Angina

Clinical signs

acute Ignition of the Oropharynx and amygdalae mainly. It is characterized by a pharyngée pain, otalgies and potential a Dysphagie. General signs can be noted like a faintness general and a fever. The clinical examination will be delayed on the palpation of the cervical zones of lymphatic drainage in the search of adenopathies.

The examination of the oral cavity will make it possible to specify the type of angina met directing the assumption of responsibility thus.

Érythémateuse or érythémato-pultaceous angina

The examination finds érythémateuses amygdalae, and the pharyngée mucous membrane is sometimes covered with a punctiform coating blanchâtre (angina called “to white points”).

This type of angina is generally of viral origin ( rhinovirus , coronavirus , adénovirus , myxovirus influenzae , myxovirus parainfluenzae , respiratory virus syncitial,…). It is associated in this case with diffuse adenopathies and a diffusion of the infection with the respiratory tree. The biological examinations and in particular numeration formulates blood presents a normal or decreased leucocytose.

However, this type of angina can be of bacterial origin , and makes the gravity of the diagnosis because of the rare complications but serious of the anginas to streptocoque of the group has (local suppurations, acute Rheumatoid arthritis, acute glomerulonephritis, Scarlatine). The other possible germs are the pneumococci, Haemophilius influenzae and the staphilococca (rare). The infection is brutal and localized with amygdalae. The fever is high 39°-40°. The palpable adenopathies are under-digastriques. The blood examinations present a hyperleucocytosis to polynuclear neutrophiles.

The action to be taken is stereotyped and it passes obligatorily by local taking away and the use as far as possible of kits of diagnosis fast or Doctor Tests.

When the bacterial origin is confirmed, the treatment puts back on a antibiothérapie (Penicillins: Penicillin V, Amoxicilline; Cephalosporines: Céfuroxime, Cefpodoxime; Macrolides: Josamycin, Clarithromycine, Azithromicine). The treatment is only symptomatic for a viral infection of a subject immunocompétent.

Pseudo-membranous angina

; Diphteria: Had with Corynebacterium diphteriae . Become extremely rare in France thanks to obligatory vaccination, the Diphtérie is serious. The general and functional signs are moderate. With the examination of the oropharynx one can notice on amygdalae and the pillars of the thick, adherent and coherent false membranes, invading the luette. The diagnosis is evoked according to the epidemiologic context (absence of vaccination, travels in zone of endémie) and the private clinic. It will be marked after the discovery of the bacillus on taking away of throat. One carries out the treatment in urgency by serotherapy and antibiothérapie (Penicillin V and Macrolides)

; Infectious mononucleosis: Had with the Virus of Epstein-Barr (EBV). To the clinical examination, the patient presents diffuse adenopathies and a intense Asthénie. An cutaneous eruption and a splénomégalie can be present. A numeration formulates blood will present a hyperlymphocytose to large basophilic lymphocytes characteristic of the syndrome mononucleosic although that Ci can be delayed 8 has 10 days after the beginning of the clinical signs. A hepatic cytolysis and a thrombopénie are frequently associated. The diagnosis will be affirmed by the positivity of serology. One uses for that the MNI Test and IgM (Immunoglobuline) anti-VCA. One will avoid any treatment by ampicilline which is accompanied by cutaneous eruptions.

Ulcerous or ulcéro-necrotic angina

; Angina of Vincent: Had with association fuso-spirillaire ( Fusobacterium necrophorum + Borrelia vincentii ), it is the ulcerous angina most frequent. It often joins a bad hygiene buccodentaire. A moderated fever, a stinking breath and a unilateral odynophagie are found. The examination of the oropharynx shows a unilateral ulceration with membranes grisâtres, flexible. Presence of adenopathies in the territory of drainage. The diagnosis is done after bacteriological examination of the taking away of throat. The treatment rests on a antibiothérapie by penicillin V over one 10 days duration.

; Chancre: Had with Treponema pallidum . The examination of the oropharynx shows a surface and nonpainful ulceration. The palpation of this lesion shows an induration. Attention one will take care of well carrying out this palpation with a protection (doigtier or glove) because the chancre is very contagious. One can note a satellite adenopathy of this lesion which will be it also nonpainful. The treatment will be done in only one intramuscular penicillin injection G (benzathine-benzyl-penicillin).

; Agranulocytose: The ulcéro-necrotic angina is a traditional clinical demonstration but inconstant deep Neutropénie S and Agranulocytose S. Any ulcéro-necrotic angina imposes the realization of a blood numeration-formula.

Vesiculate angina

; Herpetic angina: Had with the virus Herpes simplex , generally at the time of a primary infection. One will note a gingivo-stomatitis (ignition of the language and gums) associated with the angina. The treatment rests on aciclovir it during 5 days as well as local care by baths of mouth.

; Herpangine: Had with the Virus coxsackie has or with the Echovirus, it touches especially the children of less than 7 years. The examination of the oropharynx presents small pharyngées blisters and an inflammatory mucous membrane. One can note moreover one moderate fever. The treatment remains symptomatic.

External bond

anginas in two times, three movements, the General practitioner n°2267, November 21st 2003

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