Angina Plaut-Vincenti refers to the relatively rare subtype of tonsillitis for which a mixed infection of the bacteria Treponema vincentii and Fusobacterium nucleatum is responsible. Tonsillitis is typically unilateral and usually affects adolescents.
What is angina plaut vincenti?
Tonsillitis is an often painful but usually harmless condition that primarily affects children and adolescents and is often treated with antibiotics because of the risk of complications or sequelae. Medicine further subdivides these diseases, which often look similar to the layman, according to the different types of pathogens or assigns them to larger clinical pictures. Angina plaut vincenti is a relatively rare subtype of tonsillitis (inflammation of the tonsils).
Causes
Angina Plaut-Vincenti owes its unintuitive name, as so often in medicine, to its discoverers: as early as 1894, the German bacteriologist H.C. Plaut described the bacterium Treponema vincentii, which belongs to the class of spirochetes, and thus gave it its name. Somewhat later, the disease was specified in more detail by the French scientist J.H. Vincent. A special feature of these bacteria is that they do not simply migrate from one person to another by infection, as is the case, for example, with the most common form of tonsillitis caused by streptococci. Rather, they can also live on human mucous membranes without causing any harm – it is only the combination of the two bacteria (coinfection) that causes them to become pathogenic; they need each other for their pathogenic effect. In addition, the bacteria usually need favorable conditions to do so: Inadequate oral hygiene, a poor nutritional status or a generally weakened immune state of the organism can prepare the ground for them. Plaut-Vincenti angina is also known as ulcerative tonsillitis because its clinical picture is characterized by ulcer-like changes in the tonsils, which are accompanied by necrosis (tissue destruction). This may also spread to the surrounding oral cavity as it progresses.
Symptoms, complaints, and signs
Angina plaut vincenti is indeed a severe tonsillar infection, but apart from dysphagia, there are initially hardly any symptoms worth mentioning. The general condition is usually not affected. The body temperature is only slightly elevated. It is usually between 36 and 37 degrees Celsius. However, close examination may reveal a unilateral ulcer on a palatine tonsil, which leads to the death of the mucosa. This results in the formation of greasy green-gray-yellowish coatings that cause a foul-smelling mouth odor. The ulcers already differ in appearance from a normal tonsillitis. It is a special form of angina tonsillitis. While normal tonsillitis is caused by streptococci, here there is a mixed infection between spirochetes and fusobacteria. These can also infect the cheeks, gums, lips and larynx in addition to the tonsils. The lymph nodes present in the angle of the jaw are almost always swollen. Adolescents in particular frequently become infected with these pathogens. However, fusobacteria and spirochetes are very aggressive bacteria that can lead to destruction of the cheeks and gums, especially in immunocompromised individuals. Thus, in various developing countries where the population suffers from malnutrition and hunger, this infection often results in disfigurement of the face due to necrosis of the cheeks. However, in exceptional cases, angina plaut vincenti can also lead to gangrenous destruction of the cheeks.
Diagnosis and course
Another important difference between angina plaut-Vincenti and the other, more common forms of tonsillitis is the unilateral occurrence: Usually, only one palatine tonsil is affected, but this one is massive: a fibrin-covered ulcer with necrosis is seen on inspection of the oral cavity, and a gray-greenish smeary coating of the affected tonsil is also noticeable, which may also bleed when scraped with a wooden spatula. The inflammation secretes a foul odor. In contrast, streptococcal angina usually affects both palatine tonsils and looks completely different with its typical white stipple-like coatings at the base – a visual diagnosis.In keeping with the inspector’s picture, the complaints of angina Plaut-Vincenti are also usually unilateral, but are in striking contrast as far as their severity is concerned: the disease looks nasty, but causes hardly any general complaints, often no fever; only unilateral swallowing difficulties are noticeable and, in addition to the visible findings and the foul odor, usually lead to a visit to the doctor.
Complications
Angina plaut vincenti usually progresses without severe complications in modern industrialized countries. However, if oral hygiene is poor, tissue necrosis can spread from the tonsils to the entire oral cavity. There is a risk of tooth loss and destruction of gum tissue. In developing countries, the clinical picture can develop much more dramatically. In weakened and malnourished people or those suffering from immune deficiency, angina plaut vincenti not infrequently becomes chronic. Since necrosis leads to anaerobic conditions in the tissues, consequences may include intestinal ulcers, tropical ulcers, and pulmonary gangrene. A feared complication is gangrenous stomatitis, also known as noma, buccal gangrene, or water canker. Due to the often poor medical care in the affected countries, the disease is progressing. Starting in the oral mucosa, oral flora bacteria destroy the mucosa, bones and face over time. If left untreated, the general condition deteriorates dramatically and life-threatening complications develop. These include bloody diarrhea, pneumonia and sepsis. In 70 to 90 percent of cases, affected children die as a result.
When should you go to the doctor?
