In the practice of the therapist and otorhinolaryngologist, upper respiratory tract diseases are quite common. Especially in the autumn-winter period. Pathogens can be very different, but bacterial infections, such as purulent pharyngitis, are most severe. Symptoms and treatment of it will be described below in the relevant sections of the article. For the "seed" we can say that this disease is rarely found in isolation. Most often, this is a complication of another pathology.
Definition
Purulent pharyngitis is an infectious disease of the pharyngeal mucosa caused by pathogenic microorganisms. Most often, this process develops as a result of trauma to the organs of the neck and the attachment of secondary microflora or as a complication of inflammatory diseases of neighboring tissues and organs.
The disease proceeds against the background of severe intoxication, so the patient should immediately go to the hospital for emergency care. Poor or untimely treatment can seriously harm the patient and cause a lot of complications.
Causes
Various microorganisms can cause purulent pharyngitis, but beta-hemolytic streptococcus of group A is considered the most common option. Arganobacteria, the causative agent of gonorrhea, spirochetes, mycoplasmas and chlamydia can be the cause of the disease. In addition, viruses can cause acute purulent pharyngitis, for example, adenoviruses, rhinoviruses, coronaviruses, herpes viruses, influenza, parainfluenza.
At risk are children from five to fifteen years old and recruits, since they are most of the time in organized groups. The causative agent is transmitted by airborne droplets, and the rate of spread depends on crowding.
Pathogenesis
Purulent pharyngitis begins when bacteria colonize the mucous membrane of the oropharynx. Local inflammation develops, accompanied by swelling, redness, and pain. The causative agent penetrates the lymphoid tissue of the tonsils, causing them to increase and accumulate pus in the follicles. Pus also appears on the mucous membrane of the posterior pharyngeal wall, it dries up and forms crusts.
At the same time, the toxins that bacteria secrete increase the permeability of the vessel walls, and this allows microbial agents to enter the systemic circulation. An increase in the number of pathogens stimulates the immune system. Antibodies to the pathogen appear in the body. But, in addition to this, they react to the cells of the heart muscle and kidneys, which causes severe complications.
Symptoms
Purulent pharyngitis develops three to four days after contact with a sick person. In adults, the disease begins with acute sore throat when swallowing. At the same time, headache, weakness and fever are observed. These symptoms are caused by intoxication.
In general, the condition of patients is assessed as moderate. The temperature does not exceed 39 degrees Celsius, there is a rapid heartbeat and breathing. The mucous pharynx is reddened, palatine tonsils are enlarged, yellowish deposits may be present on them. Patients complain of pain when swallowing, eating, talking. Some patients have a dry cough and a sore throat. In addition to inflammation in the tissues of the oropharynx, changes are observed in the nasal passages, where pus and mucus can accumulate. It flows down the back of the throat and exacerbates inflammation.
In addition, the symptoms of general intoxication are observed in patients: weakness, lethargy, headache, discomfort in the muscles, joints and bones. The temperature is usually subfebrile (up to thirty-seven degrees), but with the appearance of pus it can reach febrile numbers.
In the averaged version, purulent pharyngitis manifests itself in exactly this way. Symptoms may vary depending on the age of the person and the properties of his immunity. In general, the disease lasts no more than a week and ends independently even without treatment. Symptoms of inflammation go away, but difficulty swallowing may remain for a while, as the tonsils will be enlarged for a couple more weeks.
Purulent pharyngitis of children
The disease is more often diagnosed in patients of this age category and proceeds more rapidly. The incubation period is reduced to twenty-four hours, the first symptom is redness of the throat. Purulent pharyngitis in this case is a secondary disease, and the focus of infection can be both in the lungs and in the sinuses. Chronic pharyngitis can be caused by reflux disease or regurgitation of an infant.
Symptoms of the disease in children correspond to those in adults:
- sore throat when swallowing and eating;
- rise in temperature;
- drowsiness, weakness and lack of appetite;
- dry coughing.
Complications
There are purulent and non-purulent complications of pharyngitis. The former, as a rule, are found in neighboring anatomical areas in the form of otitis media, sinusitis, sinusitis, as well as phlegmon and abscesses of adipose tissue. In rare cases, foci of infection can be in the joints, bones, internal organs. Until the first antibiotics appeared, the incidence of complications approached fifteen percent of the total number of cases. To date, such patients are less common. This is due both to improving the quality and accessibility of treatment, and to the fact that people are less likely to see a doctor, self-medicating.
Non-purulent complications include pneumonia, myocarditis, glomerulonephritis and other diseases that develop against a background of compromised immunity. This is due to the fact that the pathogen antigens mimic the receptors located on the surface of the cells of parenchymal organs, such as the heart or kidneys.
Diagnostics
How to detect purulent pharyngitis? A photo of the oropharynx in this case for the specialist will not be very informative, since redness of the mucosa will be observed with a significant number of diseases. In addition, only fortunetellers are diagnosed, and at the same time treated, according to the photograph.
The doctor must carefully question the patient, find out the details of the disease first hand. Then measure the temperature, feel the lymph nodes of the head and neck and, of course, look at the throat. For differential diagnosis, he may need a sterile spatula. With his help, the doctor will try to separate the plaque and pus and look at the result. If the films are removed easily, and after them the tonsils do not bleed, then this is catarrhal tonsillitis or pharyngitis, and if there is a mucosal defect and bleeding, you need to think about diphtheria and send the patient to an infectious diseases hospital.
After all the manipulations with a sterile swab, a smear is taken from the surface of the tonsils for microbiological examination. The discharge is sown on a nutrient medium, and after seven days, when the bacterial culture grows, it will be possible to say exactly which pathogen provoked the disease.
Antibacterial therapy and its ineffectiveness
Antibiotics for purulent pharyngitis are always used. The drugs of choice are penicillins, and in case of their ineffectiveness - cephalosporins or macrolides. This treatment tactic is justified if pharyngitis is caused by streptococcal bacteria. If the disease is caused by viruses, then antibiotics will be not only ineffective, but also harmful. Because bacteria that are constantly located on the mucous membranes of the mouth and nose develop resistance to treatment. As a rule, the doctor does not wait for the results of the bacteriological examination, but prescribes the drugs empirically. Later, he can adjust the therapy if the patient does not feel better.
In order to properly prescribe treatment, the doctor must remember some features of the pathogen of purulent pharyngitis:
- in order to destroy streptococcal bacteria, it is necessary to take antibiotics for at least ten days;
- the sooner you start treatment, the easier the course of the disease will be.
Sometimes a doctor cannot immediately pick up an antibiotic that can stop purulent pharyngitis. Treatment is considered ineffective if the symptoms persist for more than three days after the start of therapy, and also if the pathogen is released after antibiotics are stopped. Such situations are more common in children, because they do not always exactly fulfill the doctor's prescriptions, and are also explained by bacterial resistance.
Prevention
Acute purulent pharyngitis is better to prevent than to treat. You do not need to do anything specific for this. These rules will help prevent not only colds:
- To wash hands. After walking on the street, traveling by public transport, before eating. If it is not possible to use the bathroom, this is not a reason to neglect the rules of hygiene. Now there are a large number of antibacterial gels, wipes and sprays. Carry any of these in your purse.
- Cover your mouth while coughing and sneezing. Firstly, it is polite, and secondly, so you protect yourself and others from bacteria. Be sure to teach this to your children.
- Try to use an individual set of dishes, napkins, towels and linen.