Follicular tonsillitis - symptoms, treatment in children and adults. Complications and prognosis

Inflammation of the palatine lymphoid accumulations (tonsils) is manifested by pain, difficulty swallowing, and high fever. For follicular tonsillitis characterized by lacunar plugs, which are pus mixed with cellular detritus and have a toxic effect.

How and with what to treat follicular sore throat

The disease manifests itself with violent symptoms, accompanied by swelling of the tonsils, significant pain in the throat, up to the inability to swallow. Follicular tonsillitis causes hyperthermia up to 40°C, severe weakness, aches. The tonsils and surrounding mucous membranes are red, often covered with a thick coating, through which yellowish or whitish spots are visible. The purulent component of inflammation leads to dangerous complication– intoxication, therefore treatment of follicular tonsillitis should be thorough and prescribed by a doctor.

Purulent sore throat without fever is not a sign of the beginning of recovery, but rather alarm signal about a decrease in immune defense. For treatment, a patient with follicular angina is prescribed a gentle regime, preferably bed. Rinsing has a beneficial effect and can be done indefinitely: the more often, the more more noticeable effect. You will need antipyretics and painkillers. An abundance of purulent deposits, severe swelling of the tonsils, high temperature require antibacterial treatment, and hospitalization may be necessary.

Antibiotics

Sore throat is most often caused by streptococci (streptococcal tonsillitis according to the ICD code), but the causative agents are staphylococci, diplococci, and corynebacteria. Taking into account pathogenic flora, antibiotics for illness are selected from semi-synthetic (inhibitor-protected) penicillins: Amoxicillin, Solutab, Flemoxin. If bacteria are resistant to this series of drugs, Augmentin, Amoxiclav, and Ecoclave are prescribed. It takes 7-9 days to treat a sore throat with basic antibacterial agents.

In case of severe tonsillitis, antibiotics of a number of macrolides “Azitrox”, “Hemomycin”, “Klacid” are used. They cannot be used for treatment longer than five days due to accumulation in the body, but these drugs have a prolonged effect. As a result, the drugs suppress pathogenic bacteria for another 5 days after stopping use. Before starting antibacterial treatment for a sore throat, throat swabs should be taken to rule out diphtheria in the patient.

Other drugs

Treatment of acute tonsillitis is supplemented with anti-inflammatory drugs, often nonsteroidal ones. The doctor will prescribe Ibuklin, Paracetamol, Nurofen. Since the listed drugs have an analgesic effect, analgesics are not needed. Allergic manifestations require desensitizing therapy with Loratadine, Claritin, and Citrine. Necessary warm drink, preferably neutral or slightly acidic, herbal teas, fruit drinks, compotes are suitable. It must be remembered that sore throat is contagious; caring for the patient requires caution.

Follicular disease implies pus in the tonsils, it must be removed, this explains the importance of rinsing. Sodas, saline solutions, herbal decoctions, even boiled water will reduce the amount of plaque, reduce the toxic component of the infection, and reduce swelling of the follicles. In treatment, you can use ready-made antiseptics “Dolphin”, “Iodinol”, “Miramistin”, “Chlorophyllipt”. Irrigation with aerosol products “Hexoral”, “Ingalipt”, “Verde”, “Tantum” are useful. Medicinal lozenges “Faringosept” and “Gexoral Tabs” help clear the throat.

Folk remedies

To clear the throat in the treatment of follicular sore throat folk recipes It is advised to suck a piece of hardened honey without drinking for half an hour. Natural antiseptic helps suppress pathogen activity, reduce doses medicinal substances. Positive effect provides treatment with lemon juice, which reduces the symptoms of tonsillitis and saturates the body with vitamin C, which is necessary in this case. It is good to gargle with beet juice with the addition of a small amount of vinegar.

Features of the treatment of purulent sore throat

Acute tonsillitis It occurs individually in each patient, so it is difficult to say how many days a sore throat will be treated. Difficulties are created allergic manifestations, intolerance to antibacterial agents. Such patients are prescribed sulfonamide drugs and the dose of desensitizing drugs is increased. Rinsing and irrigating the tonsils in such cases become the main component of the treatment of sore throat. Multiple purulent plugs become the cause of severe intoxication, instrumental cleansing of the lacunae is prescribed.