With the symptoms of tonsillitis should go to the doctor no later than the next day. The physician can determine whether angina plaut-Vincent is present by swabbing the throat and examining the oral cavity, and can initiate appropriate treatment steps. A typical warning sign of angina plaut-Vincent is foul-smelling greenish-gray coating in the throat. The discharge is often accompanied by difficulty swallowing, bad breath and the typical symptoms of tonsillitis. In the later course, an ulcer may also form on the palatine tonsil. If the above leading complaints are present, medical advice is required. An immediate visit to the doctor is recommended if a high fever of over 39 °C is also present. If children are affected, they should be taken to the pediatrician immediately. Medical advice is especially called for in cases of severe physical symptoms that increase rapidly despite the use of home remedies and mild medications. Advanced angina Plaut-Vincent must be treated by a doctor in any case. This can prevent complications such as tissue necrosis, tooth loss and spread of the inflammation.
Treatment and therapy
Since other serious diseases can also be behind such a picture of tonsillitis, a visit to the doctor is doubly worthwhile. In particular, malignant oral cavity tumors may look similar, but usually grow more slowly and typically affect other age groups (angina plaut vincenti: adolescents ; oral cavity tumors: middle-aged smokers and older). Diseases such as tuberculosis or another treponematosis, syphilis, must also be considered in principle. Furthermore, chronic tonsillitis caused by other bacterial pathogens can lead to greater destruction of the affected tonsil, but then has accordingly a longer history. If the inflammation develops within a short time and without further general complaints such as cough, night sweats or weight loss, a simple angina is the most likely diagnosis. An experienced physician can assess this with a few questions and a glance; in case of doubt, a microbiological examination after swabbing the affected tonsil, rarely also a blood test, can provide clarity. In principle, however, the distinction from streptococcal angina is a visual diagnosis, and angina plaut vincenti can then be treated without much fuss: Antibiotic therapy is only really necessary in more severe cases and is then carried out with penicillins, for example. Otherwise, disinfecting local measures and careful oral hygiene are sufficient.
Outlook and prognosis
In angina plaut vincenti, the patient primarily experiences very severe swallowing difficulties and pain in the throat.These can significantly impair the quality of life and lead to discomfort and complications in everyday life. Furthermore, tonsillitis occurs and those affected also suffer from very strong bad breath in many cases. The swallowing difficulties make it much more difficult to take in food and liquids, which can lead to dehydration or malnutrition. Furthermore, those affected appear fatigued and tired and are usually unable to concentrate. Coughing and sweating often occur, especially at night. Angina Plaut-Vincenti can be treated with medication and does not lead to further complications or discomfort. As a rule, the course of the disease is always positive if a doctor is consulted at an early stage. There are no particular consequential damages. The patient’s life expectancy is also not reduced by angina plaut vincenti. After treatment, however, a recurrence of the disease cannot be ruled out. This is especially true if the affected person suffers from a weakened immune system.
Prevention
The latter measures are also the best means of prevention, especially if the organism is already immunocompromised due to other diseases or medication.
Aftercare
In most cases of angina plaut-vincenti, no follow-up care is necessary or possible. First and foremost, patients rely on medical treatment to fully relieve the symptoms of angina plaut vincenti and prevent further complications. The disease can be cured well in most cases, so there is also no reduced life expectancy of the patient. Patients with this disease are primarily dependent on taking medication. This is the only way to kill the bacteria. It is important to ensure that the antibiotics are taken regularly. Possible interactions with other medications should also be taken into account in angina plaut vincenti. Patients should not consume alcohol during treatment so as not to reduce the effect of the antibiotics. Regular blood tests are also useful to keep track of the state of healing. Furthermore, a high standard of hygiene should be maintained, especially oral hygiene. Hospitalization is not necessary for angina plaut vincenti.
What you can do yourself
This particular form of tonsillitis usually occurs when the bacteria that cause it find favorable conditions in the host. In particular, poor oral hygiene, poor nutrition, and a weakened immune system can promote the onset of angina plaut vincenti and complicate its course. Self-help measures should therefore be aimed at eliminating these factors. Moreover, good dental hygiene not only reduces the risk of developing angina plaut-vincenti, but also lowers the risk of caries and periodontal disease. Everyone should therefore know and take to heart the basic principles of oral hygiene. The teeth must be thoroughly cleaned at least twice a day. This requires brushing for about three minutes from red to white, i.e. from the gums towards the teeth. The tongue, on which plaque and bacteria accumulate, must not be forgotten either. A healthy diet additionally supports oral hygiene. This also has a positive effect on the immune system, so that angina plaut vincenti is prevented twice. A healthy diet is based on whole grains, nuts and seeds, and as much fresh fruit and vegetables as possible. Animal fats and proteins should be reduced and replaced with plant-based products. Furthermore, attention should be paid to sufficient exercise, whereby health already benefits from a brisk walk of about 30 minutes per day.
