Angina, streptococcal angina J03.0

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 31.01.2023

Synonym(s)

Angina; angina catarrhalis; angina lacunaris; angina lateral strand angina; angina lingualis; angina retronasalis; Streptococcus angina; Tongue base angina

Definition
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Inflammation, redness and swelling of the throat, especially of the tonsils.

Pathogen
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Mostly Streptococcus pyogenes, rarely Streptococcus pneumoniae or Staphylococcus aureus.

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Clinical features
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Severe pain, especially when swallowing, foetor ex ore, fever, headache, swelling of the mandibular angle lymph nodes. Distinguish:

A. catarrhalis: redness and swelling of the palatine tonsils.
A. lacunaris (tonsillitis, angina follicularis): Formation of purulent stipples and patches in the crypts of the tonsils.
A. lingualis (tongue base angina): Serous to purulent inflammation of the tongue base tonsils.
A. retronasalis: inflammation of the pharyngeal tonsil, swelling of the nuchal lymph nodes.
Lateral trangangina: inflammation of the lateral cords.

Differential diagnosis
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Angina Plaut-Vincenti, angina agranulocytotica, specific angina, angina in tuberculosis, angina diphtherica, herpangina, infectious mononucleosis, candidiasis, tonsil carcinoma.

Complication(s)
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Peritonsillar abscess, tonsillogenic sepsis, streptococcal secondary diseases ( rheumatic fever, post-streptococcal glomerulonephritis).

General therapy
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Bed rest, always detect streptococci in children first (throat swab).

External therapy
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Antiseptic mouth rinses e.g. chlorhexidine gargle solution ( R045, chlorhexidine digluconate solution), tormentil astringent R255, dexpanthenol solution (Bepanthen Roche solution, R066 ).

Internal therapy
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Penicillin V: adults 3 times 600,000 IU or 2 times/day 1 million IU p.o. over 10 days. Children: 50.000-100.000 IU/kg bw/day p.o.
Alternative: In case of penicillin allergy erythromycin (e.g. paediathrocin) 3-4 times 250-500 mg/day p.o. or i.v., children 20-50 mg/kg bw/day divided into 2-4 doses, clarithromycin (e.g. Klacid) 2 times 250-500 mg/day p.o., children 15 mg/kg bw/day divided into 2 doses p.o.
Alternatively cephalosporins like cefpodoxime (orelox). In case of recurrence cephalosporin or clindamycin (e.g. sobelin) 3-4 times/day 300 mg p.o. p.o., children 8-25 mg/kg bw/day p.o. divided into 4 ED.
Analgesics like paracetamol (e.g. ben-u-ron Supp.) for children or acetylsalicylic acid (e.g. ASS) for adults.