Chronic tonsillitis - causes, pathogenesis, symptoms, complications

Author: Dr. İsmayıl İ. Category: Throat

Published:  2022 - 30 - Oct

Chronic tonsillitis is a long-lasting chronic process of inflammation of the palatine tonsils, which is accompanied by such recurrent exacerbations as tonsillitis and a general toxic-allergic reaction.

In recent years, tonsillar pathology has remained a high priority in clinical settings due to the ever-increasing incidence worldwide, as well as the relatively rapid chronicity of the process in the palatine tonsils and the possibility of developing generalized, up to lethal, complications, as well as the peculiarities of the course and effect on the body of conjugate (metatonsillar ) diseases; however, its true prevalence has not been sufficiently studied. According to a number of authors who have specifically dealt with this issue, the frequency of occurrence of tonsillar
pathology among different contingents of the population is quite variable - from 0.8 to 45% or more. Recurrent or chronic tonsillitis is currently a global public health problem that can seriously impair a person's quality of life.

Infectious agents that cause inflammation of the lymphoid tissue of the throat include bacteria, viruses, fungi.

Up to 2/3 of cases of exacerbation of chronic tonsillitis are caused by viruses, which often include adenoviruses, influenza viruses, parainfluenza viruses, enteroviruses and Epstein-Barr virus (EBV), as well as mycoplasmas.

Fungal infection is also often an etiological factor in the development of chronic tonsillitis.

Bacteria cause 15 to 30 percent of cases of tonsillitis - streptococci, staphylococci, pneumococci and Haemophilus influenzae. Group A beta-hemolytic streptococcus (GABHS) is the most common bacterium that causes tonsillitis. Bacterial tonsillitis caused by hemolytic streptococci is called angina. It is believed that angina is spread by airborne droplets when an infected person coughs or sneezes, or by contact - through shared food, drinks, kisses, and so on.

The pathogenesis of acute tonsillitis in children and adults is the same. The structure of the tonsils is represented by lymphoid tissue with narrow branched channels and depressions (lacunae or follicles). They produce a large number of lymphocytes and leukocyte phagocytes - immune cells that protect the respiratory system from infection. In the event of a large-scale attack by infectious agents, the bulk of the defending cells die, turning into toxic decay products. Purulent masses are formed from them, which accumulate in the gaps. So, lacunar (follicular) tonsillitis develops, turning into chronic tonsillitis.

Chronic tonsillitis is a classic example of a focal infection, in essence it is a chronic infectious-allergic disease with a local inflammatory reaction in the palatine tonsils, which can lead to the development of a whole chain of complications, which are based on the activity of β-hemolytic streptococcus, its antigens and various factors pathogenicity, among which the main place is occupied by streptolysins.

Streptolysins are a group of exotoxins and enzymes produced by streptococci and have a local and systemic toxic effect and contribute to the spread of infection in the body.
These include:
1 - Streptolysin S and streptolysin O, which actively damage cell membranes and cause hemolysis, lead to the development of systemic intoxication, cardiotoxicity, which is explained by the suppression of energy processes in the mitochondria of myocardial cells under conditions of O-streptolysin activity. Both of these enzymes negatively affect immune cells, especially phagocytes.
2. streptokinase, catalyzing the conversion of plasminogen into the proteolytic enzyme plasmin
3. deoxyribonuclease, streptodornase (DNA-ase), which destroys elements of the genome of connective tissue cells
4. proteases and erythrogenic toxins of types A, B and C (aka pyrogenic exotoxin).
5. hyaluronidase, which destroys hyaluronic acid, which is the main component of connective tissue

The action of erythrogenic toxin is due to the rash in scarlet fever.

Symptoms of tonsillitis
The clinical manifestations of tonsillitis are quite specific. The disease can be easily diagnosed.

Typical symptoms include:

1. Pain in the throat of the most varied intensity, from discomfort to severe sharp pains when swallowing;
2. The palatine arches, behind which the tonsils themselves are located, become red, swollen;
3. The submandibular lymph nodes are enlarged, which we can feel by palpation, and ascertain on ultrasound;
4. Long-term increase in body temperature, increasing in the evening. Often the body temperature does not exceed 37.3, which exhausts the body;
5. Burning, discomfort, heaviness and sore throat are common in chronic tonsillitis;
6. In chronic tonsillitis, sometimes there is an inexplicable cough;

7. The so-called plugs, which are caseous masses inside the lacunae of the tonsils, formed as a result of the mixing of extinct immune cells, bacteria, extinct cells of the epithelium of the tubules of the lacunae and the remains of food masses;
8. Halitosis - bad breath caused by decomposed caseous plugs located in the lacunae of the palatine tonsils;
9. Rarely chills;
10. Headache is a common symptom in chronic tonsillitis;
11. A very common symptom of chronic tonsillitis is increased fatigue, decreased performance and weakness
12. Feeling of ache in the limbs, especially in the area of ​​​​the joints - sure signs of a toxic-allergic form of chronic tonsillitis

Possible complications of tonsillitis
There are two categories of complications of chronic tonsillitis: local and general.

 The locals include:
1. Abscess of the posterior pharyngeal wall, when suppuration develops under the mucous membrane of the posterior pharyngeal wall;
2. Paratonsillar abscess - suppuration is observed behind the capsule of the palatine tonsils;
3.Cervical purulent lymphadenitis is a rare, but very formidable complication.

There are common complications, among which an important place is occupied by the so-called rheumatic. They appear approximately 3-5 weeks after the onset of exacerbation of chronic tonsillitis.

These common complications include:
1. Rheumatic heart disease (myocarditis, endocarditis, arrhythmia, pericarditis);
2. Rheumatic kidney damage (pyelonephritis, glomerulonephritis);
3. Rheumatic lesions of large compounds (vasculitis);
4. Rheumatic damage to the brain and nerves, the so-called rheumatic chorea, or "Sydenham's chorea";
5. Sepsis - generalized infection;
6. Scarlet fever - an acute infectious disease
7. Thrombophlebitis of the jugular vein (Lemierre's syndrome) is a rare but very dangerous complication that occurs more often in young and healthy people.

Detailed information about the methods of treatment of chronic tonsillitis can be obtained by clicking on this link.