In an adult

It is important to know that lacunar plugs cannot be squeezed out. Even a slight impact on the inflamed tissue of the tonsils leads to increased swelling; damage to the mucous membrane can be complicated by a secondary infection. Pus can only be washed out using a syringe without a needle or a small syringe. Purulent sore throat in an adult must be treated properly, as prescribed by a specialist. It is better to entrust the removal of plugs to an otolaryngologist.

In children

A doctor should treat follicular tonsillitis in a child, preferably in a hospital. The high reactivity of the child's body is manifested by a significant increase in the submandibular, behind-the-ear, and cervical lymph nodes. Intoxication threatens with complicated forms of purulent tonsillitis; without proper treatment, paratonsillar abscesses, meningitis, toxic shock. Incorrectly selected antibacterial agent may cause the development of rheumatism and glomerulonephritis.

It is important to exclude diphtheria damage to the pharynx in a child, so smears must be done for bacterioscopic examination. The baby's throat may become inflamed and look like a purulent sore throat. early stage measles Mucous posterior sections The oral cavity becomes covered with spots in the form of a rash, which can be confused with purulent deposits. These are Belsky spots - an early and quickly passing symptom of measles infection. It is advisable to take a photo before the doctor arrives; the photo will help in differential diagnosis.

Follicular tonsillitis is a purulent inflammation of the follicles of the tonsils (lymphoid formations of the pharynx), in which the pus is located in the form of separate point foci. The palatine, tubal, pharyngeal and lingual tonsils may be affected. The disease is accompanied by enlargement and inflammation of the cervical regional lymph nodes, into which lymph flows from foci of inflammation.

• Most often, adults and children become ill upon initial contact with streptococcus or staphylococcus.
• And also carriers of microbes in the cold season
• Or with local hypothermia of the throat ( ice water, ice cream) and decreased immunity.

Streptococcal tonsillitis accounts for approximately 90% of cases of the disease. Primary streptococcal tonsillitis caused by beta-hemolytic stereptococcus, in combination with a skin allergic reaction in the form of a rash, is called scarlet fever. The difference between lacunar tonsillitis and follicular tonsillitis lies in the location of purulent foci and the depth of their occurrence. Follicles are smaller and more superficial formations than lacunae filled with pus.

Symptoms of follicular sore throat

The clinical picture of such a sore throat begins with pain when swallowing, sometimes radiating to the ear. With acute follicular angina, changes in blood composition are observed: an increase in leukocytes (above 9 g/l), a shift leukocyte formula to the left with an increase in band and segmented leukocytes, sometimes eosinophilia, increased ESR(sometimes significant).

Very often, at an early stage of the disease, the symptoms of follicular tonsillitis are very similar to infectious mononucleosis, exacerbation of chronic tonsillitis, herpetic tonsillitis, and oral candidiasis. Secondary angina with mononucleosis is very similar to follicular, although it can also occur as a lacunar angina:

• It begins on the first day of illness or appears on the 5-6th day.
• Besides high temperature, which flows in waves, the lymph nodes enlarge and become painful. But at the same time, not only the cervical, but also the axillary, occipital, subclavian, and inguinal groups of nodes are affected.
• Also very typical are abdominal pain and enlargement of the liver and spleen, which are not present in primary follicular angina.
• Mononucleosis is distinguished by blood tests (lymphocytosis, detection of mononuclear leukocytes).
• The diagnosis is confirmed by immunological tests (detection of antibodies and determination of their titers) and serological reactions blood.

It is especially important to distinguish infectious mononucleosis from follicular tonsillitis, the treatment of these two diseases is radically different. In case of mononucleosis, antibiotics should never be taken, and purulent follicular tonsillitis can only be treated with them.

