Necrotic angina: signs and symptoms of the disease, provoking factors and treatment. Methods for the effective treatment of necrotic angina Infectious diseases ulcerative necrotic angina

Angina is a fairly common disease, which sometimes does not even pay attention. They carry it on their feet, apply symptomatic treatment and do not understand that not only cold ice cream, but also opportunistic bacteria can provoke a sore throat. Since the microflora of the oral mucosa consists of beneficial and harmful microorganisms, when immunity is weakened, harmful microbes begin to show their activity. As a result, pathological processes develop.

There is necrotic angina (Simanovsky-Plaut-Vincent), which is accompanied by the destruction of the superficial tissues of the tonsils. On the tonsils appears dense white coating. It is very important to recognize the symptoms in time and start appropriate treatment, since this disease is contagious.

Reasons for development

Symptoms of necrotizing angina

Necrotic angina is the result of a purulent-inflammatory process. Therefore, the symptoms are characteristic signs:

Ulcerative sore throat can cause a purulent lesion of the entire oral cavity, as a result of which there is a danger of falling out of the extreme teeth and the development of sepsis.

Diagnostics

Purulent- ulcerative angina diagnosed based on general clinical picture, patient complaints, as well as the results of the tests. A sample of purulent deposits on the tonsils is taken, general analysis blood and urinalysis.

With the help of bacteriological culture is determined:

The causative agent of the disease and the state of the microflora of the oral cavity is assessed.
Sensitivity of the body to a particular group of antibiotics.
The presence of beta-hemolytic streptococcus.

Visually, the doctor assesses the asymmetry of the edema on the tonsils, the nature of purulent deposits, the color of the film and the presence of ulcers.

It is very easy to confuse membranous angina with:

Diphtheria.
Tumor.
Manifestation of syphilis.
Scarlet fever.
Lacunar angina.
Leukemia.

Treatment of necrotizing angina

Treatment of ulcerative membranous angina is carried out in a hospital under the supervision of a doctor. First, purulent deposits are removed with a special spatula, and the sores are treated with hydrogen peroxide, iodine, potassium permanganate, potassium chloride or furacilin. Rinsing and wiping the tonsils is carried out at least 4-5 times a day.

If local therapy fails, a course of antibiotics is prescribed. The most effective in this situation are the means of the penicillin series.

Additional measures in the treatment of purulent-ulcerative tonsillitis are constant oral care, dental treatment for caries, and anti-inflammatory drugs are taken.

Alternative methods of treatment of necrotic sore throat:

Ulcerative necrotic angina in children

AT early age children rarely get ulcerative angina because they do not have teeth close to the larynx. Consequently, carious processes do not cause membranous lesions of the tonsils. However, at an older age, the child may become a victim of ulcerative sore throat. In this case, the symptoms develop much faster and brighter than in adults. A dense white coating is clearly visible on the child's tonsils, the swallowing reflex is disturbed, and when ulcers occur, the temperature rises. The child often complains of discomfort during swallowing. After 3-5 days, the film begins to move away, causing pain in the throat area.

Treatment of purulent-membranous tonsillitis in a child is also performed using local therapy. Mandatory are antiseptic and antimicrobial agents. Antibiotics are used only as a last resort.

Ulcerative necrotic angina in pregnant women

During pregnancy, any disease is risky for future mother and her child. Necrotic angina is the most dangerous.

Do not wait and be treated with home remedies, you need to see a doctor as soon as possible

First of all, it is worth understanding the cause of the disease and eliminating it. It is important to prevent complications, since ulcerative angina is quite acute. You need to actively gargle, follow all the recommendations of a specialist and try to get plenty of rest so that the body gets the strength to recover.

Prevention

Preventing the development of necrotic sore throat is much easier than treating it. To do this, it is necessary to exclude the possibility of contact with an already infected person. For example, if a child in your family falls ill, then you should not use the same dishes, a towel and sleep together with him. For the duration of treatment, arm yourself with gauze bandages.

plays an important role in disease prevention proper nutrition, healthy lifestyle life and regular wet cleaning indoors. Don't neglect going to the dentist when you feel like your teeth are starting to decay.

Complications and rehabilitation

In the absence of proper treatment, serious complications can develop:

The temperature rises.
There is a sharp and debilitating pain in the larynx.
There are symptoms of intoxication: weakness, nausea, chills.
Quite a rare complication is extensive necrosis of the tonsils.
Bleeding ulcers.
Gradually, the gums begin to collapse.

