Herpangina is a viral infection that causes a sore throat and painful mouth sores. It is most commonly seen in children, especially those under the age of 5, and is caused by a group of viruses known as enteroviruses. Herpangina is most common during the summer and fall months and is typically spread through contact with an infected person’s saliva or stool.
The illness is usually mild and self-limited but can cause significant discomfort and may require medical treatment in some cases. Symptoms are typically last for 7-10 days and include fever, sore throat, headache, and a rash of small blisters or ulcers in the back of the mouth and throat.
Epidemiology
Herpangina is a viral infection that primarily affects children and is caused by enteroviruses, most commonly Coxsackievirus A. Here are some key points about the epidemiology of herpangina:
Age and Population: Herpangina is most commonly reported in children under the age of 10, with peak incidence occurring in children between 3 and 6 years old. It can also affect adults, but it is less common.
Seasonal Variation: Herpangina is more prevalent during the summer and early fall months, although cases can occur throughout the year. Warmer weather and increased outdoor activities during these seasons may contribute to the higher incidence.
Transmission: Herpangina is primarily transmitted through the oral-fecal route, typically by close contact with infected individuals, contaminated surfaces, or respiratory droplets. It can also spread through contaminated food or water.
Anatomy
Pathophysiology
The pathophysiology of herpangina involves the interaction between the enterovirus, typically Coxsackievirus A, and the host’s immune response. Here are some key points about the pathophysiology of herpangina:
Viral Entry: Coxsackievirus A, the most common virus causing herpangina, enters the host through the oral route. It can be ingested by the host through contaminated food or water or transmitted by respiratory droplets from an infected person.
Viral Replication: After entering the host, the virus attaches to the host’s throat mucosa, where it invades the host’s cells, particularly the epithelial cells. Once inside the host’s cells, the virus replicates, leading to the destruction of the infected cells and the release of viral particles.
Immune Response: The host’s immune system recognizes the viral infection and mounts an immune response to eliminate the virus. This immune response involves the activation of various immune cells, such as T-cells and B-cells, which release cytokines and antibodies to neutralize the virus and promote inflammation.
Inflammatory Response: The immune response triggered by the viral infection results in inflammation of the throat mucosa, leading to the characteristic clinical features of herpangina, including fever, sore throat, and the formation of blister-like lesions or ulcers in the back of the throat.
Lesion Formation: The inflammatory response and destruction of infected cells by the virus result in the formation of small, grayish-white blister-like lesions or ulcers on the tonsils, soft palate, and uvula, which are the hallmark clinical feature of herpangina. These lesions can be painful and may interfere with swallowing and eating.
Resolution: Herpangina is usually a self-limited illness, and the immune system eventually clears the virus from the body. The infected cells regenerate, and the inflammation resolves, leading to the resolution of symptoms and healing of the lesions.
Complications: Although rare, herpangina can rarely lead to complications such as dehydration, febrile seizures, or secondary bacterial infections due to the damaged throat mucosa providing an entry point for bacteria.
Etiology
Herpangina is primarily caused by enteroviruses, most commonly Coxsackievirus A. Enteroviruses are a group of RNA viruses that belong to the Picornavirus family. Coxsackievirus A is a subtype of enteroviruses that can cause various clinical manifestations, including herpangina.
The specific etiology of herpangina involves the following:
Coxsackievirus A: Coxsackievirus A is the primary causative agent of herpangina. There are several serotypes of Coxsackievirus A, including Coxsackievirus A1, A2, A3, A4, A5, A6, A7, A8, A9, A10, A12, A14, A16, and others, which can cause herpangina.
Viral Transmission: Herpangina is highly contagious and is primarily transmitted through the oral-fecal route. The virus can be shed in the feces of infected individuals and can spread through contaminated food or water or by direct contact with respiratory droplets from an infected person. Close contact with an infected person, such as through sharing utensils or personal items, can also facilitate viral transmission.
Host Susceptibility: Herpangina can affect individuals of all ages, but it is most commonly reported in children under the age of 10. Children between 3 and 6 years old are particularly susceptible, likely due to their immature immune systems and close contact in daycare or school settings. However, herpangina can also affect adults, especially those with weakened immune systems.
Environmental Factors: Environmental factors, such as warm weather and increased outdoor activities, may contribute to the seasonality of herpangina, with higher incidence reported during the summer and early fall months.
Genetics
Prognostic Factors
Herpangina is typically a self-limited viral infection that resolves on its own within a week or two, and the prognosis is generally favorable. Most cases of herpangina are mild and do not result in complications. However, there are some prognostic factors that may impact the course and outcome of herpangina, which include:
Age: Herpangina is more commonly seen in children, particularly those under the age of 10. Younger children may be more susceptible to severe symptoms and complications due to their immature immune systems and smaller airways.
Viral Strain: The specific viral strain responsible for the herpangina infection may affect the severity and duration of the illness. Enteroviruses, particularly Coxsackievirus A, are the most common viruses causing herpangina, and some strains may cause more severe symptoms than others.
Overall Health Status: The overall health status of the affected individual may impact the prognosis of herpangina. Individuals with weakened immune systems, such as those with underlying health conditions, may have a higher risk of complications or a longer recovery time.
Presence of Complications: Complications of herpangina, although rare, can impact the prognosis. For example, if secondary bacterial infections occur due to open sores or ulcers in the oral cavity, it may result in more severe symptoms or prolonged recovery.