How to treat follicular sore throat with antibiotics

On the first day after the development of follicular tonsillitis, swabs from the patient’s throat and nose should be taken for Lefler’s bacillus (the causative agent of diphtheria), with which it is necessary to differentiate the sore throat. After this, treatment of the disease begins. Basic treatment – prescription of antibiotics. First of all, they must suppress the bacterial flora and in case of streptococcal sore throat to ensure the prevention of such a formidable complication as rheumatism:

• If acute rheumatic fever only gives fever with intoxication and provokes inflammation of the joints, damage to the nervous system, walls and valves of the heart
• That chronic rheumatic disease is severe valve defects hearts with progressive heart failure and disability of patients. Also, with angina of streptococcal origin, we are afraid of secondary glomerulonephritis, leading to chronic renal failure.

Therefore, always, if you are not allergic to this type of antibiotic:

• First line drugs penicillins (semi-synthetic or inhibitor-protected) become. These are drugs wide range actions effective against staphylococci and streptococci. The course of penicillins should be 10 days. This is Amoxicillin (Flemoxin Solutab), if the pathogen is resistant, Amoxicillin with clavulanic acid Augmentin (140-250 rubles), Amoxiclav (120-300 rubles), Ecoclave (170-280 rubles) is indicated.
• Second line of antibiotics- These are macrolides. Azithromycin (Sumamed, Azitrox, Hemomycin), clarithromycin (Klacid), josamycin. Their course of treatment can be limited to 5 days, since the drugs accumulate in the blood, and such a course will give ten days of exposure to bacteria.

Efficiency antibacterial therapy We evaluate within 72 hours for a decrease in temperature and improvement general well-being. For this purpose, the patient is visited by a doctor during the first three days. If the antibiotic is ineffective, it is replaced with a drug from another group.

With this serious illness Like follicular tonsillitis, antibiotic treatment should not be stopped once it gets better. If you complete the course early, you may experience drug resistance bacteria to this antibiotic and if a relapse of sore throat occurs, he will be powerless, as well as the development of serious complications.

Symptomatic therapy

The patient should follow bed rest, a weakened patient should not go outside, as this can lead to a serious deterioration of his condition.

• Antipyretics and antihistamines

To reduce the symptoms of sore throat, use non-steroidal anti-inflammatory drugs that reduce pain and fever (nurofen, paracetamol, ibuclin). Also to reduce allergic component inflammation resort to antihistamines (see list of allergy medications, Loratadine, Claritin, Clarisens, Cetrin).

• Drinking regime

To avoid severe dehydration of the body from fever and severe intoxication, for the speedy removal of toxins, drinking plenty of warm water is best. warm milk with soda or mineral water without gases, herbal teas also help well - with chamomile, sage, rose hips. The temperature of the liquid should be optimally comfortable, not hot or cold, so as not to cause unnecessary injury to the inflamed mucosa.

• Nutrition

The food should be as homogeneous as possible, since when swallowing solid food brings a significant increase in pain when swallowing, the diet should consist of liquid cereals, soups, and broths. It is also important to ventilate the room frequently and clean it every day.

• Local procedures

In addition to the antibiotic, it is necessary to supplement the treatment local procedures. The process of development of this disease consists first in the formation of a purulent follicle, then its maturation, growth in size, and finally, the process of opening the follicle. It is precisely because of the constant presence of purulent discharge in the oral cavity the most important condition proper treatment Frequent gargling is considered follicular sore throat.

If you have a sore throat, you need to gargle as often as possible, up to 6-10 times a day. You can use special antiseptics, such as Iodinol, Dolphin, Lugol, Chlorophyllipt, Miramistin, furatsilin (2 tablets per glass of water), herbal infusions, a solution of soda and salt. Pharmaceutical industry also offers a great variety of different aerosols that are convenient to use - Ingalipt, Tantum Verde, Hexoral. You can also alleviate sore throat and swelling with the help of absorbable tablets and lozenges - Faringosept, Hexoral Tabs, etc. In addition to the disinfectant effect, gargling promotes flushing purulent discharge, which are formed after the opening of the follicles.

