. The pain in the throat is expressed significantly increasing with the act of swallowing. The almonds are red and very echoes. On the surface of the GRAND, oval grayish-white plates are found, which have a diameter of up to 15 mm. The angular lymph nodes are not greatly and painless.
3. Severe shape - the temperature reaches 39 ° C; The inflammatory-necrotic process affects the sky (solid and soft), gums, larynx and the rear wall of the pharynx. Ulcers that are formed under the layer of plaque have a form of crater. They destroy the mucous membrane and lying deeper than the tissue, and in the absence of treatment they reach periosteum. Paints are very strong. Lymphatic angular hubs are increased and painful.

In the absence of treatment, there is a transition of the disease from light to severe form.

Depending on the characteristics of the process in glands, the disease is divided into 2 types.

1. False-film tonsillitis, the second name is the ulcer-film angina - the almonds are formed a thin layer of the plaque. There is a disease against the background of infection of staphylococcal nature.
2. Yazin tonsillitis - ulcer is formed more often on 1 and less often on 2 almonds. Flip thick dirty yellow.

Possible complications

Complications occur with the severe form of the disease or with a protracted course of medium. The consequences of necrotic angina may be as follows:

• abscess root of the language;
• toxic shock;
• phlegmon oral cavity;
• gangrene fabrics one or both cheeks;
• gangrene larynx;
• sepsis.

With additional infection of the ulcers with pathogenic microorganisms, the risk of violations in the work of the cardiovascular system, kidneys and liver increases.

Methods of diagnosis

Different types of angin at the beginning of the disease have similar symptoms, which is why these analyzes are necessary for the formulation of an accurate diagnosis.

With a primary visit, the patient's doctor reports:

• the time of the first manifestations of the disease;
• diseases transferred in the last 45 days;
• the presence of chronic diseases;
• regularly taken medicines.

At the first reception, the throat is also conducted and the condition of lymphatic nodes is estimated. With a severe form of necrotic angina, the patient listens to the heart and lungs.

For the final detection of the disease, the results of blood test and smear from the throat are needed (with a nourishing medium and microscopic examination with contrasting staining). With the simanovsky-plat-Wensenan's threats in the blood, an increased level of leukocytes is detected and the excessive rate of deposition of erythrocytes.

Treatment methods

Treatment of necrotic angina should be carried out only by a doctor. Self-treatment is dangerous to the progression of the disease and the development of complications. For medical help, it is necessary to apply as soon as the first symptoms of the disease appeared. Therapy is carried out in the infectious compartment under the constant control of the otolaryngologist. In rare cases, with a slight form of the disease, an outpatient treatment with a permanent visit to the doctor is possible.

For therapy, the following methods are applied:

• drug;
• physiotherapeutic;
• surgical;
• folk remedies.

When to shoot down the temperature

The temperature during necrotic tonsillitis is knocked down in the event that it rose 38 ° C. It is also shown to reduce the temperature if the patient is seriously tolerated even its minor increase.

Medicate

Acute tonsillitis immediately treat antibiotics, while with necrotic form they are used only in the serious course of the disease. If applied antibiotic treatment immediately, high risk that the pathogen is formed, resistant to this drug.

At the beginning of therapy, local treatment is used with the help of antiseptic drugs, which wipe the areas of the defeat or irrigate them. For this purpose, use:

a solution of manganese intense pink (for rubbing);

• silver nitrate solution for wiping;
• solution of hydrogen peroxide for rinsing and wiping;
• lugol solution for lubricating the almonds and foci of necrosis on other sites;
• Chlorophyllipte infusion for irrigation, rubbing and rinsing.

If within 3-5 days there is no improvement, or the progression of pathology is observed, antibiotics are used:

• macrolides;
• penicillins;
• cephalosporins.

Antibacterial agents may be for oral administration or for administration by injection.

For children and pregnant women, treatment is carried out using local antibiotics in the form of spray.

