Why does my throat hurt and there is a white coating on my tongue? Causes and treatment

Treatment

For your information! In certain cases, treatment may differ radically (based on the root cause of the appearance of white plaque).

So, depending on the underlying pathology, the patient is prescribed the following treatment:

• In case of problems with the gastrointestinal tract the diet is , excluding all harmful foods from the diet. First of all, fatty meat, fried foods, fast food. This also includes sour cream, butter, alcohol and sweet carbonated drinks. Prescribe medications appropriate to the current disease. The treatment is carried out by a gastroenterologist.
• For influenza and ARVI, antipyretics (Paracetamol, Ibuprofen, etc.) and drugs for topical use are prescribed Among them, nasal drops - Naphthyzin, Xylometazoline, Otrivin, etc.; tablets and lozenges for resorption with anti-inflammatory action - Doctor Mom, Strepsils, etc.
• In case of fungal infection of the oral cavity , the patient is prescribed antifungal drugs. Among them: Rumicosis, Fungicidin, Diflucan, Nystatin, etc.
• If you have a sore throat and other throat diseases , drugs such as Faringosept, Ingalipt, Neo-angin, Septolete , etc. are recommended. Antiseptics (Miramistin and Chlorhexidine), Furacilin solution (1 tablet per glass of warm water) are prescribed as rinses. You can use a soda-salt solution (1 teaspoon of each per glass of warm water). Decoctions of chamomile, sage, and calendula are also suitable (1 tablespoon of raw material per glass of boiling water).
• For bacterial infections , oral antibiotics are indicated (Sumamed, Amoxiclav, Cephalexin, Azitrox, etc.). In this case, it is necessary to complete the full course of treatment. Even if the symptoms go away a few days after starting therapy.
• For glossitis , first of all, it is necessary to exclude hot and spicy foods from the diet. Remove from the diet too salty, with the addition of red or black pepper, garlic, onion, mustard, various sauces, etc. And it is important to rinse your mouth with Chlorhexidine, Miramistin, a weak solution of potassium permanganate, Furacilin, herbal infusions, etc. .
• In case of hormonal disorders , treatment is carried out by an endocrinologist. The course of treatment and dosage of certain medications is prescribed by the doctor. Self-medication is unacceptable, because without knowing the true cause of plaque, therapy will be meaningless and can only worsen the situation.

Differential diagnosis and treatment tactics for acute tonsillitis (tonsillitis) at the present stage

Acute tonsillitis (AT), or tonsillitis, is an acute infectious disease of one or more components of the lymphadenoid pharyngeal ring with primary damage to the parenchyma, lacunar and follicular apparatus of the tonsils. Sore throat can be an independent nosological form, as well as a complication or one of the manifestations of infectious and somatic diseases [1].

The following forms of OT (angina) are distinguished [2]:

• by etiology: streptococcal, staphylococcal, pneumococcal, etc.;
• by localization of the pathological process: palatine tonsils, lateral pharyngeal ridges, nasopharyngeal tonsil, lingual tonsil, lymphoid formations of the posterior pharyngeal wall, lymphoid formations of the larynx;
• according to the nature of the local process: catarrhal, follicular, lacunar, membranous-necrotic;
• by severity: mild, moderate, severe;
• by disease frequency: primary, recurrent;
• along the course: smooth, non-smooth (with complications, with a layer of secondary infection, with exacerbation of chronic diseases).

Catarrhal tonsillitis is an inflammation of the mucous membrane of the tonsils without the formation of plaque on them.

Follicular tonsillitis is a purulent melting of the follicles of the tonsils, while against the background of hyperemic and hypertrophied tonsils, multiple whitish-yellowish, vaguely demarcated, “millet grain”-sized points are observed, which shine through the epithelial cover in the form of rounded yellowish islands 3-4 mm in size. The surface of the tonsils takes on, in Simanovsky’s figurative expression, the appearance of a “starry sky.”

Lacunar tonsillitis - manifested by enlargement and hyperemia of the tonsils, with a purulent coating emanating from the lacunae and spreading over the surface of the tonsils - it consists of detritus, pus - yellow, white-yellow in color, loose consistency, easily removed, rubbed with a spatula, not beyond the tonsils spreads, the surface of the tonsils does not bleed after its removal, and plaque does not renew after removal.

