Herpangina

What is Herpangina

Herpangina is an illness in which sores form inside the mouth and throat. It occurs most often during the summer and fall.

What increases the risk

This condition is more likely to develop in young children, mainly infants and children younger than 7 years.

What are the causes?

This condition is caused by a virus. A child can get the virus by coming into contact with the saliva, respiratory secretions, or stool (feces) of an infected person.

What are the symptoms?

Symptoms of this condition include:

  • Fever.
  • Vomiting.
  • Headache.
  • Irritability.
  • Poor appetite.
  • Fatigue.
  • Weakness.
  • Sore, red throat.
  • Blister-like sores in the back of the throat. These may also appear:
    • Around the outside of the mouth.
    • On the palms of the hands.
    • On the soles of the feet.

Symptoms usually develop 3–6 days after exposure to the virus.

How is this diagnosed?

This condition is diagnosed with a physical exam.

How is this treated?

This condition normally goes away on its own within 1 week. Medicines may be given to ease symptoms and reduce fever.

Follow these instructions at home:

Medicines

  • Give over-the-counter and prescription medicines only as told by your child’s health care provider.
  • Do not give your child aspirin because of the association with Reye’s syndrome.
  • Do not use products that contain benzocaine (including numbing gels) to treat mouth pain in children who are younger than 2 years. These products may cause a rare but serious blood condition.

Eating and drinking

  • Avoid giving your child foods and drinks that are salty, spicy, hard, or acidic. They may make the sores more painful.
  • Have your child eat soft, bland, and cold foods and beverages that are easier to swallow.
  • Make sure that your child is getting enough to drink.
    • Have your child drink enough fluid to keep his or her urine clear or pale yellow.
    • If your child is not eating or drinking, weigh him or her every day. If your child is losing weight rapidly, he or she may be dehydrated.

General instructions

  • Have your child rest at home.
  • If your child is old enough to rinse and spit, have your child rinse his or her mouth with a salt–water mixture 3–4 times per day or as needed. To make a salt-water mixture, completely dissolve ½–1 tsp of salt in 1 cup of warm water.
  • Wash your hands, and your child’s with soap and water. If soap and water are not available, use alcohol-based hand sanitizer.
  • During the illness:
    • Cover his or her mouth and nose when coughing or sneezing.
    • Do not allow your child to kiss anyone.
    • Do not allow your child to share food with anyone.
  • Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if:

  • Your child’s symptoms do not go away in 1 week.
  • Your child’s fever does not go away after 4–5 days.
  • Your child has symptoms of mild to moderate dehydration. These include:
    • Dry lips.
    • Dry mouth.
    • Sunken eyes.

Get help right away if:

  • Your child’s pain is not relieved by medicine.
  • Your child who is younger than 3 months has a temperature of 100°F (38°C) or higher.
  • Your child has symptoms of severe dehydration. These include:
    • Cold hands and feet.
    • Rapid breathing.
    • Confusion.
    • No tears when crying.
    • Decreased urination.

Summary

  • Herpangina is an illness in which sores form inside the mouth and throat. This condition is caused by a virus.
  • Herpangina normally goes away on its own within 1 week.
  • Medicines may be given to ease symptoms and reduce fever.
  • Wash your hands, and your child’s with soap and water. If soap and water are not available, use alcohol-based hand sanitizer.
  • Contact a health care provider if your child’s symptoms do not go away in 1 week.

Detailed Information on Herpangina

Herpangina is a self-limited upper respiratory tract infection associated with a characteristic vesicular rash on the soft palate.

Synonyms

  • Vesicular stomatitis
  • Acute lymphonodular pharyngitis

Epidemiology & Demographics

Predominant Sex

Male = female

Predominant Age

3 to 10 yr

Physical Findings & Clinical Presentation

  • •Characterized by ulcerating lesions typically located on the soft palate (ON. E1)
  • •Usually fewer than six lesions that evolve rapidly from a diffuse pharyngitis to erythematous macules and subsequently to vesicles that are moderately painful
  • •Fever, vomiting, and headache in the first few days of illness but subsiding spontaneously
  • •Pharyngeal lesions typical for several more days

Etiology

  • •Most cases caused by coxsackie A viruses (most frequently A8, A10, and A16).
  • •Occasional cases caused by other enteroviruses (echovirus and enterovirus 71).

 Diagnosis

Differential Diagnosis

  • •Herpes simplex
  • •Bacterial pharyngitis
  • •Tonsillitis
  • •Aphthous stomatitis
  • •Hand-foot-mouth disease

Workup

Diagnosis is typically based on characteristic lesions on the soft palate.

Laboratory Tests

  • •Viral and bacterial cultures of the pharynx to exclude herpes simplex infection and streptococcal pharyngitis if the diagnosis is in doubt.
  • •The type-specific antibodies appear in the blood about 1 wk after infection has occurred and attain their maximum titer in 3 wk.

 Treatment

  • •Give symptomatic treatment for sore throat: Saline gargles and analgesics, and encourage oral fluids.
  • •No antiviral therapy indicated; avoid antibacterial agents because they are ineffective, increase cost, might result in side effects, and promote antibiotic resistance.

Nonpharmacologic Therapy

Analgesic throat lozenges are helpful in some cases.

Acute General Rx

Antipyretics when indicated

Chronic Rx

Self-limited infection

Disposition

  • •Generally, resolution of symptoms within 1 wk
  • •Persistence of fever or mouth lesions beyond 1 wk suggestive of an alternative diagnosis (see “Differential Diagnosis”)

Referral

For consultation with otolaryngologist or infectious disease specialist if the diagnosis is in doubt.

 Pearls & Considerations

Comments

Household outbreaks may occur, especially during the summer months.

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