What are the features of the treatment of Simanovsky-Vincent angina

Sore throats or tonsillitis include infectious diseases characterized by inflammatory processes in the palatine tonsils. There are many such pathologies. They are usually classified according to the type of pathogen and clinical course. The most dangerous types of tonsillitis include necrotizing tonsillitis of Simanovsky-Vincent.

Nowadays it can rarely be found in patients. The main difference between ulcerative membranous tonsillitis and other forms of tonsillitis is necrosis of the tonsils and surrounding tissues. The process develops rapidly, so complications are frequent.

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:

1. 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.
2. 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.

Therapy methods

The principles of treatment of necrotizing tonsillitis provide for an integrated approach using methods such as drug therapy, local effects, and physiotherapeutic procedures. It is allowed to use folk methods as a supplement to traditional methods.

General drug treatment

The use of antibiotics becomes an integral part of the therapeutic course aimed at correcting the condition of the tonsils affected by ulcers. The most effective antibacterial drugs used to treat purulent-necrotic sore throat are represented by three main groups:

• Macrolides. Positive dynamics are observed when prescribing Azithromycin, Erythromycin, Leukomycin, Clarithromycin or Medicamycin.
• Penicillin drugs. The most effective of them are Amoxicillin (Amox), Benzylpenicillin, Phenoxymethylpenicillin.
• Cephalosporins. Efficiency is observed when using Cephylaxin, Cefazolin, Cephaloridine.

Preference is often given to drugs from the macrolide group. These antibiotics have some advantages over others. They are positively characterized by their virtual absence of negative effects on the stomach, minimal toxicity and the ability to act on pathogenic microorganisms so effectively that not only their complete destruction occurs, but also the impossibility of further reproduction from among the remaining ones.

Local treatment

The appearance of a film on the tonsils, under which ulcers with purulent accumulations are found, necessitates the use of local action to remove them. For this purpose, the following procedures are carried out:

1. Treatment of tonsils with antiseptic solutions. Such as Chlorophyllipt, Miramistin, hydrogen peroxide and Lugol's solution have proven themselves well.
2. Irrigation of tonsils. Among the most effective remedies recommended for eliminating plaque and purulent foci are Tantum Verde, Hexoral or Lugol's solution.
3. Lubricating sore tonsils. Iodine, Novarsenol or Neosalvaren is used.
4. Gargling. The effect is achieved if the procedure is carried out after each meal. It is also recommended to change the rinse composition using Furacillin or saline solution.

You can only carry out rinsing and irrigation yourself. Lubrication with iodine, Lugol or treatment with the mentioned drugs is carried out by a doctor or nurse. Carrying out these procedures on your own can lead to serious complications.

The complicated course of necrotizing ulcerative tonsillitis becomes an indication for surgical intervention. Depending on the characteristics of the lesion, the purulent focus is opened or the tonsil is removed.

Traditional methods

Considerable experience in the treatment of throat diseases has been accumulated in the collection of folk wisdom. As a supplement to the main treatment, you can resort to treatment with decoctions and infusions:

• to reduce pain and relieve inflammation in the throat, it is recommended to use sage decoction,
• Calendula infusion is an excellent gargle,
• rinsing with a saline solution (0.5 tbsp. salt + 100 ml of warm water) removes plaque from the tonsils well,
• Rinsing with infusions of chamomile or sage flowers soothe inflamed mucous membranes well,
• eucalyptus infusion: steam 5 g of dry leaves with boiling water (200 ml) and leave for 12 hours.

Before using any folk remedy, it is recommended to consult your doctor. This will help avoid side effects of medicinal herbs.

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!

Forecast

Ulcerative membranous tonsillitis is an unpleasant and serious disease. But it usually heals in three to four weeks without causing any consequences.

It is important to know that this disease is dangerous to neglect. Under the supervision of a specialist and subject to all medical recommendations, the prognosis for cure is favorable

Ulcerative membranous tonsillitis is an infectious disease that affects the palatine tonsils. Characterized by an acute inflammatory process localized in the oral cavity

. A very specific lesion of the lymphoid formations of the lymphoepithelial oropharyngeal ring is observed: superficial ulcers are formed on the palatine tonsils, emitting the smell of rot, covered with a dirty green coating.

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).

The main symptoms of stomatitis in adults

The main symptoms should be considered at different stages of the disease. It is worth noting that the disease progresses and becomes more pronounced over time. When affected by an infection, a person begins to feel weak, he regularly has headaches, there is an increase in temperature and brittleness in the joints. The patient may notice blood on the gums, feel burning and drying of the oral mucosa. Such symptoms torment a person for several hours, and sometimes for several days.

When examined by a doctor, the stage of stomatitis, symptoms and treatment are described. In this case, the optimal course for the stage of the disease is selected. The disease progresses and gradually all its manifestations intensify. The person’s general condition becomes weaker, headaches become more frequent and severe, which affects performance. Over time, the patient feels a sharp pain even with slight contact with the tongue. Brush your teeth

and it becomes more and more difficult to eat, as sharp convulsive bursts of pain occur. At the same time, the patient notices increased secretion of saliva, and also an unpleasant smell of rot from the oral cavity. If a wisdom tooth becomes infected, the ability to open the mouth decreases. This phenomenon in medicine is called trismus.