With membranous-necrotic tonsillitis, there is a sharp pain when swallowing, dirty-gray areas of necrotic tissue of the tonsils up to 10-20 mm in size, and slight swelling of the tonsils. When plaque is rejected, a bleeding defect in the tonsil tissue with an uneven surface is formed.

A mild form of OT is manifested by low-grade fever for no more than 2–3 days, slight pain in the throat when swallowing, moderate general weakness, exudative or follicular tonsillitis, an increase of up to 1 cm in the diameter of the submandibular lymph nodes, and their moderate pain.

The moderate form of OT is accompanied by fever of 38.5–39.0 °C for 4–6 days, severe intoxication (weakness, chills, headache, muscle and joint pain, sleep disturbance), severe tonsillitis (pain in the throat when swallowing, a large number of purulent follicles on the tonsils), enlargement of regional lymph nodes up to 2 cm, their severe soreness.

A severe form of OT is characterized by fever above 39.0 °C, severe intoxication, constant sore throat, severe hyperemia of the tonsils spreading to the soft palate, a large amount of pus in the lacunae, regional lymph nodes are enlarged to 3 cm, painful, there may be signs of kidney damage.

Repeated OT is a disease that occurs annually or no later than two years after the previous one, and is characterized by the more frequent formation of tonsillogenic pathology.

OT most often affects children of school age and adolescence. In early childhood (up to 3 years) and over the age of 50 years, the incidence of OT is lower. This is due to age-related imperfections of the lymphoid tissue of the pharynx in children and its age-related involution after 50 years [1].

The main causative agent of sore throat is considered to be group A β-hemolytic streptococcus (GABHS). The incubation period for acute streptococcal tonsillitis ranges from several hours to 2–4 days. Characterized by an acute onset of the disease with an increase in body temperature to 37.5–39 °C, chills, headache, general malaise, sore throat, aggravated by swallowing, arthralgia and myalgia are not uncommon. Children may have nausea, vomiting, and abdominal pain. A detailed clinical picture is observed, as a rule, on the second day from the onset of the disease, when the general symptoms reach their maximum severity. On examination, redness of the palatine arches, uvula and posterior wall of the pharynx is revealed. The tonsils are hyperemic, swollen, often with a yellowish-white purulent coating. The plaque is loose, porous, and can be easily removed with a spatula from the surface of the tonsils, without the formation of a bleeding defect. All patients experience thickening, enlargement and tenderness of the cervical lymph nodes at the level of the angle of the lower jaw. The hemogram is characterized by leukocytosis of 9–12 × 109/l, with a shift in the leukocyte formula to the left, an increase in ESR, sometimes up to 40–50 mm/h, and an increase in the level of C-reactive protein in the blood.

The relevance of streptococcal sore throat is due not only to its wide distribution, but also to the large number of complications. More than 80 complications are known, including: acute rheumatic fever (ARF), post-streptococcal glomerulonephritis, polyarthritis, systemic vasculitis, infectious-allergic myocarditis, otitis media, peritonsillar abscess, etc. [3–5].

However, OT can be of another bacterial etiology (diphtheria, tularemia, syphilitic, tuberculosis) and candidiasis. Various viruses can also cause OT - herpes simplex virus, Eptstein-Barr virus, cytomegalovirus, adenoviruses and enteroviruses.

With age, the etiology of OT undergoes significant changes. According to L.G. Aistova et al. (2012), in children aged 3 months to 3 years, in 44% of cases, OT is caused by multiple mixed herpetic infection, in 31% of cases - by opportunistic microflora (Neisseria perflava), in 35% - by streptococci of different groups (A, F, D). In children aged 3 to 7 years, on the contrary, herpes viruses were detected only in 9% of cases, and in 77% of cases, sore throat was caused by bacterial flora and was not complicated by herpetic infection; streptococci of groups A, F, D were diagnosed in 28% [6 ].

Similar results were obtained by A. Yu. Medvedev et al. (2011). During OT, streptococci of different types were isolated: Streptococcus pneumoniae - in 52%, Streptococcus pyogenes - in 18%, Streptococcus agalactiae - in 2% of patients, staphylococci (Staphylococcus aureus, etc.) - in 18%. In 10% of patients, gram-negative and gram-positive opportunistic bacteria were noted as independent pathogens of OT, and herpes viruses were found in 18% [7].