Timely and Appropriate Treatment: Prompt and appropriate supportive care, such as pain relief, hydration, rest, and good oral hygiene, can help manage symptoms and prevent complications, which may positively impact the prognosis.
Compliance with Treatment: Compliance with recommended treatments, such as pain medications and hydration, as well as following appropriate precautions to prevent the spread of the virus to others, may also impact the prognosis.
Clinical History
Clinical history
The clinical history of a patient with suspected herpangina typically includes information obtained through a comprehensive medical interview, which may include the following:
Chief Complaint: The patient may present with symptoms such as sore throat, difficulty swallowing (dysphagia), fever, and/or oral discomfort. The chief complaint is usually related to the symptoms that prompted the patient to seek medical attention.
History of Present Illness: The patient may provide details about the onset, duration, and severity of symptoms, including the progression of sore throat, presence of fever, and any associated symptoms such as headache, malaise, or rash. The patient may also describe any difficulty in eating or drinking due to oral discomfort.
Past Medical History: The patient’s past medical history may be relevant, as certain medical conditions or immunocompromised states may affect the severity or course of herpangina. This may include information on any history of recurrent or chronic sore throat, other viral or bacterial infections, or any known immune system disorders.
Medications and Allergies: The patient’s current medications, including prescription and over-the-counter medications, as well as any known allergies, may be relevant in assessing the patient’s medical condition and guiding treatment decisions.
Social History: The patient’s social history, including occupation, recent travel history, and exposure to sick contacts, may provide clues about potential sources of infection or transmission.
Family History: Information on the patient’s family history, including any history of similar symptoms or recurrent sore throats in family members, may be relevant in assessing for potential genetic or familial predisposition to herpangina.
Immunization History: The patient’s immunization history, including vaccination status for common childhood vaccinations such as the measles, mumps, and rubella (MMR) vaccine or the polio vaccine, may be relevant, as some of these vaccinations may protect against enterovirus infections, including Coxsackievirus A, which is a common cause of herpangina.
Lifestyle Factors: The patient’s lifestyle factors, such as tobacco or alcohol use, may be relevant in assessing overall health and potential risk factors for herpangina or other infections.
Other Symptoms: The patient may be asked about any other associated symptoms, such as respiratory symptoms, rash, headache, or gastrointestinal symptoms, which may provide additional clues about the underlying cause of the patient’s symptoms.
Obtaining a detailed clinical history is crucial in the evaluation of suspected herpangina to help guide the diagnostic process and determine appropriate management, including the need for further diagnostic tests or referral to a specialist. It is important to consult a healthcare professional for a thorough evaluation and accurate diagnosis.
Physical Examination
Physical examination:
A physical examination of a patient with suspected herpangina typically includes a comprehensive assessment of the patient’s vital signs and general appearance and a focused examination of the head, neck, and oral cavity. The following components may be included:
Vital Signs: The patient’s vital signs, including temperature, heart rate, blood pressure, and respiratory rate, are typically assessed to evaluate the severity of the illness and monitor for any signs of systemic involvement.
General Appearance: The patient’s general appearance is assessed, including their overall demeanor, level of consciousness, and signs of distress or discomfort.
Head and Neck Examination: A thorough examination of the head and neck may be performed, including inspection and palpation of the neck for lymphadenopathy (enlarged lymph nodes) or tenderness.
Oral Examination: A focused examination of the oral cavity is typically performed, including inspection of the lips, tongue, gums, tonsils, and posterior pharynx. In herpangina, characteristic findings may include small vesicles or ulcers on the posterior oropharynx, soft palate, tonsils, and uvula, which may be red, swollen, and covered with white or gray exudates.
Skin Examination: The skin may be examined for any rash or lesions that may be associated with herpangina, such as a rash on the palms or soles, which may be present in some cases.
Respiratory Examination: A respiratory examination may be performed to assess for any associated respiratory symptoms, such as cough, congestion, or abnormal breath sounds.
Other Systemic Examination: Depending on the patient’s symptoms and medical history, other systemic examinations may be performed as indicated to assess for any other signs of systemic involvement, such as cardiovascular, gastrointestinal, or neurological examinations.
Additional Testing: Based on the findings of the physical examination and the patient’s clinical presentation, additional diagnostic tests may be ordered, such as a throat swab for viral testing or blood tests to rule out other possible causes of the symptoms.
It is important to note that herpangina is typically a clinical diagnosis based on the characteristic findings of physical examination. However, other conditions with similar symptoms, such as strep throat, hand-foot-and-mouth disease, or another viral or bacterial pharyngitis, may need to be ruled out through further diagnostic tests or evaluation by a healthcare professional. A thorough physical examination, in conjunction with a detailed clinical history, can help guide the diagnosis and management of herpangina or other related conditions. It is recommended to consult a healthcare professional for an accurate diagnosis and appropriate management.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Differential diagnosis
Herpangina is a viral illness that presents with specific clinical features, including fever, sore throat, and characteristic blister-like lesions or ulcers on the back of the throat. However, several other conditions can present with similar symptoms, and a differential diagnosis is important to rule out other potential causes. The following are some of the conditions that may be considered in the differential diagnosis of herpangina:
Acute Pharyngitis/Tonsillitis: Various viral or bacterial infections, such as streptococcal pharyngitis (commonly known as strep throat), adenovirus, or Epstein-Barr virus (EBV) infection, can cause acute pharyngitis or tonsillitis, which may present with similar symptoms as herpangina, including sore throat, fever, and difficulty swallowing.