Physiotherapy

Physiotherapeutic impact applies to restore normal blood circulation in almonds and lymph nodes. Also physiotics accelerate the removal of edema and reduce the number of pathogenic bacteria in the focus of the lesion. The standard course of therapy consists of 12 procedures that are fully safe for the overall health of the patient. For treatment apply:

• magnetotherapy;
• dry heat - depending on the equipment of the medical institution, it will be a laser or ultraviolet;
• wave ultrasound impact.

Medicinal preparations with physiotherapy procedures with necrotic angina are not entered.

Surgical

Surgical treatment is appointed if the disease often gives relapses. In such a situation, the removal of almonds is shown. The operation is carried out under anesthesia under the conditions of the surgical department of the hospital or ENT branch.

Folk remedies

Folk therapy applies only as an auxiliary measure and in coordination with the doctor if it does not reduce the effectiveness of drug impact.

1. Sugar syrup with a concentration of 60%. It is used to wip almonds twice a day. The means acts as a preservative and for most causative agents of necrotic tonsillitis creates unsuitable conditions.
2. Rinsing the decoction of eucalyptus prepared at the rate of 1 tbsp. l. Raw materials for 1 cup boiling water. Welcome throat 3 times a day. Eucalyptus has a powerful antiseptic effect and stimulates tissue regeneration.
3. Rinsing using aloe juice. The tool is shown since the start of healing of ulcers to prevent its re-infection. In 1 glass of boiled water add 1 tsp. Fresh juice and carry out processing using the entire portion over 1 time. Clamp in the morning and evening.

It is prohibited only to engage in the treatment of necrotic angina only with the use of folk remedies.

Food rules and a gentle diet

Treat the disease without a certain diet is difficult. Food so as not to act annoyingly on the sore throat, should be soft, warm and not burning. Optimal broths and soups puree. You should drink as much warm as possible. You can not drink alcohol, carbonated drinks, strong tea and coffee. To enrich the diet, with vitamins, it is necessary to eat baked or grilled fruits and vegetables with a blender.

Elena Malysheva and Herman Gandelman tell how to treat an angina.

Features of treatment during pregnancy and feeding

During pregnancy and breastfeeding, therapy is subject to adjustment. If the child is more than 6 months, it is recommended to stop lactation and take full-fledged treatment, as otherwise it will take refusal to antibiotics, which is dangerous in the severe form of the disease.

During the period of having a child, the therapy has the following features:

• full refusal of physiotherapy;
• non-use aspirin to reduce temperature;
• conduct additional examination to determine the risk of intrauterine infection of the child;
• selection of antibiotics, which have a low penetration percentage through a placental barrier.

In the early periods of pregnancy for full-fledged therapy, an abortion is sometimes raised. It may be necessary at a particularly severe form of necrotic tonsillitis.

Features of the treatment in children

Cases of necrotic tonsillitis in children are extremely rare, and in their treatment therapy is carried out almost similar to the one that is prescribed by adults, but with the selection of drugs suitable for the patient by age.

1. Mandatory appeal to the doctor.
2. Bedroom to prevent violations in the work of the cardiovascular system.
3. The use of only antibiotics appointed by the doctor.
4. Compliance with the recommendations on the dosage and duration of antibiotics.
5. Regular use of local therapy.
6. Reception of analgesics if the pain is strong.
7. The reception of antipyretic drugs, if the temperature rose more than 38 ° C.
8. Mandatory daily ventilation of the child's room in his absence.

Taking advantage of the Soviets, which gives a pediatrician Komarovsky, you can properly treat a child without exposing its life danger.

What you can not do

During the disease, self-media is prohibited and changed at its discretion of the amount of the received medication and the duration of the therapy. Also unacceptable:

• physical exercise;
• stay for dampness.

For the most quick recovery and reducing the risk of complications, it is necessary to comply with all medical recommendations.