Due to the wide variety of etiologies of OT, infectious disease specialists and pediatricians face an important task - competent diagnosis and timely prescription of adequate therapy. In modern Russia, 95% of OT patients receive antibiotics, including often doctors at clinics prescribing ineffective drugs: ampicillin (45%), erythromycin (19%), ciprofloxacin (7%), doxycycline (6%), etc. [5]. Not every OT needs to prescribe antibiotics, but they are required for streptococcal sore throat. With the latter, the main goal of antibacterial therapy (ABT) is the eradication of group A streptococcus, since only in this case the risk of developing a complication such as ARF is eliminated.

Unjustified use of antibiotics leads to the development of microbial resistance to them, the development of complications (anaphylactic reactions, intestinal imbalance, the development of fungal complications), and increases the cost of therapy.

To diagnose OT caused by GABHS [2, 8], the following are used:

• clinical differential diagnosis;
• clinical scale method;
• method of cultural studies (microbiological diagnostics);
• express diagnostic method (rapid tests).

However, none of these methods are 100% effective and each has disadvantages.

Considering that no clinical symptom can be absolute proof in identifying streptococcal tonsillitis and the diagnostic significance of various symptoms is not the same, a progressive step was the formalization of symptoms and their reduction into clinical scales. From them, the doctor will know the likelihood of isolating GABHS during a cultural examination of a smear from the oropharynx. The following scales have been developed: Breeze scale (1975), Walsh scale (1977), Sentor scale (1981), MacIsaac scale (1998). The higher the total score for them, the higher the likelihood of isolating GABHS. The predictive power of clinical scales is not high enough (with a maximum MacIsaac score of 51–53%), and therefore, even if the patient has a maximum score, streptococcal tonsillitis cannot be diagnosed with confidence. However, the scales allow us to identify a group of patients with a low risk of streptococcal sore throat. If the Sentor or MacIsaac clinical scale is used, then with a score of 1 point or less, the risk of GABHS isolation does not exceed 10% [8, 9].

The MacIsaac scale for a patient with OT provides [9]:

• body temperature above 38 °C - 1 point;
• absence of cough - 1 point;
• enlargement and tenderness of cervical lymph nodes - 1 point;
• swelling of the tonsils and the presence of exudate - 1 point;
• age from 3 to 14 years - 1 point;
• age from 15 to 44 years - 0 points;
• age over 45 years - 1 point.

Medical tactics for a patient with OT depends on the number of points on the MacIsaac scale and is presented in table. 1.

The gold standard for examining a patient with complaints of sore throat is a bacteriological examination of an oropharyngeal smear [10–12]. The smear collection technique has a significant impact on the sensitivity of the method. A smear is taken using a swab from the surface of the tonsils, from the mouths of the tonsil crypts and from the back wall of the pharynx. You should not touch the swab to other areas of the mucous membrane before and after collecting the material. The swab should not be taken soon after eating. The material cannot be representative if taken after the start of ABT. The sensitivity of the culture method is 90%, specificity 95–99%. The disadvantage of this method is that the answer is received only 1–2 days after collecting the material, as well as the need for a bacteriological laboratory [12]. The desire to avoid these shortcomings led to the development of rapid tests that can detect GABHS directly in an oropharyngeal smear [11, 12]. Comparative characteristics of these tests are given in table. 2.

The sensitivity of the first and second generation tests is not a fixed value and depends on the number of microorganisms in the material and the severity of the clinical picture. The lower the clinical scale score and the lower the amount of GABHS, the less sensitive the system is [12].

Rapid tests complement, but do not replace the cultural method, since a negative rapid diagnostic result does not exclude streptococcal etiology of the disease [13]. In addition, only by isolating the pathogen can its sensitivity to antibiotics be determined, which is an important aspect in working to reduce antibiotic resistance [14]. Rapid testing involves obtaining results “at the patient’s bedside” within 4–10 minutes. The analysis is performed by a physician and does not require a special laboratory, and the sensitivity and specificity of modern second-generation tests, exceeding 90%, make it possible to avoid duplicate bacteriological testing if the rapid test result is negative [15].

K. V. Shpynev et al. (2007) proposed the following algorithm for diagnosis and treatment tactics for OT [3] (Fig.).

Therapy for any etiology includes bed rest for the first 3–4 days of illness, a diet with a predominance of dairy and plant-based foods rich in vitamins, and drinking plenty of fluids. All patients with OT are prescribed pathogenetic and symptomatic therapy with non-steroidal anti-inflammatory drugs (NSAIDs) and antihistamines.