Hand, Foot, and Mouth Disease (HFMD): HFMD is a viral illness caused by enteroviruses, such as Coxsackievirus A16, which can present with similar clinical features as herpangina, including fever, sore throat, and the presence of vesicles or ulcers on the palms, soles, and mouth.
Scarlet Fever: Scarlet fever is a bacterial infection caused by group A Streptococcus (GAS) bacteria, which can cause symptoms such as sore throat, fever, and a characteristic rash that may resemble the “strawberry tongue” appearance seen in some cases of herpangina.
Viral Pharyngitis: Other viral infections, such as influenza, respiratory syncytial virus (RSV), or other respiratory viruses, can also cause pharyngitis with similar symptoms as herpangina, including fever, sore throat, and respiratory symptoms.
Infectious Mononucleosis (Mono): Mono is a viral illness caused by the Epstein-Barr virus (EBV), which can present with symptoms such as sore throat, fever, fatigue, and swollen lymph nodes, similar to herpangina.
Canker Sores: Canker sores, also known as aphthous ulcers, are painful ulcers that can occur in the mouth, including the throat, and may resemble the ulcers seen in herpangina. However, canker sores are not caused by viral infections and have different etiology and risk factors.
Other Conditions: There are other less common conditions that may present with similar symptoms, such as acute retroviral syndrome (ARS) in HIV infection, fungal or bacterial infections, and certain autoimmune conditions. These conditions may need to be considered in specific clinical contexts or when the typical features of herpangina are not present.
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
The treatment of herpangina is primarily supportive, as it is a viral infection that typically resolves on its own within a week or two. The goals of treatment are to relieve symptoms, prevent complications, and provide supportive care. The following approaches may be considered:
Pain Relief: Over-the-counter pain medications such as acetaminophen (Tylenol) or ibuprofen (Advil) may be used to relieve pain and reduce fever. Aspirin should be avoided in children due to the risk of developing a serious condition called Reye’s syndrome.
Hydration: Encouraging the patient to drink plenty of fluids, such as water or non-caffeinated beverages, to prevent dehydration and maintain adequate hydration is important, especially if swallowing is uncomfortable.
Symptomatic Relief: Gargling with warm saline solution or using over-the-counter throat lozenges or sprays may provide temporary relief of sore throat symptoms. Avoiding spicy or acidic foods and drinks, which may further irritate the throat, may also be helpful.
Rest: Adequate rest and avoiding strenuous activities can help the body fight off the viral infection and promote recovery.
Oral Care: Practicing good oral hygiene, such as regular brushing of teeth and tongue, may help maintain oral health and prevent secondary bacterial infections.
Prevention of Transmission: Taking appropriate precautions to prevent the spread of the virus to others, such as frequent handwashing, covering the mouth and nose when coughing or sneezing, and avoiding close contact with others, may be recommended.
Antiviral Medications: Antiviral medications are generally not used for the treatment of herpangina, as it is caused by a viral infection, and there are no specific antiviral medications available for herpangina.
It is important to note that antibiotics are not effective in treating herpangina, as it is a viral infection, and antibiotics are only effective against bacterial infections. Antimicrobial mouthwashes or sprays are also not recommended, as they are not proven to be effective in treating viral infections like herpangina.
In some cases, complications such as severe dehydration, difficulty swallowing, or secondary bacterial infections may require additional medical intervention. If symptoms are severe, persistent, or worsening, or if there are concerns about complications, it is important to consult a healthcare professional for further evaluation and management.
As with any medical condition, it is crucial to follow the advice of a healthcare professional for appropriate diagnosis and management of herpangina, including any specific treatments or medications recommended based on the patient’s individual condition and medical history.
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References
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Herpangina is a viral infection that causes a sore throat and painful mouth sores. It is most commonly seen in children, especially those under the age of 5, and is caused by a group of viruses known as enteroviruses. Herpangina is most common during the summer and fall months and is typically spread through contact with an infected person’s saliva or stool.
The illness is usually mild and self-limited but can cause significant discomfort and may require medical treatment in some cases. Symptoms are typically last for 7-10 days and include fever, sore throat, headache, and a rash of small blisters or ulcers in the back of the mouth and throat.
Herpangina is a viral infection that primarily affects children and is caused by enteroviruses, most commonly Coxsackievirus A. Here are some key points about the epidemiology of herpangina:
Age and Population: Herpangina is most commonly reported in children under the age of 10, with peak incidence occurring in children between 3 and 6 years old. It can also affect adults, but it is less common.
Seasonal Variation: Herpangina is more prevalent during the summer and early fall months, although cases can occur throughout the year. Warmer weather and increased outdoor activities during these seasons may contribute to the higher incidence.
Transmission: Herpangina is primarily transmitted through the oral-fecal route, typically by close contact with infected individuals, contaminated surfaces, or respiratory droplets. It can also spread through contaminated food or water.
The pathophysiology of herpangina involves the interaction between the enterovirus, typically Coxsackievirus A, and the host’s immune response. Here are some key points about the pathophysiology of herpangina:
Viral Entry: Coxsackievirus A, the most common virus causing herpangina, enters the host through the oral route. It can be ingested by the host through contaminated food or water or transmitted by respiratory droplets from an infected person.
Viral Replication: After entering the host, the virus attaches to the host’s throat mucosa, where it invades the host’s cells, particularly the epithelial cells. Once inside the host’s cells, the virus replicates, leading to the destruction of the infected cells and the release of viral particles.
