Лакунарная ангина – форма острого тонзиллита, которая характеризуется гнойным воспалением в лакунах, то есть складках миндалин. Эта форма болезни более тяжелая, чем фолликулярная ангина. В чистом виде она встречается редко. Чаще всего она развивается на фоне фолликулярной.
Причины
Причины лакунарной ангины — чаще всего стрептококки, реже – стафилококки, нейссерии, коринебактерии и другие. Они попадают на небные миндалины с вдыхаемым воздухом, пищей, водой, при контакте с больным человеком.
Внешними провоцирующими факторами могут быть переохлаждение, влажность, высокая агрессивность микробов. Для развития ангины чаще всего необходимы и внутренние причины – снижение общего или местного иммунитета при переутомлении, хронических заболеваниях, недосыпании, недостатке белка в пище и другие.
Лакунарная ангина – инфекционно-аллергическое заболевание. Это означает, что местный воспалительный процесс на миндалинах вызывает сенсибилизацию (аллергическую гиперчувствительность) всего организма.
Клиническая картина
Лакунарная ангина у взрослых начинается внезапно, при этом сочетаются местные и общие симптомы. У вполне здорового человека быстро поднимается температура до 38˚С и выше, появляется озноб, чувство разбитости, головная боль. Практически одновременно появляется сильная боль в горле, сопровождающаяся иногда гнусавостью голоса, изменением речи.
У больного покрыт налетом язык, имеется неприятный запах изо рта. При осмотре миндалины, дужки, прилегающие участки мягкого неба покрасневшие, отечные. На поверхности миндалин вначале в устьях лакун (складок) появляются очаги светлого налета в виде пленок, которые быстро увеличиваются в размерах и сливаются, не выходя за границы миндалин. Этот налет легко удаляется шпателем. Поверхность слизистой при удалении налета не кровоточит.
У больного увеличены и болезненны лимфоузлы на шее. Боль в области шейных лимфоузлов и в горле может вызывать затруднение при поворотах головы.
Симптомы лакунарной ангины сохраняются до 14 дней.
Особенности у детей
Лакунарная ангина у детей развивается очень быстро. Для нее характерны симптомы интоксикации – высокая температура, рвота и даже судороги. Увеличенные миндалины могут затруднять поступление воздуха в гортань, вызывая удушье. Лакунарная ангина у детей – повод для срочного обращения к врачу.
Диагностика
Для бактериологической диагностики берут мазок с поверхности миндалин. Также назначают общий анализ крови, иногда определяют антитела (антистрептолизин О), при необходимости проводят и другие исследования. Основной метод диагностики – осмотр полости рта, глотки и миндалин (фарингоскопия).
Лечение
Ориентировочные сроки временной нетрудоспособности при лакунарной ангине составляют от 8 до 10 дней.
При лихорадке показан постельный режим. Диета должна включать полноценные белки, витамины. Пища должна легко усваиваться и щадить органы пищеварения. Желательно ограничивать сладкое, а также любые раздражающие продукты (копчености, наваристые супы, консервы, соленья, острые блюда и так далее). Полезны кисломолочные продукты, фрукты и овощи.
Больному рекомендуется обильное питье – морсы, компоты, отвар шиповника, вода с лимонным соком, зеленый чай.
Основное лечение – антибиотики. Назначается амоксициллин, амоксициллина клавуланат или сульбактам в течение 10 дней. Также могут быть назначены цефалоспорины, например, цефадроксил. При их непереносимости могут назначаться макролиды – азитромицин, кларитромицин, мидекамицин, рокситромицин, спирамицин.
Препаратами резерва являются линкозамиды – линкомицин, клиндамицин.
Лечение должно включать противовоспалительные средства, например, ибупрофен.
Для местного лечения применяются антибиотики – фузафунгин, ингалипт, грамицидин.
К антисептикам для местного применения (полоскание горла, орошение миндалин, аэрозоли) относятся гексетидин, йокс, каметон, мирамистин, пропосол (с прополисом), ротокан, себидин (с хлоргексидином), стрепсилс, фалиминт и другие препараты.
Комплексное лечение включает иммунокорректоры – ИРС-19, бронхомунал, имудон и другие.
Существуют гомеопатические препараты, облегчающие состояние больного с лакунарной ангиной: тонзилотрен, тонзилгон Н, фарингомед, лимфомиозот, траумель С.
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