Prediction and prevention

With timely appeal to the medical assistance and the passage of high-quality treatment, the forecast is favorable. Complete recovery occurs in 10-30 days. In case of severely form, the therapy is complex and complications are possible, which is why the forecast is unfavorable.

Prevention of the disease includes:

• maintaining the health of the oral cavity;
• increasing overall immunity with hardening;
• high-quality meals with sufficient vitamins;
• treatment of inflammatory diseases of the nasal sinuses.

Compliance with these uncomplicated rules reduces the risk that purulent-necrotic angina will arise several times.

Attending doctor

At the initial reception of the patient can go to the therapist. After performing the primary diagnosis, the patient will receive a direction to the otolaryngologist and in the hospital in the ENT branch. The otolaryngologist is engaged in direct treatment of the disease.

(ulcerative-necrotic agnulty) is an atypical form of inflammation of the sky almonds, accompanied by the formation of ulcers and fibrinous membranes on their surface. Clinically manifests itself with discomfort in the throat when swallowing, which is later replaced by pain, rotten smell of mouth, increased salivation. In the process of diagnostics, patient complaints are used, anamnestic information, the results of pharyingoscopy, generally clinical analyzes, bacteriological research. The treatment is the appointment of local antiseptics, soiling and symptomatic means, antibiotics.

MKB-10.

A69.1. Other infections of Wensena

General

The ulcerative-film angina or a simanovsky-plat-Wensenian angina is relatively rare, is about 5-6% of all tonsillites. For the first time, this pathology was described in 1899 by the domestic otolaryngologist N. P. Simanovsky. In 1898, the French bacteriologist J. Vensan and the German physician S. Plata identified the pathogens of this option of tonsillitis.

The incidence of this form of angina is predominantly sporadic, but epidemic outbreaks are also possible. For Angina, Simanovsky-Venasan is characterized by seasonality - the largest number of cases are recorded in the cold season: from the middle of October to the end of April. Persons face aged 18 to 40 years old.

The reasons

The basis of etiology is a fuzospirosyotic infection. The development of the disease is due to the penetration of almonds and symbiosis of conditionally pathogenic spindle-shaped sticks (B. Fuciformis) and a representative of the normal oral microflora - spirochaeta buccalis. Also in the focus of the infection can be determined by pathogenic coil flora: ß-hemolytic streptococcus group B, golden staphylococcus. Provoking factors are:

• Immunodeficiency.The activation of fuzospi-ethomatic symbiosis contributes to a decrease in the reactivity and resistance of the organism against the background of HIV infection, diseases of the blood formation organs, malignant tumors, transferred radiation therapy or chemotherapeutic treatment, alimentary dystrophy and cachexia, hypovitaminosis with and group in, acute or chronic infections, overalling.
• Foci of chronic infection.The development of pathology often cause carious teeth, chronic stomatitis, periodontalosis, frontitis, sinteritis, etmoidites, sphenoidites, pharyngitis, etc. Separately isolated adenoiditis against the background of the growth of adenoid vegetations, since in addition to the constant irritation of almonds with purulent masses, they are the cause of oral respiration - one of the risk factors The emergence of an angina.

Pathogenesis

Parenchima almonds becomes a focus of infection, primary pathological changes arise as a result of accumulating microflora activity products. The forming inflammatory response is accompanied by the release of histamine, pro-inflammatory cytokines, violation of the permeability of the vessels of the microcirculatory channel, the output of leukocytes and proteins beyond their limits.

Histological changes in the panel almonds are presented with hyperplasia of lymphatic follicles, small-cell infiltration, trombosis of regional veins of the coating epithelium, which is why the latter begins to be peeling. Morphologically, pathology is characterized by the formation of a site of necrosis on the almond surface addressed to the yv. At the bottom of the focus, a fibrinous membrane of a loose consistency is formed, covering the necrotic lymphadendic fabric.