Immune Response: The host’s immune system recognizes the viral infection and mounts an immune response to eliminate the virus. This immune response involves the activation of various immune cells, such as T-cells and B-cells, which release cytokines and antibodies to neutralize the virus and promote inflammation.
Inflammatory Response: The immune response triggered by the viral infection results in inflammation of the throat mucosa, leading to the characteristic clinical features of herpangina, including fever, sore throat, and the formation of blister-like lesions or ulcers in the back of the throat.
Lesion Formation: The inflammatory response and destruction of infected cells by the virus result in the formation of small, grayish-white blister-like lesions or ulcers on the tonsils, soft palate, and uvula, which are the hallmark clinical feature of herpangina. These lesions can be painful and may interfere with swallowing and eating.
Resolution: Herpangina is usually a self-limited illness, and the immune system eventually clears the virus from the body. The infected cells regenerate, and the inflammation resolves, leading to the resolution of symptoms and healing of the lesions.
Complications: Although rare, herpangina can rarely lead to complications such as dehydration, febrile seizures, or secondary bacterial infections due to the damaged throat mucosa providing an entry point for bacteria.
Herpangina is primarily caused by enteroviruses, most commonly Coxsackievirus A. Enteroviruses are a group of RNA viruses that belong to the Picornavirus family. Coxsackievirus A is a subtype of enteroviruses that can cause various clinical manifestations, including herpangina.
The specific etiology of herpangina involves the following:
Coxsackievirus A: Coxsackievirus A is the primary causative agent of herpangina. There are several serotypes of Coxsackievirus A, including Coxsackievirus A1, A2, A3, A4, A5, A6, A7, A8, A9, A10, A12, A14, A16, and others, which can cause herpangina.
Viral Transmission: Herpangina is highly contagious and is primarily transmitted through the oral-fecal route. The virus can be shed in the feces of infected individuals and can spread through contaminated food or water or by direct contact with respiratory droplets from an infected person. Close contact with an infected person, such as through sharing utensils or personal items, can also facilitate viral transmission.
Host Susceptibility: Herpangina can affect individuals of all ages, but it is most commonly reported in children under the age of 10. Children between 3 and 6 years old are particularly susceptible, likely due to their immature immune systems and close contact in daycare or school settings. However, herpangina can also affect adults, especially those with weakened immune systems.
Environmental Factors: Environmental factors, such as warm weather and increased outdoor activities, may contribute to the seasonality of herpangina, with higher incidence reported during the summer and early fall months.
Herpangina is typically a self-limited viral infection that resolves on its own within a week or two, and the prognosis is generally favorable. Most cases of herpangina are mild and do not result in complications. However, there are some prognostic factors that may impact the course and outcome of herpangina, which include:
Age: Herpangina is more commonly seen in children, particularly those under the age of 10. Younger children may be more susceptible to severe symptoms and complications due to their immature immune systems and smaller airways.
Viral Strain: The specific viral strain responsible for the herpangina infection may affect the severity and duration of the illness. Enteroviruses, particularly Coxsackievirus A, are the most common viruses causing herpangina, and some strains may cause more severe symptoms than others.
Overall Health Status: The overall health status of the affected individual may impact the prognosis of herpangina. Individuals with weakened immune systems, such as those with underlying health conditions, may have a higher risk of complications or a longer recovery time.
Presence of Complications: Complications of herpangina, although rare, can impact the prognosis. For example, if secondary bacterial infections occur due to open sores or ulcers in the oral cavity, it may result in more severe symptoms or prolonged recovery.
Timely and Appropriate Treatment: Prompt and appropriate supportive care, such as pain relief, hydration, rest, and good oral hygiene, can help manage symptoms and prevent complications, which may positively impact the prognosis.
Compliance with Treatment: Compliance with recommended treatments, such as pain medications and hydration, as well as following appropriate precautions to prevent the spread of the virus to others, may also impact the prognosis.
Clinical history
The clinical history of a patient with suspected herpangina typically includes information obtained through a comprehensive medical interview, which may include the following:
Chief Complaint: The patient may present with symptoms such as sore throat, difficulty swallowing (dysphagia), fever, and/or oral discomfort. The chief complaint is usually related to the symptoms that prompted the patient to seek medical attention.
History of Present Illness: The patient may provide details about the onset, duration, and severity of symptoms, including the progression of sore throat, presence of fever, and any associated symptoms such as headache, malaise, or rash. The patient may also describe any difficulty in eating or drinking due to oral discomfort.
Past Medical History: The patient’s past medical history may be relevant, as certain medical conditions or immunocompromised states may affect the severity or course of herpangina. This may include information on any history of recurrent or chronic sore throat, other viral or bacterial infections, or any known immune system disorders.
Medications and Allergies: The patient’s current medications, including prescription and over-the-counter medications, as well as any known allergies, may be relevant in assessing the patient’s medical condition and guiding treatment decisions.
Social History: The patient’s social history, including occupation, recent travel history, and exposure to sick contacts, may provide clues about potential sources of infection or transmission.
Family History: Information on the patient’s family history, including any history of similar symptoms or recurrent sore throats in family members, may be relevant in assessing for potential genetic or familial predisposition to herpangina.
Immunization History: The patient’s immunization history, including vaccination status for common childhood vaccinations such as the measles, mumps, and rubella (MMR) vaccine or the polio vaccine, may be relevant, as some of these vaccinations may protect against enterovirus infections, including Coxsackievirus A, which is a common cause of herpangina.