In such situations, antibiotic therapy is used, the patient is hospitalized in the infectious diseases department and recovers there for at least 10 days. He is on a special diet rich in proteins and permanent peace.

After treatment, the patient is prescribed a special course of vitamins, which helps to further prevent the development of tonsil necrosis.

Necrotic angina is an acute inflammatory disease of the tonsils, which is caused by a symbiosis of the spirochete of the oral cavity and the fusiform rod. The disease leads to the appearance of ulcers on the tonsils (tonsils), covered with a dense coating of a dirty green color with an extremely unpleasant smell of rotten meat. Pathology is rare and most often affects men aged 18 to 35 years. Necrotic sore throat lasts from 1 to 4 weeks. Its second name is Simanovsky-Plaut-Vincent's angina. The disease is recognized as conditionally non-contagious, since the transmission of the disease from person to person is extremely rare as a special exception.

Causes

The disease often accompanies purulent-necrotic stomatitis or turns out to be its complication. Angina can develop, like an independent disease, against the background of contributing factors, which are:

Necrotizing angina often occurs in people with oncological diseases, leukemia and radiation sickness.

Types and symptoms

There are 3 forms of the disease, which differ in the severity of symptoms and the degree of damage to the tonsils. Their clinic varies greatly.

Mild form - the patient has a slight increase in temperature (no more than 37.5 ° C) or its absence, a slight sore throat at the time of swallowing, redness and swelling of the tonsils. The plaque does not go beyond the tonsils. Lymph nodes are not changed.
The moderate form is an increase in temperature from 37 to 38 ° C. severe sore throat, greatly aggravated by the act of swallowing. The tonsils are red and very swollen. On the surface of the tonsils, oval grayish-white plaque islands are found, which have a diameter of up to 15 mm. Mandibular lymph nodes are not greatly enlarged and painless.
Severe form - the temperature reaches 39 ° C; inflammatory-necrotic process affects the palate (hard and soft), gums, larynx and back wall throats. Ulcers that form under a layer of plaque are crater-shaped. They destroy the mucosa and underlying tissues, and if left untreated, reach the periosteum. Pain very strong. Lymphatic maxillary nodes are enlarged and painful.

If left untreated, the disease can go from mild to severe.

Depending on the characteristics of the process in the tonsils, the disease is divided into 2 types.

False film tonsillitis, the second name is ulcerative membranous tonsillitis - a thin layer of plaque forms on the tonsils. The disease occurs against the background of a staphylococcal infection.
Ulcerative tonsillitis - an ulcer is formed more often on 1 and less often on 2 tonsils. The coating is thick dirty yellow.

Possible Complications

Complications occur with a severe form of the disease or with a protracted course of moderate. The consequences of necrotic sore throat may be as follows:

abscess of the root of the tongue;
toxic shock;
phlegmon of the oral cavity;
gangrene of the tissues of one or both cheeks;
gangrene of the larynx;
sepsis.

With additional infection of ulcers with pathogenic microorganisms, the risk of malfunctions increases. of cardio-vascular system, kidney and liver.

Diagnostic methods

Different types of angina at the onset of the disease have similar symptoms, which is why analysis data is needed to make an accurate diagnosis.

During the initial visit to the doctor, the patient reports:

the time of occurrence of the first manifestations of the disease;
diseases transferred in the last 45 days;
the presence of chronic diseases;
regularly taken medications.

At the first appointment, a throat examination is also performed and the condition of the lymph nodes is assessed. In a severe form of necrotic sore throat, the patient listens to the heart and lungs.

For the final detection of the disease, the results of a blood test and a throat swab (with sowing on a nutrient medium and microscopic examination with contrast staining) are necessary. With angina Simanovsky-Plaut-Vincent in the blood is detected elevated level leukocytes and excessive erythrocyte sedimentation rate.

Treatment Methods

Treatment of necrotic sore throat should only be carried out by a doctor. Self-medication is dangerous with the progression of the disease and the development of complications. Per medical care should be treated as soon as the first symptoms of the disease appear. Therapy is carried out in the infectious diseases department under constant control otolaryngologist. In rare cases, when mild form disease is possible ambulatory treatment with regular visits to the doctor.