Fever below 38°C in initially healthy children and adults generally does not require treatment. However, with streptococcal sore throat, fever is often combined with manifestations of intoxication, which significantly worsens the well-being of patients.

Antipyretic therapy for OT is indicated [16]:

• previously healthy: - at t > 39 °C; - for muscle aches; - for headaches.
• with a history of convulsions at t > 38 °C.
• for severe chronic diseases (t > 38 °C).
• in the first 3 months of life (t > 38 °C).

Prescribing acetylsalicylic acid (Aspirin) for this purpose to children and adolescents has been prohibited in the United States since the 70s, and in Russia since the late 1990s, due to the proven connection of their use with the development of Reye's syndrome. Analgin is not used as an over-the-counter antipyretic, which is associated with the risk of developing agranulocytosis and collapse with hypothermia; this drug is prescribed only as an analgesic or to quickly reduce temperature for special indications as part of a lytic mixture: IM Analgin 50% solution 0.1–0.2 ml/10 kg + Papaverine 0.1–0.2 ml 2% solution . Paracetamol is a frequently used antipyretic and mild analgesic in children, a derivative of phenacetin, but much less toxic than the latter. Contraindicated for liver diseases. Ibuprofen (Nurofen for children, Nurofen) - a derivative of propionic acid - has antipyretic, analgesic and anti-inflammatory properties. Currently used in more than 30 countries [16].

The safety of Nurofen for children is due to:

• short half-life (1.8–2 hours);
• during metabolism in the liver, pharmacologically active substances are not formed, so there is no direct toxic effect on parenchymal organs (liver, kidneys, etc.);
• excretion of drug metabolites in urine is completed 24 hours after taking the last dose. The rapid metabolism and excretion of ibuprofen to some extent explain its relatively low toxicity compared to other NSAIDs and the lack of negative effects on renal function. With long-term use, its accumulation in the body does not occur.

If there is a history of allergic diseases and concomitant pathology of the digestive organs, it is rational to use paracetamol or Nurofen in suppositories due to the absence of flavoring additives in the rectal form and a direct effect on the gastric mucosa [16].

Local treatment includes gargling with solutions containing antiseptic or anti-inflammatory agents to mechanically remove debris from the tonsils. It is of leading importance compared to irrigating the throat with aerosols. The most effective aerosol today is Miramistin. Symptomatic and local therapy for acute tonsillitis shortens the course of the disease by one day, which does not mean that it should be neglected.

Drugs recommended for local treatment of OT:

• chlorophyllipt - 1 tsp must be dissolved in 100 ml of water;
• tea tree essential oil - essential oils do not dissolve in water, so 4-5 drops of oil must first be dropped into a teaspoon of salt or soda, and then stirred in warm water (1 glass);
• Miramistin 3-4 times pressing 3-4 times a day. The amount of the drug per irrigation is 10–15 ml.

Rinse solutions should be as fresh and warm as possible. Rinsing should be done at least 3 times a day, especially after meals. After the procedure, you should not eat or drink for 20–30 minutes. One rinse should last at least 30 seconds.

Systemic ABT is aimed at eradicating the main causative agent of angina - GABHS [17]. When choosing ABT, it should be taken into account that GABHS are highly sensitive to penicillins and cephalosporins. The route of administration for systemic ABT should provide the necessary concentration of the drug at the site of infection, be simple and not burdensome for the child. For outpatients, antibiotics are usually prescribed orally, except in cases where one intramuscular injection is sufficient. In the hospital, the antibiotic is often administered intramuscularly (in the absence of blood clotting disorders), and in severe forms and the possibility of venous catheterization - intravenously. Parenteral administration of antibiotics should be used at the beginning of treatment, and when the patient’s condition improves, it is advisable to switch to taking the drug orally. In pediatrics, this provision is especially important for reducing negative reactions on the part of the child.