Lifestyle Factors: The patient’s lifestyle factors, such as tobacco or alcohol use, may be relevant in assessing overall health and potential risk factors for herpangina or other infections.
Other Symptoms: The patient may be asked about any other associated symptoms, such as respiratory symptoms, rash, headache, or gastrointestinal symptoms, which may provide additional clues about the underlying cause of the patient’s symptoms.
Obtaining a detailed clinical history is crucial in the evaluation of suspected herpangina to help guide the diagnostic process and determine appropriate management, including the need for further diagnostic tests or referral to a specialist. It is important to consult a healthcare professional for a thorough evaluation and accurate diagnosis.
Physical examination:
A physical examination of a patient with suspected herpangina typically includes a comprehensive assessment of the patient’s vital signs and general appearance and a focused examination of the head, neck, and oral cavity. The following components may be included:
Vital Signs: The patient’s vital signs, including temperature, heart rate, blood pressure, and respiratory rate, are typically assessed to evaluate the severity of the illness and monitor for any signs of systemic involvement.
General Appearance: The patient’s general appearance is assessed, including their overall demeanor, level of consciousness, and signs of distress or discomfort.
Head and Neck Examination: A thorough examination of the head and neck may be performed, including inspection and palpation of the neck for lymphadenopathy (enlarged lymph nodes) or tenderness.
Oral Examination: A focused examination of the oral cavity is typically performed, including inspection of the lips, tongue, gums, tonsils, and posterior pharynx. In herpangina, characteristic findings may include small vesicles or ulcers on the posterior oropharynx, soft palate, tonsils, and uvula, which may be red, swollen, and covered with white or gray exudates.
Skin Examination: The skin may be examined for any rash or lesions that may be associated with herpangina, such as a rash on the palms or soles, which may be present in some cases.
Respiratory Examination: A respiratory examination may be performed to assess for any associated respiratory symptoms, such as cough, congestion, or abnormal breath sounds.
Other Systemic Examination: Depending on the patient’s symptoms and medical history, other systemic examinations may be performed as indicated to assess for any other signs of systemic involvement, such as cardiovascular, gastrointestinal, or neurological examinations.
Additional Testing: Based on the findings of the physical examination and the patient’s clinical presentation, additional diagnostic tests may be ordered, such as a throat swab for viral testing or blood tests to rule out other possible causes of the symptoms.
It is important to note that herpangina is typically a clinical diagnosis based on the characteristic findings of physical examination. However, other conditions with similar symptoms, such as strep throat, hand-foot-and-mouth disease, or another viral or bacterial pharyngitis, may need to be ruled out through further diagnostic tests or evaluation by a healthcare professional. A thorough physical examination, in conjunction with a detailed clinical history, can help guide the diagnosis and management of herpangina or other related conditions. It is recommended to consult a healthcare professional for an accurate diagnosis and appropriate management.
Differential diagnosis
Herpangina is a viral illness that presents with specific clinical features, including fever, sore throat, and characteristic blister-like lesions or ulcers on the back of the throat. However, several other conditions can present with similar symptoms, and a differential diagnosis is important to rule out other potential causes. The following are some of the conditions that may be considered in the differential diagnosis of herpangina:
Acute Pharyngitis/Tonsillitis: Various viral or bacterial infections, such as streptococcal pharyngitis (commonly known as strep throat), adenovirus, or Epstein-Barr virus (EBV) infection, can cause acute pharyngitis or tonsillitis, which may present with similar symptoms as herpangina, including sore throat, fever, and difficulty swallowing.
Hand, Foot, and Mouth Disease (HFMD): HFMD is a viral illness caused by enteroviruses, such as Coxsackievirus A16, which can present with similar clinical features as herpangina, including fever, sore throat, and the presence of vesicles or ulcers on the palms, soles, and mouth.
Scarlet Fever: Scarlet fever is a bacterial infection caused by group A Streptococcus (GAS) bacteria, which can cause symptoms such as sore throat, fever, and a characteristic rash that may resemble the “strawberry tongue” appearance seen in some cases of herpangina.
Viral Pharyngitis: Other viral infections, such as influenza, respiratory syncytial virus (RSV), or other respiratory viruses, can also cause pharyngitis with similar symptoms as herpangina, including fever, sore throat, and respiratory symptoms.
Infectious Mononucleosis (Mono): Mono is a viral illness caused by the Epstein-Barr virus (EBV), which can present with symptoms such as sore throat, fever, fatigue, and swollen lymph nodes, similar to herpangina.
Canker Sores: Canker sores, also known as aphthous ulcers, are painful ulcers that can occur in the mouth, including the throat, and may resemble the ulcers seen in herpangina. However, canker sores are not caused by viral infections and have different etiology and risk factors.
Other Conditions: There are other less common conditions that may present with similar symptoms, such as acute retroviral syndrome (ARS) in HIV infection, fungal or bacterial infections, and certain autoimmune conditions. These conditions may need to be considered in specific clinical contexts or when the typical features of herpangina are not present.
The treatment of herpangina is primarily supportive, as it is a viral infection that typically resolves on its own within a week or two. The goals of treatment are to relieve symptoms, prevent complications, and provide supportive care. The following approaches may be considered:
Pain Relief: Over-the-counter pain medications such as acetaminophen (Tylenol) or ibuprofen (Advil) may be used to relieve pain and reduce fever. Aspirin should be avoided in children due to the risk of developing a serious condition called Reye’s syndrome.
