streptococcal pharyngitis
Introduction
Introduction to streptococcal pharyngitis Streptococcal pharyngitis is a common disease, which occurs mostly in winter and spring, and can be sporadic or prevalent, and has certain contagiousness. Children and adolescents are susceptible to illness, and those who are less than 1 year old and over 50 years old rarely have symptoms. This disease not only has acute inflammation in the pharynx, but also affects the whole body and other organs to varying degrees. basic knowledge The proportion of sickness: 0.5% -1% Susceptible people: good for children Mode of infection: respiratory transmission Complications: abscess around the tonsils, parapharyngeal abscess, posterior pharyngeal abscess, acute lymphadenitis
Cause
Causes of streptococcal pharyngitis
The pathogens are mostly hemolytic streptococcus and other S. pyogenes, and contact with hemolytic streptococcus carriers is the main cause of the disease. The rate of infection in patients with chronic tonsillitis is very high, about 40% is beta-hemolytic streptococcus, whole body And environmental factors can be its incentives, such as malnutrition, excessive fatigue, physical weakness and other physical resistance or immunocompromised people are susceptible to the disease, through coughing, sneezing droplets spread or into the contaminated food after the onset, streptococcus mainly Its toxins and metabolites harm the body, such as streptolysin O and S, erythema toxin, streptokinase, hyaluronidase and several proteases, and some can directly destroy the toughness of tonsil tissue, making the lesion easy to spread, or through Allergies cause complications.
Prevention
Streptococcal pharyngitis prevention
Health education should be strengthened, exercised, and increased resistance to disease. People often suffer from pharyngitis. If tonsillitis is cured for a long time, consider tonsillectomy and find patients, and timely isolation and treatment to avoid mutual infection.
The general prognosis is good, such as no complications, more than 7 to 10 days after recovery, therefore, the early diagnosis and treatment of complications is very important, because its occurrence or not is not affected by chemotherapy or antibiotic therapy, can evolve after the occurrence For chronic heart valve disease, it will harm your health for a long time.
Complication
Streptococcal pharyngitis complications Complications around the tonsils, abscesses, parapharyngeal abscess, posterior pharyngeal abscess, acute lymphadenitis
Those who have no co-occurrence will gradually heal within a week. Once complications occur, they are extremely harmful to the body. The mechanism of their complications is divided into the following three categories:
(1) Direct spread of infection caused by the spread of the pharynx to nearby tissues, inflammation around the tonsils, abscess around the tonsils, parapharyngeal abscess, retropharyngeal abscess, acute lymphadenitis, acute sinusitis, acute otitis media, acute laryngitis, trachea and Bronchitis, pneumonia, etc.
(B) blood line spread infection through the blood circulation and other parts of the body, can occur acute arthritis, acute osteomyelitis, sepsis, peritonitis, meningitis and so on.
(3) Late complications include rheumatic fever, arthritis, nephritis, myocarditis, etc. These non-suppurative late complications are called "pathological after streptococcal infection". It is currently considered that this complication is not directly caused by streptococcus. It is the sensitive response of the tissue to this pathogen or its metabolites after pharyngeal infection.
Symptom
Streptococcal pharyngitis symptoms Common symptoms Leukocytosis, weak tonsils, congestion, dyspnea, nasal congestion, loss of appetite, cervical lymph nodes, sore throat, proliferative hypertrophy
The disease is acute, the systemic and pharyngeal symptoms are heavier, the body temperature is more than 38 ~ 40 ° C, blood test: leukocytosis, neutrophil increased, according to the history and clinical manifestations of the disease is easier to diagnose, but should Attention to the diagnosis of complications and differentiation with the prodromal symptoms of acute infectious diseases is especially important for children.