The first-line drugs in the treatment of infectious processes caused by streptococcus pyogenes, both in Russia and abroad, are semi-synthetic penicillins [8, 18, 19]. Beta-lactams remain the only class of antibiotics to which GABHS has not developed resistance [4, 8]. At the same time, resistance to tetracyclines and sulfonamides in Russia exceeds 60%. In addition, tetracyclines, sulfonamides, co-trimoxazole do not provide eradication of GABHS, and therefore they should not be used for the treatment of acute streptococcal tonsillitis caused even by strains sensitive to them in vitro [18]. Macrolide antibiotics, due to the rapid increase in streptococcal resistance to them, are third-line drugs for the treatment of acute tonsillitis [20].

To eradicate GABHS, a 10-day course of ABT is required (the exception is azithromycin, which is used for 5 days). Early administration of antibiotics significantly reduces the duration and severity of symptoms of the disease. Repeated microbiological examination at the end of ABT is indicated for children with a history of rheumatic fever, in the presence of streptococcal tonsillitis in organized groups, as well as in cases of high incidence of rheumatic fever in a particular region [14].

The choice of drug for ABT of streptococcal OT is reflected in table. 3.

The clinical effect of penicillins is assessed at the turn of 48-72 hours of therapy, macrolides (azalides) - 48-56 hours.

A review of the initial ABT is carried out when:

• absence of clinical signs of improvement within 48–72 hours (depending on the type of antibiotic) from the start of therapy;
• at an earlier time as the severity of the disease increases;
• with the development of severe adverse reactions;
• when clarifying the causative agent of infection and its sensitivity to antibiotics based on the results of a microbiological study.

If natural penicillins are ineffective and with recurrent streptococcal tonsillitis, other antibacterial drugs are prescribed orally for 10 days: amoxicillin/clavunate, cefuroxime axetil, clindamycin, lincomycin [14, 17, 18].

Errors in the treatment of streptococcal tonsillitis include [14, 18]:

• incorrect differential diagnosis of streptococcal, viral and tonsillitis of other etiologies;
• neglect of the combination of analytical methods (clinical, scale method, microbiological studies);
• unreasonable preference for local treatment (rinsing, etc.) to the detriment of systemic ABT;
• underestimation of the clinical and microbiological effectiveness and safety of penicillins;
• prescription of sulfonamides, co-trimoxazole, tetracycline, fusidine, aminoglycosides;
• reduction of the ABT course with clinical improvement.

Acute tonsillitis of another etiology may have similar symptoms. Differential diagnosis of tonsillitis is carried out during pharyngoscopy based on the predominance of certain changes in the tonsils, as well as taking into account other changes in the pharynx and general manifestations of the disease, including symptoms characteristic of certain infectious diseases.

The most dangerous disease accompanied by OT is diphtheria. Diphtheria can occur in localized and toxic forms. The localized form of oropharyngeal diphtheria is characterized by an acute or subacute onset, chilling, increased body temperature up to 38 °C, headache, weakness - signs of moderate intoxication. A sore throat may not appear immediately; it is not very severe. Plaque on the tonsils forms already in the first hours, and by the end of the first day (beginning of the second day) a dense film with a smooth surface of a grayish-white, pearlescent color is formed. Around the plaque there is a faint hyperemia of the mucous membrane with a cyanotic tint. In the early stages, the film can be removed without damaging the mucous membrane. Subsequently, the plaque becomes denser, thickens, and when you try to remove it, the mucous membrane bleeds. In areas where plaque has been removed, it forms again. The plaque rises above the surface of the tonsils, its edge is clearly demarcated from healthy tissue. Swelling of the tonsils corresponds to the intensity of plaque formation. The reaction of the lymph nodes is moderate. The period of elevated body temperature with localized diphtheria lasts 3 days. With normalization of temperature, sore throat decreases, but plaque on the tonsils persists for 6–7 days [21].

Toxic diphtheria of the oropharynx begins acutely, with chills, headache, nausea, and severe sore throat. Body temperature rises to 39–40 °C. Fibrinous deposits in toxic diphtheria are detected in the first hours of the disease. From the second day they become denser and spread beyond the tonsils. An early sign of toxic diphtheria is swelling of the mucous membrane of the oropharynx, which spreads from the tonsils to the soft palate, arches, and uvula. The relief of the tonsils is smoothed out, and they merge with the tissue of the arches, closing with the internal surfaces. The swelling does not have clear boundaries, grows quickly, the tonsils acquire a purplish-bluish tint; hyperemia can be bright. There is severe pain when swallowing, difficulty in eating any food, pain in the neck, and a sweetish-sweet odor emanates from the mouth. From the first day of illness, there is a significant increase in lymph nodes; they are dense and painful [21].