Hydration: Encouraging the patient to drink plenty of fluids, such as water or non-caffeinated beverages, to prevent dehydration and maintain adequate hydration is important, especially if swallowing is uncomfortable.
Symptomatic Relief: Gargling with warm saline solution or using over-the-counter throat lozenges or sprays may provide temporary relief of sore throat symptoms. Avoiding spicy or acidic foods and drinks, which may further irritate the throat, may also be helpful.
Rest: Adequate rest and avoiding strenuous activities can help the body fight off the viral infection and promote recovery.
Oral Care: Practicing good oral hygiene, such as regular brushing of teeth and tongue, may help maintain oral health and prevent secondary bacterial infections.
Prevention of Transmission: Taking appropriate precautions to prevent the spread of the virus to others, such as frequent handwashing, covering the mouth and nose when coughing or sneezing, and avoiding close contact with others, may be recommended.
Antiviral Medications: Antiviral medications are generally not used for the treatment of herpangina, as it is caused by a viral infection, and there are no specific antiviral medications available for herpangina.
It is important to note that antibiotics are not effective in treating herpangina, as it is a viral infection, and antibiotics are only effective against bacterial infections. Antimicrobial mouthwashes or sprays are also not recommended, as they are not proven to be effective in treating viral infections like herpangina.
In some cases, complications such as severe dehydration, difficulty swallowing, or secondary bacterial infections may require additional medical intervention. If symptoms are severe, persistent, or worsening, or if there are concerns about complications, it is important to consult a healthcare professional for further evaluation and management.
As with any medical condition, it is crucial to follow the advice of a healthcare professional for appropriate diagnosis and management of herpangina, including any specific treatments or medications recommended based on the patient’s individual condition and medical history.
https://www.ncbi.nlm.nih.gov/books/NBK507792
medtigo
Herpangina
Updated :
August 30, 2023
Herpangina is a viral infection that causes a sore throat and painful mouth sores. It is most commonly seen in children, especially those under the age of 5, and is caused by a group of viruses known as enteroviruses. Herpangina is most common during the summer and fall months and is typically spread through contact with an infected person’s saliva or stool.
The illness is usually mild and self-limited but can cause significant discomfort and may require medical treatment in some cases. Symptoms are typically last for 7-10 days and include fever, sore throat, headache, and a rash of small blisters or ulcers in the back of the mouth and throat.
Herpangina is a viral infection that primarily affects children and is caused by enteroviruses, most commonly Coxsackievirus A. Here are some key points about the epidemiology of herpangina:
Age and Population: Herpangina is most commonly reported in children under the age of 10, with peak incidence occurring in children between 3 and 6 years old. It can also affect adults, but it is less common.
Seasonal Variation: Herpangina is more prevalent during the summer and early fall months, although cases can occur throughout the year. Warmer weather and increased outdoor activities during these seasons may contribute to the higher incidence.
Transmission: Herpangina is primarily transmitted through the oral-fecal route, typically by close contact with infected individuals, contaminated surfaces, or respiratory droplets. It can also spread through contaminated food or water.
The pathophysiology of herpangina involves the interaction between the enterovirus, typically Coxsackievirus A, and the host’s immune response. Here are some key points about the pathophysiology of herpangina:
Viral Entry: Coxsackievirus A, the most common virus causing herpangina, enters the host through the oral route. It can be ingested by the host through contaminated food or water or transmitted by respiratory droplets from an infected person.
Viral Replication: After entering the host, the virus attaches to the host’s throat mucosa, where it invades the host’s cells, particularly the epithelial cells. Once inside the host’s cells, the virus replicates, leading to the destruction of the infected cells and the release of viral particles.
Immune Response: The host’s immune system recognizes the viral infection and mounts an immune response to eliminate the virus. This immune response involves the activation of various immune cells, such as T-cells and B-cells, which release cytokines and antibodies to neutralize the virus and promote inflammation.
Inflammatory Response: The immune response triggered by the viral infection results in inflammation of the throat mucosa, leading to the characteristic clinical features of herpangina, including fever, sore throat, and the formation of blister-like lesions or ulcers in the back of the throat.
Lesion Formation: The inflammatory response and destruction of infected cells by the virus result in the formation of small, grayish-white blister-like lesions or ulcers on the tonsils, soft palate, and uvula, which are the hallmark clinical feature of herpangina. These lesions can be painful and may interfere with swallowing and eating.
Resolution: Herpangina is usually a self-limited illness, and the immune system eventually clears the virus from the body. The infected cells regenerate, and the inflammation resolves, leading to the resolution of symptoms and healing of the lesions.
Complications: Although rare, herpangina can rarely lead to complications such as dehydration, febrile seizures, or secondary bacterial infections due to the damaged throat mucosa providing an entry point for bacteria.
Herpangina is primarily caused by enteroviruses, most commonly Coxsackievirus A. Enteroviruses are a group of RNA viruses that belong to the Picornavirus family. Coxsackievirus A is a subtype of enteroviruses that can cause various clinical manifestations, including herpangina.
The specific etiology of herpangina involves the following:
Coxsackievirus A: Coxsackievirus A is the primary causative agent of herpangina. There are several serotypes of Coxsackievirus A, including Coxsackievirus A1, A2, A3, A4, A5, A6, A7, A8, A9, A10, A12, A14, A16, and others, which can cause herpangina.