Symptoms

The disease develops gradually. The first sign becomes a feeling of discomfort or an outsider during swallowing, described by patients as a "lump in the throat". Gradually, these sensations are transformed into pain, which, with further development, is preserved and at rest. In the overwhelming majority of cases, one-sided defeat is observed. There is an unpleasant peeling smell of mouth and increased salivation.

A characteristic feature of this form of the disease is the lack of fever or intermittent subfebilitation. Only in some cases, Simanovsky-Wenzanan's angina debuts a sharp increase in body temperature up to 38.5 ° C with chills. In patients, there is an increase in the front and rear cervical, occipital, subbands of the earliest lymph nodes from the side of the affected almond.

Complications

Complications for the ulcer-necrotic form of tonsillitis are conjugate with the long flow of the disease, the spread of destructive processes on the adjacent anatomical structures and to be tissue. They develop by the end of 2-3 weeks of the disease. The absence of timely therapy leads to the formation of sections of necrosis on the surface of the celestial and sinking, mucous membranes of the cheek, other sections of the language. During this period, the attachment of the glorodular microflora is observed, accompanied by the formation of systemic intoxication syndrome and transformation of pathology into purulent tonsillitis. Next occurs the destruction of the solid sky, a fatality with the nasal cavity is formed. In some patients, degradation of dental junks leads to the fraud of the teeth.

Diagnostics

The diagnosis is made on the basis of complaints, data of the history, physical research, laboratory tests and differentiation with other possible diseases. Differential diagnosis is carried out with lacunar and necrotic angina, diphtheria of palatal almonds, syphilitic and tuberculous ulcers, malignant tumors, sharp leukemia. The survey program consists of:

• Collection of anamnesis and complaints.When polling the patient, the otolaryngologist details complaints, finds out the presence of concomitant immunodeficiency states, the pathologies of the LOR-organs and other factors that could contribute to the activation of the conditionally pathogenic flora.
• Examination of the pharynx.With pharyngoscopy on the upper third or the entire surface of one of the palatal almonds, a grayish yellow or green flare from a stain type from a stearin candle is visualized. Occasionally he is revealed on the front packer. After the membrane removal, the bleeding surface of yellowish color with clear boundaries covered with ulcers and necrosis areas is found.
• Generally clinical laboratory tests.In general blood test, there is an increase in leukocyte levels, the displacement of the leukocyte formula towards the rod and young neutrophils, an increase in ESR. If you need differential diagnostics, almond biopsy can be carried out, the Vasserman reaction.
• Bacteriological research.In a smear of the affected area, a large amount of spiru-shaped sticks is determined. To confirm the diagnosis and selection of antibacterial agents, the detected microorganisms can be cultivated on nutrient media, followed by the antibioticogram.

Treatment of ulcer-film angina

The treatment is conservative, with a satisfactory condition of the patient and the absence of risk of developing complications is carried out in an outpatient basis. The main objectives of drug therapy are the sanitation of infection, strengthening nonspecific immunity, prevention of the development of complications. The following therapeutic agents are used:

• Local preparations.The care of the oral cavity by removing necrotic masses and rinsing with antiseptic solutions is important. For processing affected almonds, hydrogen peroxide, manganese solutions, iodine, Lyapisa are used. Rinsing is carried out with furaciline, potassium permanganate solution.
• Systemic antibacterial drugs.Antibiotics are prescribed only with the severe course of pathology. Medications from the group of ß-lactam are effective, namely amoxicillin with clavulanic acid or ampicillin. In case of inefficiency, drugs are replaced by drugs selected according to the results of antibiotic sensitivity.
• Symptomatic and secrets.Depending on the state of the patient, antipyretic agents can additionally be used, intravenous infusions with plasma proceeds, etc. To strengthen the protective forces of the body, multivitamin complexes, adaptogens, immunomodulators are introduced into the treatment program.