Some facts about the symptoms of the disease at different stages:

• the first manifestations of the disease are pain in areas of damaged teeth and damaged gums;
• Mild stomatitis is characterized by a limited spread process. At an early stage, only certain types of teeth are affected. The general condition of a person does not undergo significant changes, so performance does not suffer either;
• Severe stomatitis occurs with a body temperature of up to 40 degrees. At the same time, the person feels very bad. The mucous membrane of the oral cavity is especially severely affected. In some situations, the infection affects muscle mass and bones. If you do not seek help from a hospital in time, complications of the disease can lead to melting of the jaw bones. You can easily see the image of stomatitis in the photo, the treatment that was started;
• if the infection gets to the site of the palate or tonsil, then this disease belongs to the category of angina ailments;
• in the acute form of stomatitis, the disease can progress to the chronic stage.
• Males are most often susceptible to infection at a young age, namely from 17 to 30 years. The season of exacerbation of the disease is observed in the autumn.

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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Risk group

The greatest likelihood of developing pathology is in patients with weakened immune systems. A particularly important role is played by the reduction of local resistance to pathogenic microorganisms, when the amount of protective substances on the throat mucosa decreases.

If the pathogen hits the epithelium, it penetrates the tissue, and primary inflammation develops in the palatine tonsils. Toxins produced by microorganisms contribute to the destruction of lymphoid tissue and the occurrence of erosions. If not treated in a timely manner, ulcerative defects form in their place.

In addition to persons with reduced immunity, the risk of developing a necrotizing ulcerative form of the disease is increased in the following patients:

• with malnutrition, malnutrition;
• with a lack of vitamins and minerals;
• long-term sufferers of intestinal and other infections.

The risk of developing gangrenous tonsillitis is highest in patients with leukemia and patients with malignant neoplasms. This is also facilitated by the need to undergo radiation therapy for these diseases. With insufficient oral hygiene, they develop this disease.

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!

Diagnosis of stomatitis in children for treatment

As we said earlier, young men and young children under 3 years of age are most often affected by the disease. Diagnosing the disease is only possible in a clinical setting. When analyzing, they try to find symbiotic organisms. If their presence is detected, then a course of treatment is prescribed. It is especially important to timely diagnose the presence of infection in young children, since their bodies are still weak to resist infection.

If stomatitis turns into a sore throat, then it is necessary to take an analysis of a sample from the surface of the necrosis or a deeper layer, in case of a complicated form. It is worth noting that Vincent’s illness very often accompanies other dangerous diseases, including HIV, leukemia, syphilis, gingivitis, scorbuta and others. It is for this reason that the examination often includes procedures to screen out the above diseases. When stomatitis is detected in children, treatment is prescribed only after an accurate diagnosis.

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:

1. The following is taken in equal proportions: thyme, sage, lavender and dried juniper berries.
2. 1 tbsp. The mixture must be poured with 1 cup of boiling water.
3. The ingredients are placed in a water bath and left for 15 minutes, stirring constantly.
4. After preparation, steam inhalations are performed. The collection should cool slightly, and the clouds of steam should be moderately warm.
5. 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.

Traditional treatment

Aloe has a disinfecting effect and can reduce pain at the site of infection. You should cut off a piece of aloe leaf, rinse it and put it on your cheek overnight.

Sprinkling the surface of the ulcer with powdered sugar or lubricating it with sugar syrup also has a positive effect. The fact is that such a “sweet” environment is unfavorable for the bacteria that cause sore throat.

Due to the fact that the cause of fusospirochetosis can be both dental caries and decreased immunity, in order to prevent its occurrence, you need to visit the dentist in a timely manner, give up alcohol and nicotine abuse and add fresh vegetables and fruits to your diet .

The most valuable thing we have is our health, so we need to treat it with care and not put off visiting a doctor.

Author: Tatyana Tsoi, pediatrician, especially for Moylor.ru

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.

Antibacterial therapy

Since acute tonsillitis is in most cases a bacterial disease, antibiotics are the most effective cure for sore throat. Penicillin drugs are mainly used. However, in case of allergy to penicillin, sulfonamides or tetracycline are used. Amoxicillin is prescribed for the catarrhal form of the disease.

The choice of drug is influenced by factors such as:

• Form of the disease
• Severity
• Individual sensitivity
• Related disorders

It is possible to use local antibacterial drugs in the form of a spray, for example, Bioparox. But only with mild acute tonsillitis.

There are rules for taking antibiotics that patients must adhere to. So, antibacterial therapy is carried out for 7–10 days. If you stop treatment early, there is a high risk that not all bacteria will die. The result is re-inflammation.

Antibiotics are the most effective remedy for sore throat; improvement occurs within 1–2 days. If this does not happen, you should consult a doctor who will suggest replacing the drug.

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).

Description of ulcerative necrotizing stomatitis

This disease refers to infection with a spindle-shaped rod or spirochete, which is called Vincent. World medical dictionaries describe the disease under terms such as trench mouth, sore throat and stomatitis with the presence of various types of ulcers. If the bacterium affects the gums, then doctors interpret the diagnosis as Vincent gingivitis. In practice, there are situations when the infection affects several parts of the human body. For example, the palatine tonsils may be affected, and then this disease is called Vincent's angina.

Why are sore throats dangerous?

At first glance, tonsillitis is a local inflammatory process of the tonsils. However, in the mechanism of development of this disease, a cascade of various biochemical, immunological and other reactions occurs, affecting the entire body. Therefore, failure to comply with treatment principles and not taking this disease seriously can lead to the development of complications such as:

1. acute rheumatic fever;
2. nephritis (inflammation of kidney tissue) up to the development of severe renal failure;
3. nonspecific infectious polyarthritis;
4. formation of chronic tonsillitis, etc.