Viral Transmission: Herpangina is highly contagious and is primarily transmitted through the oral-fecal route. The virus can be shed in the feces of infected individuals and can spread through contaminated food or water or by direct contact with respiratory droplets from an infected person. Close contact with an infected person, such as through sharing utensils or personal items, can also facilitate viral transmission.
Host Susceptibility: Herpangina can affect individuals of all ages, but it is most commonly reported in children under the age of 10. Children between 3 and 6 years old are particularly susceptible, likely due to their immature immune systems and close contact in daycare or school settings. However, herpangina can also affect adults, especially those with weakened immune systems.
Environmental Factors: Environmental factors, such as warm weather and increased outdoor activities, may contribute to the seasonality of herpangina, with higher incidence reported during the summer and early fall months.
Herpangina is typically a self-limited viral infection that resolves on its own within a week or two, and the prognosis is generally favorable. Most cases of herpangina are mild and do not result in complications. However, there are some prognostic factors that may impact the course and outcome of herpangina, which include:
Age: Herpangina is more commonly seen in children, particularly those under the age of 10. Younger children may be more susceptible to severe symptoms and complications due to their immature immune systems and smaller airways.
Viral Strain: The specific viral strain responsible for the herpangina infection may affect the severity and duration of the illness. Enteroviruses, particularly Coxsackievirus A, are the most common viruses causing herpangina, and some strains may cause more severe symptoms than others.
Overall Health Status: The overall health status of the affected individual may impact the prognosis of herpangina. Individuals with weakened immune systems, such as those with underlying health conditions, may have a higher risk of complications or a longer recovery time.
Presence of Complications: Complications of herpangina, although rare, can impact the prognosis. For example, if secondary bacterial infections occur due to open sores or ulcers in the oral cavity, it may result in more severe symptoms or prolonged recovery.
Timely and Appropriate Treatment: Prompt and appropriate supportive care, such as pain relief, hydration, rest, and good oral hygiene, can help manage symptoms and prevent complications, which may positively impact the prognosis.
Compliance with Treatment: Compliance with recommended treatments, such as pain medications and hydration, as well as following appropriate precautions to prevent the spread of the virus to others, may also impact the prognosis.
Clinical history
The clinical history of a patient with suspected herpangina typically includes information obtained through a comprehensive medical interview, which may include the following:
Chief Complaint: The patient may present with symptoms such as sore throat, difficulty swallowing (dysphagia), fever, and/or oral discomfort. The chief complaint is usually related to the symptoms that prompted the patient to seek medical attention.
History of Present Illness: The patient may provide details about the onset, duration, and severity of symptoms, including the progression of sore throat, presence of fever, and any associated symptoms such as headache, malaise, or rash. The patient may also describe any difficulty in eating or drinking due to oral discomfort.
Past Medical History: The patient’s past medical history may be relevant, as certain medical conditions or immunocompromised states may affect the severity or course of herpangina. This may include information on any history of recurrent or chronic sore throat, other viral or bacterial infections, or any known immune system disorders.
Medications and Allergies: The patient’s current medications, including prescription and over-the-counter medications, as well as any known allergies, may be relevant in assessing the patient’s medical condition and guiding treatment decisions.
Social History: The patient’s social history, including occupation, recent travel history, and exposure to sick contacts, may provide clues about potential sources of infection or transmission.
Family History: Information on the patient’s family history, including any history of similar symptoms or recurrent sore throats in family members, may be relevant in assessing for potential genetic or familial predisposition to herpangina.
Immunization History: The patient’s immunization history, including vaccination status for common childhood vaccinations such as the measles, mumps, and rubella (MMR) vaccine or the polio vaccine, may be relevant, as some of these vaccinations may protect against enterovirus infections, including Coxsackievirus A, which is a common cause of herpangina.
Lifestyle Factors: The patient’s lifestyle factors, such as tobacco or alcohol use, may be relevant in assessing overall health and potential risk factors for herpangina or other infections.
Other Symptoms: The patient may be asked about any other associated symptoms, such as respiratory symptoms, rash, headache, or gastrointestinal symptoms, which may provide additional clues about the underlying cause of the patient’s symptoms.
Obtaining a detailed clinical history is crucial in the evaluation of suspected herpangina to help guide the diagnostic process and determine appropriate management, including the need for further diagnostic tests or referral to a specialist. It is important to consult a healthcare professional for a thorough evaluation and accurate diagnosis.
Physical examination:
A physical examination of a patient with suspected herpangina typically includes a comprehensive assessment of the patient’s vital signs and general appearance and a focused examination of the head, neck, and oral cavity. The following components may be included:
Vital Signs: The patient’s vital signs, including temperature, heart rate, blood pressure, and respiratory rate, are typically assessed to evaluate the severity of the illness and monitor for any signs of systemic involvement.
General Appearance: The patient’s general appearance is assessed, including their overall demeanor, level of consciousness, and signs of distress or discomfort.
Head and Neck Examination: A thorough examination of the head and neck may be performed, including inspection and palpation of the neck for lymphadenopathy (enlarged lymph nodes) or tenderness.
Oral Examination: A focused examination of the oral cavity is typically performed, including inspection of the lips, tongue, gums, tonsils, and posterior pharynx. In herpangina, characteristic findings may include small vesicles or ulcers on the posterior oropharynx, soft palate, tonsils, and uvula, which may be red, swollen, and covered with white or gray exudates.
Skin Examination: The skin may be examined for any rash or lesions that may be associated with herpangina, such as a rash on the palms or soles, which may be present in some cases.