Swelling of the subcutaneous tissue of the neck is detected from the second day of illness. It has a doughy consistency, painless, and spreads from the regional lymph nodes to the neck. The spread of edema of the tissue serves as a criterion for assessing the severity of toxic diphtheria of the oropharynx: if the edema is localized only above the regional lymph nodes, they speak of a subtoxic form, if the lower border reaches the 1st cervical fold - of the toxic form of the 1st degree, up to the clavicles - 2nd degree, below the clavicles — III.

Simanovsky–Plaut–Vincent angina accounts for 5–8% of all angina. It is caused by the association of two microorganisms: Borrelii vincenti and the fusiform bacillus - Fusobacterii fusiforme hoffman, and is characterized by the absence of severe intoxication. Body temperature does not rise above subfebrile values. Sore throat is mild. The process is often one-sided, manifested by a grayish coating followed by the formation of a crater-shaped ulcer and a putrid odor from the mouth.

Candidomycosis is also practically not accompanied by general symptoms; it often develops against the background of HIV infection or other immunodeficiencies. The plaque resembles a cheesy mass; after removing the plaque, the mucous membrane does not bleed. Plaques can merge and spread to the soft palate and the back of the pharynx. Cervical lymphadenitis is not typical [1].

Herpangina is more common in children under 15 years of age. The causative agent is considered to be Coxsackievirus type A. This form of tonsillitis is accompanied by severe symptoms of intoxication and high fever. Vesicles with serous contents are visible on the anterior palatine arches; the palatine tonsils themselves may be only slightly hyperemic, but in some cases they are covered with small white blisters or ulcerations [1].

Infectious mononucleosis caused by the Epstein-Barr virus is characterized by severe malaise, fever up to 38–39 °C, sore throat, hepatosplenomegaly, enlargement of the superficial and deep lymph nodes of the neck, snoring, nasal congestion, and later a reaction appears in other groups of lymph nodes. The timing of the appearance of tonsillitis lags behind other signs of infectious mononucleosis. Plaques on the tonsils are white or white-yellow in color and are difficult to separate. In the hemogram, the initial leukopenia is replaced by pronounced leukocytosis (up to 20–30 × 109/l); in the leukocyte formula, up to 80–90% are lymphocytes, monocytes and atypical mononuclear cells. In infectious mononucleosis, drugs from the aminopenicillin group (ampicillin, amoxicillin (Flemoxin Solutab), amoxicillin with clavulanate (Amoxiclav, Moxiclav, Augmentin)) are contraindicated due to the possibility of developing an allergic reaction in the form of exanthema 5–7 days after the start of administration.

Peritonsillar abscess is a complication of chronic tonsillitis and develops following its exacerbation. It is characterized by high fever and severe intoxication. The sore throat is sharp, increasing in intensity as the disease progresses. Due to pain, the patient cannot swallow food, water, or saliva. Characterized by a forced position of the head with a tilt to the side, trismus of the masticatory muscles (during the formation of an abscess). Hyperemia of the pharynx is bright, there may be plaques that can be easily removed and rubbed. There is no correspondence between the prevalence of plaque and edema - an increase in edema is not accompanied by the transfer of plaque from the tonsils to the soft palate; there may be no plaque at all. Swelling and infiltration are one-sided, pronounced, and there is an overhang of the pharynx vault. Hypersalivation is characteristic.

Medical tactics for tonsillitis caused by these etiological agents include timely referral of the patient to an infectious diseases hospital for laboratory examination and treatment in accordance with the etiology of the disease.

Literature

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E. I. Krasnova1, Doctor of Medical Sciences, Professor N. I. Khokhlova, Candidate of Medical Sciences V. V. Provorova, Candidate of Medical Sciences A. N. Evstropov, Doctor of Medical Sciences, Professor

Federal State Budgetary Educational Institution of Higher Education NSMU Ministry of Health of the Russian Federation, Novosibirsk

1 Contact information: [email protected] ru

Differential diagnosis and therapeutic tactics for acute tonsillitis (tonsillitis) at the present stage / E. I. Krasnova, N. I. Khokhlova, V. P. Provorova, A. N. Evstropov For citation: Attending physician No. 11/2018; Page numbers in issue: 58-63 Tags: infections, differential diagnosis, β-hemolytic streptococcus

Possible reasons

Possible causes of the appearance of white plaque in combination with a sore throat include the following factors:

Minor injuries and any other damage to the tongue

For example, a person accidentally cuts his tongue with a fork or toothpick, and pathogenic bacteria penetrate through the damaged tissue, causing inflammation.