The following methods are used for therapy:

medication;
physiotherapy;
surgical;
folk remedies.

When to bring down the temperature

The temperature with necrotic tonsillitis goes astray if it rises to 38 ° C. It is also shown to reduce the temperature if the patient is difficult to tolerate even a slight increase.

Medical

Acute tonsillitis is immediately treated with antibiotics, while in the necrotic form they are used only in severe cases of the disease. If antibiotic treatment is applied immediately, there is a high risk that a pathogen resistant to this drug will form.

At the beginning of therapy, local treatment with the help of antiseptic preparations, which wipe the affected areas or irrigate them. For this purpose, use:

intense pink manganese solution (for rubbing);

silver nitrate solution for wiping;
hydrogen peroxide solution for rinsing and wiping;
Lugol's solution for lubricating the tonsils and foci of necrosis in other areas;
Chlorophyllipt infusion for irrigation, rubbing and rinsing.

If there is no improvement within 3-5 days, or progression of the pathology is observed, antibiotics are used:

macrolides;
penicillins;
cephalosporins.

Antibacterial agents may be oral administration or for administration by injection.

For children and pregnant women, treatment is carried out using local antibiotics in the form of a spray.

Physiotherapy

Physiotherapeutic effects are used to restore normal blood circulation in the tonsils and lymph nodes. Also, physiotherapy accelerates the removal of edema and reduces the number of pathogenic bacteria in the lesion. The standard course of therapy consists of 12 procedures that are completely safe for the general health of the patient. For treatment apply:

magnetotherapy;
dry heat - depending on equipment medical institution, it will be a laser or ultraviolet;
wave ultrasonic influence.

Medicines with the help of physiotherapeutic procedures for necrotic sore throat are not administered.

Surgical

Surgical treatment is prescribed if the disease often relapses. In such a situation, the removal of the tonsils is indicated. The operation is performed under anesthesia in the surgical department of the hospital or ENT department.

Folk remedies

Alternative therapy is used only as an auxiliary measure and in agreement with the doctor, if it will not reduce the effectiveness of the drug exposure.

Sugar syrup with a concentration of 60%. It is used to wipe the tonsils twice a day. The agent acts as a preservative and creates unsuitable conditions for most pathogens of necrotizing tonsillitis.
Rinsing with a decoction of eucalyptus, prepared at the rate of 1 tbsp. l. raw materials for 1 cup boiling water. Gargle 3 times a day. Eucalyptus has a powerful antiseptic effect and stimulates tissue regeneration.
Rinsing with aloe juice. The agent is indicated from the moment the ulcer begins to heal to prevent its re-infection. Add 1 tsp to 1 cup of boiled water. fresh juice and carry out processing, using the entire portion at a time. Caress in the morning and evening.

Engage in the treatment of necrotic sore throat only with the use of folk remedies forbidden.

Rules of nutrition and sparing diet

It is difficult to treat the disease without a specific diet. Food, in order not to act irritatingly on a sore throat, should be soft, warm and not burning. Broths and pureed soups are optimal. Drink as much as possible warm. Do not drink alcohol, carbonated drinks, strong tea and coffee. To enrich the diet with vitamins, you need to eat fruits and vegetables baked or ground with a blender.

Elena Malysheva and German Gandelman tell how to treat a sore throat.

Features of treatment during pregnancy and feeding

During pregnancy and during breastfeeding therapy needs to be adjusted. If the child is more than 6 months old, it is recommended to stop lactation and undergo full treatment, as otherwise antibiotics will be required, which is dangerous in severe cases of the disease.

During the period of bearing a child, therapy has the following features:

complete rejection of physiotherapy;
non-use of aspirin to lower the temperature;
conducting additional examination to determine the risk of intrauterine infection of the child;
selection of antibiotics that have a low percentage of penetration through the placental barrier.

On the early dates pregnancy for a full-fledged therapy, the question of abortion is sometimes raised. This may be required with a particularly severe form of necrotizing tonsillitis.

Features of treatment in children

Cases of necrotizing tonsillitis in children are extremely rare, and in their treatment, therapy is carried out almost in the same way as that prescribed for adults, but with selection medicines appropriate for the patient's age.