There is one available folk way treatment of follicular sore throat - gargling with this solution: take 1 beet, grate it on a fine grater, at the rate of 1 glass of grated mass - 1 tablespoon of 6% apple cider vinegar, preferably homemade, combine the vinegar with the beet mass, put the mixture in a dark place for 4 hour, squeeze out the juice after thick fabric, gargle with this juice every 3 hours. Beet juice with vinegar have antibacterial properties.

Follicular tonsillitis - complications

If the patient still has symptoms 6 days after the start of treatment following symptoms, this indicates a deterioration of the condition and the ineffectiveness of treatment:

• worsening sore throat
• elevated body temperature
• difficulty swallowing
• external swelling in the area of ​​the inflamed tonsils in the neck
• soreness of the lymph nodes

If you have follicular tonsillitis, the treatment of which was started late, and also if the antibiotic for tonsillitis was not chosen correctly and the patient’s immunity is severely weakened, serious complications may occur:

• in the first place is paratonsillar abscess
• Lemierre's syndrome
• infectious-toxic shock
• streptococcal meningitis
• rheumatism
• glomerulonephritis

If you do not treat with an antibiotic and ignore gargling, a complication may arise if the suppurative follicle ruptures not into the oral cavity, but into the peri-almond tissue. Then this can lead to a serious consequence - blood poisoning.

We have already said that there are two options for infection - from the outside and from the inside. This means that in one case the pathogen was transmitted from another patient, and in the second case the bacteria multiplied in the body, but only due to some factors they began to capture the pharyngeal ring.

Transfer can be carried out in the following ways:

• Airborne. When your nasal passages are not protected individually medical mask, and you are in direct contact with a sick person, then bacteria or viruses enter the body when you inhale. Through the nose they enter the nasopharynx, larynx, and then are localized in the oral cavity. The most dangerous places are those where there are a lot of people - clinics and hospitals, shopping centers, public transport, kindergartens and schools. If you are at work, where an infected person works in the same room with you, you should ventilate the room more often, and also take preventive measures - lubricate your nostrils oxolinic ointment, take the immunostimulant "Tsitovir-3" and wear a disposable mask.

• Fecal-oral. This is transmission of infection through food and water. Bacteria can be found in open bodies of water, so you should not drink liquid from rivers, lakes, or wells unless they have been treated. Filtration also does not always protect against pathogens; it only saves from solid impurities. Central water supply is usually subject to more thorough inspection. The most effective way is to use distilled water.

  Food must be cooked and washed thoroughly. This is especially true for fruits, vegetables and dried fruits, since these products are collected by hand. It is necessary to give up fast food and any street food - the sun and unsanitary conditions can lead to the growth of bacteria. Eating outside the home is always dangerous, since, despite having a health certificate, a catering employee (cook, waiter) can get sick and infect you through the dish.

• Contact and household. This applies to any items public use, which are used by family members, friends living in the same place. A precautionary measure is the purchase and use of personal items: washcloths, toothbrushes, towels, spoons, forks, mugs, cosmetics.

  You should also wash your hands after visiting public places: toilet, transport, where you hold on to handrails, and others.

Internal causes of follicular tonsillitis are complications of caries, sinusitis or other chronic inflammation nasopharynx and oral cavity. The bacteria initially have a different focus, then, due to decreased immunity, the pathogen spreads to other organs, including the tonsils.

Follicular tonsillitis is one of the types of purulent inflammation of the tonsils. How it differs from other types purulent sore throats is that in this case, pus accumulates on the surface of the tonsils in the form of separate foci, forming small bubbles - follicles. This feature is of interest only to pathomorphologists, and has virtually no effect on how to treat follicular tonsillitis.

Antibiotic therapy

Since a sore throat with a purulent component is infectious pathology, then the main means of its treatment are antibiotics. This extensive class of drugs is specially created to combat pathogenic bacteria and is ideally suited for relieving the patient of inflammation of the tonsils. But it should be remembered that antibiotics are only effective against bacterial infection. At viral lesions these pharmacological preparations will be useless.