Prediction and prevention

In the absence of complications, the prognosis for the patient's life and health is favorable. Formed ulcers on tissues of almonds and adjacent structures are heal without the formation of large connective tissue defects. The duration of the disease in most cases is from 7 to 21 days, rarely - up to several months. Complications are developing no more than 3-7% of cases, but are characterized by a difficult flow.

Specific prevention of peptic-film angina is not developed. Non-specific preventive measures include compliance with personal hygiene principles when caring for the oral cavity, preventing immunodeficiency states and their timely elimination, early treatment of pathologies of neighboring LOR organs.

Non-critical angina is an acute tonsillar disease characterized by the inflammatory necrotic process of almonds. The pathogens of this pathology are the spi-like stick and spirochet. These microorganisms include the colosty saprops.

This disease is rather rare and manifests itself in people with weakened immunity with radiation disease, leukemia, immunodeficiency and other blood diseases. And necrotic pharyngitis may be complicated after some suffering diseases, such as scarletin, tularemia or diphteria.

The main distinctive feature from classic angina is the destruction of tissues of almonds, in particularly severe cases, soft tissues can be destroyed to the bone itself. In this case, the process will progress and spread to closer areas of mucous membranes. Therefore, with this form of pathology, it is important to contact a specialist and begin timely treatment.

The reasons

The main cause of the disease is the symbiosis of two microorganisms - spirochetes and spindle-shaped sticks.

The photo shows the spirochete - one of the pathogens of pathology

Also, necrotic angina in some cases can cause cocked types of microorganisms, such as staphylococci and streptococci. In addition to the main reason, the disease has risk factors that contribute to the development of pathology.

These include:

• weakened immunity after a long admission of antibacterial drugs;
• immunodeficiency;
• long deficiency of vitamins and minerals;
• cachexia;
• acute intestinal infections;
• complications of chronic diseases;
• elderly age;
• oncology;
• purpose diseases, caries.

Non-necrotic alaria can be primary and secondary. The primary occurs mainly due to the systemic lesions of the incompicant fabric and the launched caries. Secondary is a consequence of infectious diseases.

Symptoms

Non-necrotic districts, described by slow progressive development, with a gradual increase in symptoms. The first feature that the patient notes is discomfort when swallowing. Gradually, pain in the pharynge area is enhanced. The patient describes signs like a feeling of a foreign body in the throat.

When examining almonds, on their surface, there is a grayish-yellow raid, which is easily removed. Under the wave there may be bleeding necrotic ulcers having uneven edges and a grayish-yellow bottom. The body temperature for the disease is most often subfebrile, the patient has chills.

The pain syndrome is manifested already during the conversation. The almonds have hyperemia, the patient is tormented by a strong salivation, a rotten smell of mouth, an increase in cervical lymph nodes. There are signs of intoxication of the body.

Manifestation of necrotic angina in a relatively light form

In children, especially until a year, the disease is extremely rare. This is due to the fact that the kids still do not have teeth, which in a launched form and provoke the disease. But over time, the risk of disease increases. Symptoms in children show themselves more aggressively and grow faster.

When inspection on almonds, dense white raids are formed, and the reflex of swallowing and sucking is extremely difficult. The child becomes sluggish, capricious, refuses to eat and drink. The appearance of ulcers in the field of almonds is often accompanied by an elevated temperature.

White raid after a few days of the disease "disappears" by itself, which leads to even greater discomfort in the field of rotogling.

Most often there is a one-sided lesion of almonds. The first time when the symptom occurs, the symptoms are manifested in a lung form. But as pathology is increasing, signs are becoming more noticeable. Nerctic tonsillitis with a burdened form can cause strong bleeding and perforation of solid sky.

Diagnostics

When the first, even the most minor signs of the disease, you need to consult a doctor. Timely diagnosis and treatment of the key to rapid recovery without complications. The diagnosis and subsequent therapy appoints a otolaryngologist.