After the infection occurs, the mucous membrane is acutely congested and swollen, the secretion of mucous glands is increased, the mucous membrane surface is covered with thick mucus, lymphocytes infiltrate around the submucosal blood vessels and mucous glands, and the lymphatic tissue of the pharyngeal wall is also congested and swollen. In severe cases, white spotted infiltration is observed. Exudates, the tonsils are swollen and swollen, and the epithelium is shed in the crypt. The bacteria and metabolites and exudates form yellow-white dots. If they are fused into a piece, they form a pseudomembrane. Inflammation invades the tonsils, causing the whole tonsils to enlarge. There is suppuration in the follicles, and the lymph nodes in the neck are also swollen.
The onset is urgent, and the symptoms are similar to the upper sensation, followed by chills and high fever, headache, general malaise, loss of appetite, soreness in the back and limbs, sore throat, and the corresponding symptoms can be caused by the inflammation invading the site. Inflammation causes difficulty in swallowing, pain, accompanied by earache, inflammation of the base of the tongue, and severe burning or stinging, and radiates to both ears. When it affects the Eustachian tube, there are ear nausea, tinnitus and heavy hearing. Such as lesions and invasion of the throat, there are cough, hoarseness, difficulty breathing and other symptoms, children with severe illness, can occur convulsions, if accompanied by acute infection of pharyngeal tonsils, nasal congestion, mucus secretion in the nasal cavity and nasal pores Exudation, pediatric lactation is difficult, prone to cough, check for acute congestion and swelling of the pharyngeal mucosa, especially the mucosal swelling of the pharyngeal wall and pharyngeal arch is heavy, uvula edema, sagging, weakness, cervical lymphadenopathy There is great tenderness, especially under the jaw of the jaw, the lymph nodes are swollen and the tenderness is obvious.
Examine
Streptococcal pharyngitis examination
1. Anti-streptokinase assay: Type B hemolytic streptococcus can produce streptokinase, which is antigenic and stimulates the body to produce anti-streptococcal kinase antibodies.
2. Anti-hemolytic streptococcus "O" test: It is an antibody produced by the body with streptolysin O as an antigen. Determine whether a patient has a group A hemolytic streptococcus infection by measuring the ASO antibody titer in serum.
3. Bacterial culture of ear, nose and throat swabs: There should be no bacteria in the middle ear and sinus of normal people, that is, no bacteria can be cultured; the culture of the isthmus should have normal oral flora, and no pathogenic bacteria grow.
4. Blood routine: It is the most general and basic blood test. Blood consists of two major parts, fluid and tangible cells, which are routinely tested for blood.
Diagnosis
Diagnosis and identification of streptococcal pharyngitis
Must be distinguished from the following diseases:
(1) Scarlet fever pharyngitis is also a hemolytic streptococcal infection, with fever and systemic rash, its pharyngeal performance is not easy to distinguish, but its rash is special, red spotted rash occurs from the second day of onset, from the neck quickly Spread to the dry and limbs, facial flushing, pale mouth, the beginning of the disease has a "strawberry tongue", 3 to 4 days after the onset of the disease, "yang berry tongue", the recovery of the rash subsided, there may be significant desquamation.
(2) Ulcer pharyngeal angina (Finsen angina) The pharyngeal and systemic symptoms are mild, and there is ulceration on one side of the tonsil or pharynx, ulceration can occur in the oral mucosa and gums, and the smear can be found in Fensen. Helicobacter and Clostridium.
(3) The pharyngeal white-throated pharyngeal mucosa is lightly congested, with a grayish white pseudomembrane formed on the pharyngeal wall and the tonsil. The adhesion is dense and difficult to wipe off. If it is not rubbed strongly, see oozing, pharyngeal mucosa culture and smear can be detected. Diphtheria bacilli.
(D) adenovirus catarrhal pharyngitis often accompanied by conjunctivitis, the so-called pharyngeal conjunctival heat, culture without bacterial growth, clinical symptoms are mild.
(5) Agranulocytosis The pharyngeal mucosa is purple-red, the surface of the tonsil is often ulcerated, the general condition is poor, and there is no purulent around the tonsils. According to the history of blood tests, it can be identified.