Long-term use of any medications

If a person has been taking antibiotics, steroids or other drugs for a long time , such symptoms may appear.

Hormonal disorders in the body

In women, this can happen during menopause.

Associated symptoms in this case: burning and dry mouth, increased sweating.

Gastrointestinal pathologies

Stay up to date! This can be gastritis with low or high acidity, stomach and duodenal ulcers, colitis or enterocolitis, etc.

Diseases of the digestive tract are usually accompanied by symptoms such as abdominal pain, nausea, constipation or diarrhea, and heartburn.

Inflammation of the gallbladder

Associated symptoms: pain in the lower abdomen (on the right side), dry mouth, high fever.

Infectious diseases

Among them are dysentery, scarlet fever, diphtheria, immunodeficiency virus and others.

Infections, as a rule, are not limited to just plaque and sore throat.

• White plaque on tonsils in adults: causes, methods of treatment

Usually accompanied by the following symptoms: body temperature above 38-39 degrees, muscle pain and aches, skin rash, diarrhea, vomiting.

Diseases of the throat and oral cavity

Keep in mind! As a rule, tonsillitis, tonsillitis, pharyngitis, stomatitis are characterized by such symptoms.

This may increase body temperature (in some cases) and cause weakness in the body . There may also be problems with swallowing food, burning and dry mouth, hoarseness in the voice, etc.

Viral infections

This is the flu, ARVI .

Associated symptoms: high fever, headache, cough, runny nose, body aches.

Oral candidiasis

This is usually a fungal infection of the mouth.

The disease most often occurs in young children and is accompanied by severe pain, burning and dry mouth.

Note! In this case, a white, cheesy coating is observed not only on the tongue, but also on the lips and the inside of the cheeks.

Glossitis

This is an inflammation of the tongue caused by injury or exposure to pathogenic microorganisms.

Oral leukoplakia

A disease of the mucous membrane of non-infectious etiology, in which white thickenings form on the gums, tongue and inner surface of the cheeks .

According to Ayurveda, the tongue is divided into several parts, each of which is responsible for a particular organ.

• White plaque in the throat in a child or adult - causes of appearance, means of treatment

Therefore, plaque on the front of the tongue indicates problems with the heart and liver, and near the root - intestinal pathologies.

If deposits are in the central part, they indicate a dysfunction of the spleen, stomach and pancreas.

It is worth noting! Formations in the lateral part (both on the left and on the right side) indicate problems with the kidneys.

Pharyngitis - symptoms and treatment

Treatment of acute pharyngitis begins with organizing a regimen and nutrition :

• gentle regime with enough sleep;
• creating conditions for the normal functioning of the mucous membrane - cool, moist air, eliminating active and passive smoking, contact with dust and irritants;
• diet excluding spicy and rough foods;
• warm drinks, alkaline rinses and inhalations [12].

Sometimes these measures already lead to an improvement in the condition. As prescribed by a doctor, to reduce the symptoms of pharyngitis caused by inflammation, complex products are used in the form of tablets, aerosols, rinses :

• antiseptics (chlorhexidine, hexetidine, benzydamine, iodine preparations, plant extracts, etc.);
• sometimes antibiotics (gramicidin);
• anti-inflammatory drugs (ketoprofen);
• local anesthetics (lidocaine, tetracaine, menthol) [13].

The choice of drugs is large, but excessive use can lead to suppression of the normal microflora of the pharynx, decreased local immunity, allergic reactions, damage to the mucous membrane; in addition, their effectiveness in viral infections has not been proven [7].

To reduce the temperature, non-steroidal anti-inflammatory drugs (ibuprofen, paracetamol) are prescribed.

Treatment of bacterial pharyngitis

Specific treatment of acute and chronic pharyngitis in adults with bacterial pathogens, especially with GABHS (group A beta-hemolytic streptococcus) is systemic antibiotic therapy. The drugs of choice are antibiotics from the group of semisynthetic penicillins (amoxicillin). Often sick children who have a variety of pathogenic flora on their mucous membranes are prescribed protected aminopenicillins (amoxicillin + clavulanic acid). When mycoplasma or chlamydia is detected, antibiotics are prescribed when the process descends into the bronchi and lungs or the disease becomes protracted [7]. Macrolide antibiotics (azithromycin, clarithromycin) are used.

