Angina is a very interesting and not very common disease.
On the one hand: angina is present in all medical reference books, many have had it, many know that if "glands swelled and swallowed painfully" - this is the most. On the other hand, there is no angina in the international classification of diseases (ICD-10). Paradox? Not at all.
The fact is that angina is many. More precisely, very much. A couple of dozens of varieties can be counted without leaving the place. The common feature that unites them all is the localization of the process in special formations of the lymphatic system called tonsils.
We will make a small digression in order to understand in more detail: what are tonsils, and why we need them.
Protection system
Immunity, that is, the protective system of our body, the concept is very stretchable. It is represented by cells, tissues, and even some specialized organs. A tissue that is stuffed with protective and cells is called lymphoid. In the body there are several places of its concentration. A pharynx is one of them.
The maximum amount of foreign material comes to our body through the nose and mouth - here and air, and water, and food, and many other things that are not sterile. The most aggressive enemies are best to be rendered harmless at distant approaches, not letting them in. This is the purpose of a whole ring of special formations in the throat, called tonsils.
The tonsil is essentially an "open" lymph node. On the connective tissue basis lies the advanced detachment of body defenders in the form of the same lymphoid tissue. There are many tonsils: a pair of palatines, a lingual (on the root of the tongue), pharyngeal (posterior wall of the pharynx), a pair of tubal tonsils (at the entrances to the auditory tubes at the back of the pharynx). All this constellation is called the Pirogov-Valdeier ring.
Us, in the first place, are interested in palatine tonsils, sometimes referred to in common parlance as "glands". Territorially, they are limited to palatine arches - folds of the mucous membrane, which go from the root of the tongue to the soft palate (hence the name). These tonsils are the largest, it is on their territory that a drama called "angina" plays out.
By the way, the amygdala in Latin sounds like tonsila, therefore its inflammation will be called "tonsillitis". Here under the name of acute tonsillitis and our angina inhabits the ICD-10.
Uninvited guests
The essence of acute tonsillitis is simple: the development of an inflammatory reaction in response to getting on the tonsils of pathogenic microorganisms. It can be bacteria, viruses, fungi, respectively, angina will be bacterial, viral or fungal.
There are also varieties of angina in malignant diseases of the blood, but in such a jungle we do not get to use, we will stop on the infectious process.
So, among the bacteria the most "popular" pathogens of strep throat are streptococci. Approximately 80-90% of acute tonsillitis are streptococcal. Rarely, the cause of the disease may be staphylococci or pneumococci. Even more rarely in the role of pathogen can act spirochaetes, and then develops quite a serious angina Simanovsky-Plaut-Vincent.
The most interesting thing is that angina can be transmitted not only by traditional airborne droplets, but also through food, because the same milk or mashed potatoes is the ideal medium for the reproduction of staphylococci or streptococci.
In the future, when we talk about angina, we will have in mind streptococcal acute tonsillitis, because it is the most common.
Conflict of interest
The task of streptococcus is to penetrate into the human body and profit there with something delicious. The task of the immune system is not to miss the impudent in the holy of holies and expel it with minimal losses. There is inflammation - that is, a local reaction to the introduction of the pathogen.
Inflammation of the tonsils is manifested primarily in their redness (blood flow) and increase (edema). This is the same picture that you can see by opening your mouth in front of the mirror and telling yourself "A-ah-ah-ah-ah-ah-ah." The degree of enlargement of the tonsils can be different - at a minimum they even look at the palatine arch, and at the maximum they are selected into the oral cavity and practically touch each other. Because of inflammation in the tonsils, we have the main symptom of angina - a sore throat when swallowing, and sometimes even an inability to swallow anything, even saliva.
By the way, for a sore throat the rhinitis, cough or "sat down" voice is not characteristic. These symptoms will more likely talk about ARVI or the allergic nature of the disease.
The next line of defense is regional. With angina, it manifests itself as an increase and soreness of the angular-maxillary lymph nodes. They can be palpated around the angle of the lower jaw - round formations the size of a pea or core of hazelnuts.
The last frontier is the organism. Response to the intrusion of streptococcus - high fever (up to 39 ° C), chills, muscle aches, malaise, weakness, nausea, and other signs of general intoxication that complete the clinical picture of angina.
Three stages
Angina is a stage process. And if she does not interfere, she usually goes through all her stage-varieties.
Everything begins with a catarrhal sore throat. Slightly enlarged and reddened tonsils, a slight rise in temperature, a slight pain when swallowed. A rare sore throat is delayed at this stage, moreover, the patients themselves do not always give these symptoms a proper value.
Follicular tonsillitis is the most common form of it. The name is associated with the appearance on the surface of the tonsils of points of accumulation of pus, the so-called follicles. Here we already have a full detailed picture of angina, including high fever and other noticeable symptoms.
If you do not intervene, the process will go further, and the pus will begin to fill the folds of the tonsils - the lacunae. Angina will pass into the lacunar stage.
Phlegmonous tonsillitis is extremely rare, and it means actually purulent melting of the tonsils, the transition of inflammation to surrounding tissues, the temperature to 41 ° C, which is generally poorly compatible with life.
Treatment
A doctor should treat angina. Self-medication in this case is not only unacceptable, but also dangerous, about which a little later. The diagnosis must be confirmed by bacteriological examination (swab from the nose and pharynx). The fact is that much more dangerous infections, for example, diphtheria, can give a similar picture.
Modern medicine has everything necessary to successfully deliver a person from a sore throat. The main treatment is antibiotics, which are also selected taking into account the sensitivity of the microflora (another bacteriological analysis).
It is necessary to strictly observe all the prescriptions of the doctor and in no case independently to reduce the course of antibiotics. Otherwise, you can grow a vicious and drug-resistant monster.
Possible consequences
Now about the most important thing - about what angina is really dangerous, and why doctors are obliged to observe for a whole month the sick angina, do urine tests, take an electrocardiogram and perform other studies.
The fact is that streptococci are very unpleasant guests. They are extremely active, immunogens, and can trigger a cascade of pathological reactions in our body. The most severe complications are rheumatism (with heart and joint damage) and glomerulonephritis (defeat of the glomerular apparatus of the kidneys). These two diseases are much easier to prevent than to treat later.
That is why in no case should you stop treatment, go back to the previous loads, even if the state of health improved on the 3rd-4th day of illness. Angina - a disease of insidious and frivolous attitude to itself does not forgive.
Susceptibility to angina in humans is about 10-15 percent. And young people (up to 30 years) are most at risk of disease. This is due to the age-related features of the functioning of the immune system.