Mandatory visit to the doctor.
Bed rest to prevent disorders in the cardiovascular system.
Use only antibiotics prescribed by a doctor.
Compliance with recommendations for dosage and duration of antibiotics.
Regular use of local therapies.
Taking analgesics if the pain is severe.
Taking antipyretic drugs if the temperature has risen to more than 38 ° C.
Mandatory daily airing of the child's room in his absence.

Using the advice given by the pediatrician Komarovsky, you can properly treat the child without endangering his life.

What Not to Do

In case of illness, self-medication and a change at one's discretion in the amount of medication taken and the duration of the course of therapy are prohibited. Also not allowed:

physical exercise;
damp stay.

For the fastest possible recovery and reduce the risk of complications, strict adherence to all medical recommendations is necessary.

Forecast and prevention

With timely seeking medical help and passing quality treatment the prognosis is favorable. Full recovery occurs in 10-30 days. In a severe form of the disease, therapy is complex and complications are possible, which is why the prognosis is unfavorable.

Disease prevention includes:

maintaining oral health;
increasing general immunity through hardening;
high-quality nutrition with a sufficient amount of vitamins;
treatment inflammatory diseases paranasal sinuses nose.

Compliance with these simple rules reduces the risk of purulent-necrotic tonsillitis by several times.

Attending doctor

For the initial appointment, the patient can go to the therapist. After the initial diagnosis is made, the patient will receive a referral to an otolaryngologist and to a hospital in the ENT department. The otolaryngologist is directly involved in the treatment of the disease.

Ulcerative necrotic angina (purulent-necrotic tonsillitis) is a disease of the larynx, which is non-infectious in nature and develops against the background of excessive reproduction of conditionally pathogenic microflora - spirochetes and fusiform rods that live on the mucous membranes of the oral cavity and larynx. Let's figure out what necrotic angina is, how it is diagnosed and treated.

The main symptoms of ulcerative necrotic tonsillitis are:

signs of general intoxication;
increased production of saliva;
slight sore throat when swallowing, aggravated after joining spirochetes and fusiform rods of staphylococci and streptococci;
dehydration of the body;
an increase in the size of the lymph nodes;
sensation in the throat of a foreign body;
the appearance of bad breath;
an increase in the size of the tonsils and the appearance of plaque on them, which has a pale yellow or light gray tint.

AT pathological process As a rule, only one tonsil is involved, the bilateral form of the disease is diagnosed extremely rarely.

Attention! Body temperature with necrotic sore throat does not exceed 37 C.

Reasons for the appearance

As a rule, the development of necrotic sore throat is carried out against the background of:

long-term infectious diseases;
problems with the oral cavity (stomatitis and caries);
general depletion of the body;
beriberi;
immunodeficiency;
prolonged suppuration in the nasopharynx;
inadequate oral hygiene.

However, occasionally other factors can also act as causes of purulent-necrotic tonsillitis: diphtheria, leukemia and other blood diseases, tularemia, scarlet fever.

Complications

The main complications of pathology are:

necrosis of the oral cavity;
abscesses;
kidney and heart disease;
bleeding;
perforation of the hard palate;
rheumatism and rheumatoid fever;
sepsis.

Diagnostics

Diagnosis of pathology is carried out in a complex manner and includes:

careful examination and questioning of the patient;
general blood analysis;
a swab from the throat for bacteriological culture (allows you to identify the causative agent of the pathology and determine its sensitivity to certain antibacterial drugs);
PCR diagnostics;
antigenic test for beta-hemolytic streptococcus.

These activities allow you to determine the course of further treatment and differentiate the disease from cancer, tuberculosis, syphilis, lacunar and gangrenous phlegmonous tonsillitis, as well as other forms of tonsillitis.

Read also: Tonsillitis in children: symptoms and treatment

Treatment of pathology is carried out in a complex and includes the use of antibacterial and antiseptic agents.

Therapy of necrotic pathologies with antibiotics is prescribed based on the results of bacterial culture. In the vast majority of cases, penicillins, cephalosporins and macrolides are used (the most preferred because they have a powerful therapeutic effect with low toxicity and minimal impact on the gastrointestinal tract). These drugs are used in the form of injections in a dosage corresponding to the body weight and age of the patient.

Local treatment includes a set of measures aimed at the gradual cleaning of the tissues involved in the pathological process from pus and mucus, their regeneration and restoration.

treatment of ulcers with a solution of hydrogen peroxide;
gargling (as a rule, the following rinses are used: solutions of permanganate and potassium chloride, Furacilin, silver nitrate);
irrigation of the oral cavity and larynx with antiseptic agents;
treatment of tonsils with Novarsenol, iodine, Neosalvaren.