Treatment, as a pathology caused by bacteria, begins immediately with the prescription of broad-spectrum antibiotics. This definition means that the data medicines capable of suppressing development large number microorganisms. These antibiotics include cephalosporins, macrolides, and some penicillins.

In parallel with the start of taking a broad-spectrum drug, the patient should undergo a specific examination called antibiotic sensitivity culture. To perform it, material containing microorganisms that caused the pathology is taken from the patient. For follicular sore throat, this material is usually a throat swab. Next, the laboratory grows the bacterial cultures found in the smear and checks which antibiotic most intensively inhibits the growth and reproduction of this particular strain of microorganisms. Based on the results of the study, individual treatment for follicular tonsillitis is selected for each individual patient.

Important! Antibiotics are an obligatory and main component in the treatment of purulent inflammation of the tonsils in both adults and children. This disease cannot be cured using folk remedies alone.

Taking antibiotics should continue for at least 1 week, and preferably 10 days. This is explained by the fact that most of these drugs have a cumulative effect. That is, to obtain the maximum clinical effect it is necessary that concentration pharmacological agent in the patient's body has reached a certain threshold.

One of the criteria for the effectiveness of antibiotic therapy is the subsidence of all symptoms of sore throat and normalization body temperature. But at the same time, you should finally stop taking the medications no earlier than three days after the temperature reaches normal values.

It should be remembered that after 3-5 days of a course of antibiotics, the patient may feel a temporary deterioration. It is characterized by increased weakness, symptoms of intoxication, and increased body temperature. This effect is a variant of the norm - it is caused by the massive death of pathogenic microorganisms and, as a result, an increase in the release of toxins and decay products of bacterial cells into the blood. 1-2 days after disposal of all these harmful substances, the patient’s well-being will begin to gradually improve.

Another important point when treated with antibiotics is that it is systemic therapy. That is, antibacterial drugs do not act on a specific location of infection, but on the entire body as a whole. In adults, there are microorganisms in the intestines that should normally be there - they help digest food. But antibiotics affect them just as negatively as they do pathogenic bacteria. In order to avoid dysbiosis and restore normal microflora intestines when treated with antibiotics, it is recommended to take drugs with lactic acid bacteria or regular biokefir for 10-14 days.

How many days it will take to cure follicular sore throat at home largely depends on the patient’s compliance with certain conditions:

1. The patient is prescribed strict bed rest. This will protect him from unnecessary overexertion and hypothermia. He should stay in bed for 6-8 days - at least until the temperature returns to normal.
2. Fluid intake should be increased. You can drink herbal teas, compotes, fruit drinks, fruit juices or just clean still water. This will help speed up the elimination of toxins and reduce body temperature.

Important! Taking pharmacological drugs to reduce temperature should only be started when it exceeds the threshold of 38°C.

1. The room where the patient is located should be warm. But short ventilation is necessary 2-3 times a day.
2. For several days, when the severity of angina symptoms is maximum, the patient is advised to maintain vocal rest. This will relieve the sore throat and reduce irritation of the mucous membrane.
3. It is also necessary to ensure that the patient’s food is soft, warm and does not contain aggressive substances, such as spices. This will help avoid mechanical and chemical trauma to the mucous membrane.

Among other things, the adult patient’s contact with other people should be limited as much as possible. It is quite difficult to predict how many days he will be a source of infection - therefore it is better to isolate him for the entire duration of the disease. It is especially important to avoid interaction between the patient and children, the elderly and pregnant women - all of these categories are more susceptible to infection.

Treatment of follicular sore throat also involves the use aids, which are able to locally disinfect the throat, helping fight infection. Exists a whole series drugs and compounds that can be freely used at home:

• The easiest way is to gargle with a solution that includes iodine, regular salt and baking soda. Salt and soda should be taken in equal proportions and a few drops of iodine should be added to warm water.
• You can also gargle with furatsilin solution. To do this, you need to purchase dry tableted furatsilin at the pharmacy and dissolve 1 tablet in 1 glass warm water.
• Chlorophyllipt, an extract from eucalyptus leaves, has good disinfectant properties. You should gargle with it 4-5 times a day.
• For follicular sore throat, you can disinfect the throat with a manganese solution. To do this, you need to take 2-3 grams of dry potassium permanganate per half liter of warm water and thoroughly dissolve the granules. You can also add 10-12 drops of iodine there. You should gargle with this remedy no more than 4 times a day for a maximum of 5 days.
• In addition, gargling is useful boric acid by dissolving 1 teaspoon of acid in 1 glass of warm water. You can add a pinch to the solution baking soda and salt.
• As a local disinfectant Chlorhexidine has proven itself to be excellent. It is a powerful bactericidal substance and is sometimes even able to cure follicular tonsillitis at an early stage. To do this, you need to gargle with it 2-3 times a day. But keep in mind that chlorhexidine should not be swallowed. If this does happen, then regardless of how much of the drug gets into the stomach, you should immediately take 20 tablets activated carbon or other sorbent.

In addition to pharmacological preparations for local disinfection of the throat at home, it is also useful to use folk remedies. So, for example, good antibacterial effect has a tincture of calendula or aloe. These herbal remedies can be used either as a gargle or as an inhalation.

Be sure to pay attention to such a natural antibacterial agent as garlic. You won’t find as many phytoncides—substances that destroy microorganisms—as there are in garlic—in any other natural product. You can prepare solutions based on garlic and gargle with them, but consuming it raw will also be quite effective. After placing 1 clove in your mouth, periodically bite it so that the released juice enters the oral cavity.

It is also important to know how many times a day you need to rinse. If you use pharmacological drugs, then we indicated the approximate frequency of procedures above, and in addition, you can read about this in the instructions printed on the packaging. If you prefer treatment with folk remedies, then the more rinses per day, the better. The best option is rinsing with a break of 1 hour, regardless of body temperature.

These drugs are not able to cure follicular tonsillitis, but their action is aimed at relieving its symptoms and alleviating the patient’s condition. Their task is to suppress pronounced inflammatory reactions in the throat mucosa, as well as reduce the intensity pain syndrome. This will help the patient's body focus on fighting the real reason disease - infection, which means it will directly affect how long it takes to finally get rid of a sore throat.

Anti-inflammatory and anesthetic effect Many pharmacological drugs sold in pharmacies have. Among the most popular means can be listed:

• Trachisan;
• Faringosept;
• Neo-angina;
• Septolete;
• Inhalipt;
• Kameton and a number of others.

Besides pharmaceutical drugs, at home you can widely use folk remedies. First of all, these are, of course, infusions and decoctions medicinal herbs:

• chamomile;
• St. John's wort;
• calendula;
• linden;
• yarrow;
• horsetail;
• oregano;

Important! All of these herbal remedies can cause allergic reactions. Before using them, you should make sure that the patient is not allergic to them.

Infusions and decoctions of medicinal herbs can be used to gargle or inhale the throat. Their use is indicated throughout the entire period of angina, regardless of body temperature. Moreover, even after the temperature has normalized, it is recommended to use herbal medicines for at least 2-3 more days - this will prevent the recurrence of the disease.

General strengthening agents

It also plays an important role in the fight against infection. internal protection our body's immune system. Therefore, its maintenance and stimulation will help cure a sore throat faster. In order to activate the functions of the immune system, you can use such means as:

• Vitamin complexes. Vitamins are necessary for the immune system to normal operation. It is with their help that many biochemical reactions– they serve as catalysts for the action of the immune system.
• Protein food. This substance is the main building material immune system, therefore, the patient’s diet should include increased amount easily digestible protein, for example, in the form of chicken meat.
• Immunostimulants. These are like this herbal preparations, like ginseng, echinacea, eleutherococcus, etc.

Besides this, good tonic are periodic warm-ups. First of all, keep your feet warm. For this you can use hot foot baths or installation of mustard plasters. But it should be remembered that if the body temperature rises above 380C, all warming should be canceled. In addition, they cannot be used in adults suffering from heart and vascular diseases, as well as in pregnant women.

Important! Warming compresses on the throat for follicular sore throat are completely prohibited - additional local heating will contribute to the development of infection.