Respiratory Examination: A respiratory examination may be performed to assess for any associated respiratory symptoms, such as cough, congestion, or abnormal breath sounds.
Other Systemic Examination: Depending on the patient’s symptoms and medical history, other systemic examinations may be performed as indicated to assess for any other signs of systemic involvement, such as cardiovascular, gastrointestinal, or neurological examinations.
Additional Testing: Based on the findings of the physical examination and the patient’s clinical presentation, additional diagnostic tests may be ordered, such as a throat swab for viral testing or blood tests to rule out other possible causes of the symptoms.
It is important to note that herpangina is typically a clinical diagnosis based on the characteristic findings of physical examination. However, other conditions with similar symptoms, such as strep throat, hand-foot-and-mouth disease, or another viral or bacterial pharyngitis, may need to be ruled out through further diagnostic tests or evaluation by a healthcare professional. A thorough physical examination, in conjunction with a detailed clinical history, can help guide the diagnosis and management of herpangina or other related conditions. It is recommended to consult a healthcare professional for an accurate diagnosis and appropriate management.
Differential diagnosis
Herpangina is a viral illness that presents with specific clinical features, including fever, sore throat, and characteristic blister-like lesions or ulcers on the back of the throat. However, several other conditions can present with similar symptoms, and a differential diagnosis is important to rule out other potential causes. The following are some of the conditions that may be considered in the differential diagnosis of herpangina:
Acute Pharyngitis/Tonsillitis: Various viral or bacterial infections, such as streptococcal pharyngitis (commonly known as strep throat), adenovirus, or Epstein-Barr virus (EBV) infection, can cause acute pharyngitis or tonsillitis, which may present with similar symptoms as herpangina, including sore throat, fever, and difficulty swallowing.
Hand, Foot, and Mouth Disease (HFMD): HFMD is a viral illness caused by enteroviruses, such as Coxsackievirus A16, which can present with similar clinical features as herpangina, including fever, sore throat, and the presence of vesicles or ulcers on the palms, soles, and mouth.
Scarlet Fever: Scarlet fever is a bacterial infection caused by group A Streptococcus (GAS) bacteria, which can cause symptoms such as sore throat, fever, and a characteristic rash that may resemble the “strawberry tongue” appearance seen in some cases of herpangina.
Viral Pharyngitis: Other viral infections, such as influenza, respiratory syncytial virus (RSV), or other respiratory viruses, can also cause pharyngitis with similar symptoms as herpangina, including fever, sore throat, and respiratory symptoms.
Infectious Mononucleosis (Mono): Mono is a viral illness caused by the Epstein-Barr virus (EBV), which can present with symptoms such as sore throat, fever, fatigue, and swollen lymph nodes, similar to herpangina.
Canker Sores: Canker sores, also known as aphthous ulcers, are painful ulcers that can occur in the mouth, including the throat, and may resemble the ulcers seen in herpangina. However, canker sores are not caused by viral infections and have different etiology and risk factors.
Other Conditions: There are other less common conditions that may present with similar symptoms, such as acute retroviral syndrome (ARS) in HIV infection, fungal or bacterial infections, and certain autoimmune conditions. These conditions may need to be considered in specific clinical contexts or when the typical features of herpangina are not present.
The treatment of herpangina is primarily supportive, as it is a viral infection that typically resolves on its own within a week or two. The goals of treatment are to relieve symptoms, prevent complications, and provide supportive care. The following approaches may be considered:
Pain Relief: Over-the-counter pain medications such as acetaminophen (Tylenol) or ibuprofen (Advil) may be used to relieve pain and reduce fever. Aspirin should be avoided in children due to the risk of developing a serious condition called Reye’s syndrome.
Hydration: Encouraging the patient to drink plenty of fluids, such as water or non-caffeinated beverages, to prevent dehydration and maintain adequate hydration is important, especially if swallowing is uncomfortable.
Symptomatic Relief: Gargling with warm saline solution or using over-the-counter throat lozenges or sprays may provide temporary relief of sore throat symptoms. Avoiding spicy or acidic foods and drinks, which may further irritate the throat, may also be helpful.
Rest: Adequate rest and avoiding strenuous activities can help the body fight off the viral infection and promote recovery.
Oral Care: Practicing good oral hygiene, such as regular brushing of teeth and tongue, may help maintain oral health and prevent secondary bacterial infections.
Prevention of Transmission: Taking appropriate precautions to prevent the spread of the virus to others, such as frequent handwashing, covering the mouth and nose when coughing or sneezing, and avoiding close contact with others, may be recommended.
Antiviral Medications: Antiviral medications are generally not used for the treatment of herpangina, as it is caused by a viral infection, and there are no specific antiviral medications available for herpangina.
It is important to note that antibiotics are not effective in treating herpangina, as it is a viral infection, and antibiotics are only effective against bacterial infections. Antimicrobial mouthwashes or sprays are also not recommended, as they are not proven to be effective in treating viral infections like herpangina.
In some cases, complications such as severe dehydration, difficulty swallowing, or secondary bacterial infections may require additional medical intervention. If symptoms are severe, persistent, or worsening, or if there are concerns about complications, it is important to consult a healthcare professional for further evaluation and management.
As with any medical condition, it is crucial to follow the advice of a healthcare professional for appropriate diagnosis and management of herpangina, including any specific treatments or medications recommended based on the patient’s individual condition and medical history.
https://www.ncbi.nlm.nih.gov/books/NBK507792
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