Advice. According to some experts, sugar and syrup from it affect the acid background, making it unfavorable for the growth and reproduction of pathogenic microflora in the tissues of the tonsils, and therefore can be used to process them.

Attention! Treatment of ulcers with hydrogen peroxide should be done with caution.

Mode and diet

Depending on the severity of the course of the disease, patients can be treated as outpatients (with such precautions as bed rest, separate utensils and the greatest possible isolation from healthy people), and stationary (in this case, the sick are placed, as a rule, in the infectious diseases department).

Particular attention in both cases is given to nutrition. Dishes are excluded from the diet, the use of which negatively affects the affected mucous membranes. Patients are forbidden to eat solid, hot, cold, spicy, salty and spicy foods (it is recommended to replace them with nutritious and easily digestible broths and purees with a neutral taste).

Attention! Meat (chicken, rabbit, turkey, beef, veal), dairy products (yogurt, kefir, cottage cheese and dishes from it), liver, eggs should be included in the diet in sufficient quantities.

In addition to the described changes in nutrition, patients are advised to drink plenty of fluids, which include drinks rich in B and C vitamins (rosehip broth, compotes, fruit drinks, freshly squeezed juices, tea with lemon), as well as mashed vegetables and fruits that replenish the body's vitamin reserves.

the most dangerous is ulcerative necrotic tonsillitis, which develops in the absence of treatment and with the uncontrolled development of pathogenic microorganisms in the affected areas.

This is a rare form of angina easily transmitted from a sick person to a healthy person and therefore requires isolation of the patient and prompt treatment.

What is ulcerative necrotic angina?

Disease described at the beginning of the 20th century general practitioner S.P. Botkin, who also introduced another name for this pathology - “Finland toad”.

This is due to the fact that the doctor first diagnosed such an ailment in Finland.

Reference! Subsequently, the disease received another name - "trench disease", as it often affected soldiers living in the trenches for months during the First World War.

And in such conditions (constant dampness and hypothermia, as well as lack of hygiene), the pathogens became more active and spread rapidly.

The disease is currently officially called Simanovsky-Plount-Vincent's angina.

During the development of the disease mainly affects the tonsils that are subject to inflammatory processes.

In turn, this leads to the death of tissues that are destroyed under the influence of pathogenic microflora, while necrotic areas are not subsequently restored.

Photo of the throat in case of illness

Reasons for the development of the disease

Regardless of which pathogen provoked the development of this form of angina, during the progression of the disease necrosis begins to develop in the affected areas.

In this case, pathogens do not necessarily serve as microorganisms that accumulate in the throat area.

Note! The cause of the development of necrotizing ulcer may also be the bacteria present in carious teeth. Other factors contributing to the development of pathology are:

an excess of vitamins B and C in the body;
chronic tonsillitis;
weakened immune system;
cachexia(exhaustion of the body);
dystrophy;
infections, breeding in the intestines;
a lack of necessary for the normal functioning of the body minerals and vitamins.

Interestingly, in young children who do not have teeth, and in old people whose teeth are replaced by prostheses, this type of disease practically does not occur.

Experts explain this precisely by the fact that in the oral cavity of such people there are practically no pathogens of such pathologies of the respiratory organs.

Symptoms

Ulcerative necrotic angina is characterized by the following symptoms and signs:

dehydration organism;
clear signs intoxication;
elevated salivation;
lungs pain when swallowing(increased by the addition of streptococcal or staphylococcal infections);
increase in volumes lymph nodes;
feeling as if present in grief foreign body;
bad breath.

Important! Body temperature in this form of the disease does not rise above 37.5 degrees. Tonsils affected by tonsillitis pathogens become covered with a grayish or yellowish coating and increase in size.

Basically, the pathology spreads on the surface of one tonsil: bilateral form of this type of angina is rarely diagnosed.

Diagnosis of purulent-necrotic tonsillitis

In the process of diagnosis, it is important not only to focus on further treatment, but also to differentiate the disease from lacunar tonsillitis, cancer, syphilis, tuberculosis and diphtheria (all these diseases have some similar symptoms).