The first thing the doctor examines the patient with the help of a Farisoscope, asks him about symptoms and collects anamnesis. Laboratory studies are appointed. Mandatory is a general blood test. As a rule, with necrotic tonsillitis there is an increased number of leukocytes, accelerated ESO.

This indicates the flowing inflammatory process in the body. Aid with almonds take to a laboratory study, to accurately determine the causative agent of necrotic angina and to confirm the diagnosis.

As a rule, the following laboratory studies are carried out:

• PCR diagnostics. With this method, it is possible to determine the pathogen with accuracy. The method is highly sensitive and reliable, allowing to achieve in the separated material concentration of fragments of nucleic acid microorganism.
• Express test allows in a short time to determine the presence of beta hemolytic streptococcus class A. This microorganism is the only pathogen of classical angina.
• Sowing discharged by bacteriological method. It is carried out to determine the sensitivity of the patient to antibiotics. With this analysis, a person chooses the most suitable antibacterial agent for treatment.

Laboratory research methods are an integral part in the diagnosis of necrotic angina.

In addition to laboratory studies, the doctor conducts a differential diagnosis, to eliminate diseases such as the difteria of the oz, the oncology of the oraloglot, syphilitic ulcer, tuberculosis. Additional research can assign to exclude STDs.

Treatment

Non-necrotic angina is treated only in the hospital under the control of the otolaryngologist. Therapy is carried out locally, that is, irrigation and washing with almonds with medicinal solutions and internally, the use of antibacterial drugs.

The washing and irrigation of the tonsils are carried out with a solution of hydrogen peroxide, furacilin. It is treated with ulcers and affected by the almonds by iodine infusion, potassium chloride and calcium permanganate. Rinse the throat is shown every two hours. To avoid burns of the affected tissue, almonds, a solid for rinsing should be warm, not hot.

Mandatory in the treatment of necrotic angina is the use of antibacterial agents. Usually prescribed a group of penicillins, cephalosporins and macrolides. Penicillins are active with respect to many gram-positive and some gram-negative bacteria.

Antibiotics of this group destroy the synthesis of the cell wall of bacteria. When receiving penicillins, they are well absorbed and, penetrating through the intestinal wall, distributed throughout the body. Preparations of this group are natural, semi-synthetic and biosynthetic. Penicillins have side effects in the form of allergic reactions, as a rule, they are characterized by rash.

Cephalosporins have a large spectrum of action with respect to the suppression of many microorganisms. At the same time they have low toxicity. The mechanism of action is in violation of the formation of cell walls of microorganisms. Allergic reactions are noted from side effects.

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Therapy for necrotic angina requires an integrated approach.

Macrolids are currently the least toxic drugs. They are considered the safest and effective group of antibacterial agents. Destroy many gram-positive bacteria, especially the Cockkops. The antimicrobial effect consists in violation of the synthesis of protein on the ribosomes of the microbial cell. They act gently, so no side effects cause.

After the course of antibacterial therapy, it is important to take funds to restore intestinal microflora. Usually discharge bifi and lactobacilli in lyophilized form.

In addition, it is important to constantly maintain your immunity, immunomodulating agents and vitamins can be appointed for this. After therapy, the patient must include products enriched with vitamins and microelements in his diet.

Complications

In case of untimely diagnosis and treatment, necrotic aneg is dangerous complications. The main difficult condition in this disease is necrosis or fission fabrics. Necrosis can be due to improper treatment.

Attempting to mechanically remove films with almonds can be pulled by damage to the mucous membranes and the spread of infection in the deeper layers of tissues and blood flow. When penetrating the blood flow, the pathogen affects the internal organs.

In addition, complications include:

• Non-optical changes are affecting not only almonds, but also the whole oral cavity.
• Split solid sky.
• Abscess.
• Phlegmon.
• Glomerulonephritis, renal failure.
• Rheumatism.
• Sepsis.

All complications proceed with the accompaniment of a glorious infection.

