Respiratory infections

Acute tonsillopharyngitis Laryngitis Epiglottitis (1) Epiglottitis (2) Acute tracheobronchitis Exacerbation of chronic bronchitis Exacerbation of
chronic bronchiectasis
Cystic Fibrosis (CF) Acquired Pneumonia Nosocomial pneumonia (1) Nosocomial pneumonia (2) Nosocomial pneumonia (3) Lung Pleural empyema Proteus Mirabilis

Acute tonsillopharyngitis

Case report:

A young mother brings her four year old son into practice and reported that for four days existed sore throat, high fever for two days, increasing dysphagia and significant loss of appetite. The pain had radiated from the throat to the ears, the mouth opening is very difficult and painful for 24 hours. There were still severe headache and a cloggy, mostly somewhat handicapped language with a strong subjective feeling of illness. The study of young patients results in a significant swelling and pain of the submandibular lymph nodes; Both tonsils and the environment including the pharyngeal wall are crimson and swollen and covered more than 50% with yellow-whitish deposits. A skin exanthema a endokarditisches heart murmur and splenomegaly are undetectable.


The variety and severity of symptoms point to a general disease of the organism with particular severity to the lymphoepithelial organs. However, there are also tonsillitis, in which only the local reaction is recognizable. The Tonsillarparenchym infiltrated with leukocytes (small abscess in the parenchyma and in the crypts). From such a "crypt abscesses" there is a spread of the infection through the epithelial Tonsillenparenchym (crypts parenchymal tonsillitis) and / or intrusion to kryptennahe capillaries (in batches or continuous Einschwemmung of toxins and pathogens in the circulatory system). In recurrent or chronic cases fibrosis and a downfall of Tonsillarparenchyms be induced.

Etiology and diagnosis:

B-hemolytic group A streptococci are the leading causative agent of pharyngitis and tonsillitis, especially in the presence of exudative tonsillitis. The incidence of streptococcal tonsillitis Pharyngo-correlated to age. For children under three years, pharyngitis is often viral. Rarer pathogens are staphylococci, pneumococci, Haemophilus influenzae and anaerobes. In an unclear clinical picture a streptococcal antigen detection should always be performed by means of smear as a rapid test. It should be noted that a purulent angina can also be caused by haemolytic streptococci groups B, C, or G. A pronounced granulocytosis speaks for strep throat, also the pressure pain of the regional lymph nodes.


Penicillin V (ISOCILLIN) initially remains the drug of choice for acute streptococcal tonsillopharyngitis with a treatment period of about ten days. This treatment time is necessary in order to prevent complications, in particular rheumatic fever. Substances such as cotrimoxazole (EUSAPRIM), quinolones and doxycycline (VIBRAMYCIN among others) are not indicated in the streptococcal tonsillopharyngitis. A sole local treatment with antibiotics or disinfectants is ineffective and does not prevent the unavoidable streptococcal sequelae. When penicillin allergy may macrolide antibiotics, for example, Azithromycin (ZITROMAX) or oral cephalosporins, such as Cefuroxime (ELOBACT et al) (Cave: Parallel allergies in 3-5%) can be administered.

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