With such a disease, it is much more difficult to determine the treatment than to diagnose the disease, and during the examination, the doctor first of all collects an anamnesis, finding out from the patient the circumstances of the development of the disease and fixing complaints.

At once visual examination of the oral cavity during which the condition of the tonsils is assessed. Further to the patient blood test ordered to detect the level of leukocytes and ESR.

Parallel taking a smear for bacterial culture to identify the pathogen and right choice antibiotics.

Additional diagnostic methods are PCR diagnostics and antigen test for beta-hemolytic streptococcus.

Treatment Methods

Effective treatment of ulcerative necrotic tonsillitis involves combination of medications and therapeutic methods as well as physiotherapy procedures.

Need to know! From the first day, the patient is prescribed antibiotics. Depending on the results of the tests and the severity of the disease, these can be drugs of the following groups:

macrolides(clarithromycin, azithromycin, erythromycin, midecamycin);
cephalosporins(cefazolin, cefilaxin, cephaloridine);
penicillins(benzylpenicillin, phenoxymethylpenicillin, amoxicillin).

In most cases, experts prefer macrolide antibiotics.

This is because such means have the least negative effect on the tissues of the gastrointestinal tract.

With relatively low toxicity, this type of antibiotic has the greatest bacteriostatic effect, as a result of which pathogenic microorganisms are not only destroyed, but also cease to multiply if some part of them survives.

In addition to this radical treatment benefit and local events, in particular - cleaning from plaque the surface of the affected tonsils.

Keep in mind! Additionally, the surface of the throat can be lubricated with neosalvaren, novarsenol, iodine, and in severe cases, sprinkle pathological areas with sugar (another option is to treat these areas with sugar syrup).

Sugar changes the acidic background in the mouth and throat, resulting in the formation of unfavorable conditions for the reproduction of pathogenic microflora.

Disease prevention

You can prevent the development of ulcerative necrotic tonsillitis in the following ways:

Useful video

In this video you will see how and how to treat angina:

Despite the intimidating name and dire consequences, in most cases, necrotizing tonsillitis has a good prognosis, and if treatment is started in a timely manner, the disease will recede in a maximum of two weeks.

In the same time uncontrolled development pathogens can lead to irreversible consequences therefore, at the first signs of such an ailment, it is necessary to immediately contact an otolaryngologist.

In contact with

This disease is characterized by acute lesions of the tonsils. It happens that it develops into a rare infectious pathology, which has the name Simanovsky's angina. If the disease is mild, then the use of local therapy is sufficient, if it is difficult, the doctor prescribes antibacterial drugs. In the case of a large spread of the process and the development of complications, treatment in a hospital is required. Necrotizing tonsillitis is classified according to the type of microbes, the site of the lesion, the stage of development. This contributes to the correct selection effective treatment and avoid negative consequences.

This disease is also called ulcerative necrotic angina and ulcerative membranous tonsillitis. This species is not capable of leading to an epidemic, they usually get sick one by one. Simanovsky-Vincent's angina is infected due to Vincent's spirochetes, Plaut-Vincent's fusiform sticks join them. In fact, they are not so dangerous and scary, because they are present in the human microflora. But if the protective functions of the immune system weaken, this causes their reproduction in excessive numbers. As a result, the disease develops.

Possible complications than the disease is dangerous

If Vincent's angina proceeds in a neglected form, an excessive concentration of harmful microorganisms helps the development of pathology:

the blood becomes infected;
in some places, the gums are destroyed;
tonsils are affected by necrosis;
toxic shock occurs;
purulent abscesses are observed.

Defeats internal organs are caused due to mixed microbial forms of angina.

Prevention and precautions when communicating with the patient

It is problematic to get infected with ulcerative-membranous angina.

But people whose immunity is weak, when in contact with patients, should adhere to the following recommendations:

wear a bandage or medical mask;
wash your hands regularly with soap;
disinfect household items after use by a sick person;
air the rooms several times daily, wash the floors and wipe the dust.

Prevention includes the elimination of small foci of infection in the mouth. It is also extremely important to eat well, drink vitamins.

Angina can proceed in different ways due to associated diseases and development. The initial stage can be cured without taking antibiotics, but running stage very difficult to eliminate due to a number of negative consequences.

It is important to understand that self-medication will only aggravate the situation. Only a doctor will prescribe the right course of therapy. It is in this situation that it is possible to get rid of the disease and not reach necrosis in 1-3 weeks.