The prevention of the development of complications includes local procedures

Prevention

Preventive measures are encouraged to prevent the disease. At the first signs of the disease of the o'clock, it is necessary to rinse it with drugs. Mandatory in prevention is timely treatment of teeth and visiting the dentist once every six months.

Strengthen immunity, balanced to eat, if necessary, consume a vitamin and mineral complex. Such prevention measures will prevent the development of infection. If the disease is already evolving, then timely appeal to the doctor will make it possible to cure necrotic angina without consequences.

Or Simanovsky-Platie-Wensen is a disease caused by a conditional pathogenic fleece of the oral cavity (that is, such a flora that is present in a healthy state, but in small quantities, and when weakening the protective properties of the body is activated, leading to the development of pathology). In particular, the urgent wand and spirochet take part in the development of the disease.

The disease is developing most often in protein deficiency and exhaustion of the body, which is why its second name "Troops". In addition, provoking factors are poor oral cavity, including carious teeth and malicious smoking.

Symptoms

The ulcer-necrotic aneg makes it debut from unpleasant sensations and a certain awkwardness when swallowing, which are in the future transition to pain syndrome. General well-being worsens, however, not to such an extent as local changes in the throat. The body temperature most often remains normal or rises to subfebrile values \u200b\u200b(no more than 38 degrees). The painful sensations at the beginning of the angina are weakly expressed, but every day they give more and more about themselves. Basically, only one side is involved in the pathological process, but cases and bilateral defeats are described.

With the direct inspection of the almond domain visualizes the film of whiteish-yellowish gray color. In appearance, it resembles a stain from a stearin candle of a rounded form. The film is soft (by consistency), is surrounded by inflammatory (red, edema) rim along the edge and is easily removed with a cotton swab, after which it remains an ulcent surface of yellowish color with even clear contours, which bleeds.

At the first time, the disease is ulcerative angina surface. But in the case of a long flow of the disease, the defect in the tissues becomes deep, acquires a crater shape, extends beyond the almonds, involving deep tissues. Sometimes the lens mucous membrane, language and even the periosteum is involved in the pathological process.

A distinctive feature of ulcer-necrotic angina are low-escaled increased regional lymph nodes.

An unpleasant shuttle smell is observed from the mouth. It should also be noted that in about 10% of cases, necrotic angina is combined with diphtheria.

With a favorable course of the disease, recovery occurs after 1 - 2 weeks. But angina can delay and up to several months, especially if not adequate treatment was carried out.

Treatment

The treatment of Simanovsky-Platie-Winsan's angina includes antibacterial therapy (general and local) and a constructive.

The diet must be saturated with proteins:

• Meat;
• Liver;
• Cheese;
• Cottage cheese.

In addition, it is necessary to eat enough fruits containing vitamin C (lemon tea, cranberry morse, rosehip tincture). Food should be warm, soft. Sharp, spicy and irritating dishes better limit.

A special role should be given to the occasion of the oral cavity: it is necessary to visit the dentist, cure carious teeth and not forget to clean them regularly. Be sure to abandon smoking.

Local treatment implies the processing of the focus of the lesion of the tincture of iodine, a solution of silver nitrate (10%), a solution of copper mosquap (10%), a solution of novarcelone (arsenic compounds) on glycerin, a solution of potassium chloride and methylene blue. In addition, the daily rinsing of hydrogen peroxide and a solution of manganese should be included.

With the ineffectiveness of these procedures, novarcelon's powders are prescribed to the almond surface or intramuscularly, mearsenol either intravenously novarsenol in the dosages of the appropriate weight and age.

It is believed that the sprinkting of the peptic surface with conventional sugar syrup is considered a positive effect, which is explained by a change in the acidity of the medium, which becomes unfavorable for the growth of the pathogen.

In children

In children, a peptic-necrotic angina is not easy to distinguish from diphtheria in view of the similarity of local manifestations. There are cases of the simultaneous course of two diseases.

The principle of treatment is similar to those in adults.