Viral pharyngitis does not require antibiotic therapy.

Treatment of fungal pharyngitis

For mycoses, local antimycotic agents are used (co-trimoxazole, pimafucin, 2% alkaline solution). If local therapy does not help, antifungal antibiotics (amphotericin B) or special antifungal agents (ketoconazole, mycoheptin, fluconazole) are prescribed.

Treatment of chronic pharyngitis

Treatment of chronic pharyngitis during an exacerbation is no different from treatment of the acute form of the disease. It includes symptomatic therapy, proper organization of daily routine and food intake.

Purulent pharyngitis is not isolated, so there are no separate recommendations for its treatment.

Treatment of pharyngitis at home

Mild acute viral pharyngitis, if you follow a home regimen and regular warm drinks, goes away within seven days. However, the disease can occur not only due to a viral infection, but also for another reason. Therefore, without making a diagnosis, you should not self-medicate.

Physiotherapy

For obsessive dry cough and dry throat, you can use inhalations with saline solution as directed by your doctor.

Surgery

Surgical treatment consists of correcting the nasal septum and removing nasopharyngeal polyps. Surgery is necessary if the cause of chronic pharyngitis is constantly difficult nasal breathing. Removal of adenoids and tonsils is carried out according to strict indications. The decision on the need for surgery is made by an otolaryngologist after a thorough diagnosis.

Diagnostics

After a visual examination of the oral cavity and analysis of the patient’s complaints, the patient is sent for a general blood test and a mouth smear for bacterial culture (bacteriological culture).

Next, based on the results of the studies, the patient is referred to the appropriate specialist.

It depends on the underlying disease and then treatment is prescribed.

But if gastrointestinal diseases or hormonal disorders are suspected, are prescribed by appropriate specialists.

In what case should you consult a doctor and undergo an examination?

The following signs are reasons to consult a doctor:

• The presence of a dense, cheesy plaque , which is not removed when brushing the teeth and mouth or quickly appears again.
• Edema and swelling of the tongue.
• Bad breath .
• Pain and burning in the abdomen , eating disorders.
• Presence of small ulcers in the mouth .
• Rash on the face and body.
• Impaired taste sensitivity.
• Dryness and burning in the mouth.
• High body temperature.
• Constant weakness and lack of energy.

Remember! All of the above symptoms should be a cause for concern and immediate consultation with a doctor (ENT specialist, therapist, dentist or gastroenterologist).

Associated symptoms

White coating on the tongue is usually accompanied by the following symptoms:

• burning and dry mouth;
• increased thirst;
• increased body temperature;
• heartburn and belching;
• bad breath;
• muscle weakness and causeless fatigue;
• severe sore throat, aggravated by eating;
• craving for sweets (one of the signs of candidiasis);
• irritable bowel syndrome (diarrhea, pain, etc.) and bloating.

You should know! At the same time, some of the accompanying symptoms may be absent in certain cases (depending on the underlying disease - the root cause of the appearance of white plaque).

• White plaque in the throat: in children and adults. Causes and treatment

Causes of white plaque on the tongue

The reasons that cause a white coating on the tongue include:

• poor oral hygiene;
• medications (for example, long-term use of antibiotics);
• smoking;
• excessive consumption of alcoholic beverages;
• viral infections;
• diseases of the oral cavity (oral candidiasis (thrush), leukoplakia, lichen planus, geographic tongue (desquamative glossitis));
• chronic diseases (hypothyroidism, diabetes, syphilis);
• immunodeficiency conditions (HIV/AIDS);
• heat;
• improper use of an inhaler in the treatment of asthma, COPD;
• mechanical injuries to the oral mucosa caused by sharp edges of the teeth when damaged by caries or chips, dentures, piercings in the mouth;
• burns of the oral mucosa caused by too hot food or liquid;
• chemical injuries to the oral cavity;
• xerostomia (dry mouth);
• breathing through the mouth;
• a diet containing soft and pureed food, absence of coarse fibers in food;
• oral cancer, tongue cancer;
• radiation therapy of malignant neoplasms of the maxillofacial region.