Herpangina

• Herpangina is an acute febrile illness associated with small vesicles (blisters) or ulcers on the roof of the mouth and the back of the throat.
• Viruses cause herpangina. The main causes are enteroviruses, but other virus strains may also cause disease.
• Infants and children are at highest risk for herpangina.
• The viruses that cause herpangina are highly contagious.
• The incubation period is short, about one to two days.
• The contagious period is highest during the first week of symptoms and signs. However, some enteroviruses exist in feces up to six weeks post infection.
• Signs and symptoms of herpangina may include the following:
  • Sore throat
  • Fever
  • Headache
  • Decreased or loss of appetite
  • Swallowing problems due to mouth and throat pain
  • Lymph gland swelling
  • Drooling
  • Nausea and/or vomiting
  • Neck pain
  • Ulcers in throat and back of the mouth
• Doctors usually make a diagnosis by physical exam of the patient.
• There is no specific treatment for herpangina.
• Treatment usually focuses on supportive home care and consists of staying hydrated, taking fever-reducing (antipyretic) drugs, and applying topical analgesics.
• Rarely, complications can develop, such as aseptic meningitis, neurological changes, dehydration and, in pregnant females, infant low birth weight, and preterm delivery.
• Usually, the prognosis is good for almost all patients.
• There is no vaccine available to prevent herpangina. Good hand-washing technique and avoidance of crowds and individuals who have herpangina symptoms and signs will reduce the chance of getting the disease.

Herpangina is an acute febrile illness noteworthy for its small vesicles (blisters) or ulcers on the posterior oropharynx (roof of the mouth and the back of the throat).

Infection with enteroviruses (members of the Picornaviridae family) are the main causes of herpangina. Various enteroviruses such as coxsackievirus A16, enterovirus 71, and coxsackievirus B are the most frequent causes of herpangina. However, less common causes may include echovirus, adenovirus, parechovirus, and herpes simplex virus (HSV).

Worldwide infants and children (mainly ages 3-10), especially during the summer and fall, are at risk for herpangina. However, in tropical climates, individuals are at risk throughout the year. Pregnant women who develop herpangina have an increased risk for preterm delivery and low birth weight infants.

The viruses that cause herpangina are very contagious and spread easily from person to person, especially in child care centers and schools. A fecal-oral route and/or contact with respiratory droplets from the infected person sneezing or coughing are the most common ways these viruses spread. However, some of the viruses can live on surfaces and be infectious for several days.

The incubation period for herpangina is usually short; about one to two days, with a range of about one to five days. However, this incubation period may vary somewhat depending upon the viral type causing the disease.

Like the incubation period, the length of time herpangina viral disease is contagious depends upon the viral type. For example, coxsackieviruses are contagious during the first week of symptoms and signs and may be found in the respiratory tract for up to three weeks and in feces up to six weeks after the initial infection. However, these enteroviruses are most contagious during the first week of symptoms and signs.

Initially, herpangina symptoms and signs are usually fever, a poor appetite, sore throat, cough, and feeling tired. These symptoms may last about one or two days before sores, blisters, and/or ulcerations develop. Some patients may develop a rash that itches on the palms of the hands and the soles of the feet. The buttocks and genitals may also develop a rash. Still other patients may develop conjunctivitis. In general, patients may have several of the following:

• Sore throat
• Fever
• Headache
• Decreased or loss of appetite
• Swallowing problems due to mouth and throat pain
• Lymph gland swelling
• Drooling
• Nausea and/or vomiting
• Neck pain
• Ulcers in throat and back of the mouth

Diagnostic tests are not unnecessary to diagnose the disease. A health care provider can usually diagnose herpangina by simply doing a thorough history and complete physical exam of the patient. Depending upon the signs and symptoms listed above, it may be difficult to distinguish between herpangina and closely related diseases, such as hand, foot, and mouth disease (HFMD), which coxsackieviruses may also cause.

As stated above, the treatment of herpangina is supportive, usually done at home, and consists of hydration, antipyretic drugs, and topical analgesics.

Because herpangina is usually a self-limited disease, there is no specific therapy indicated. Currently, there is no antiviral therapy. Treatment is usually supportive, including hydration, antipyretic treatment (for example, fever-reduction medications such as acetaminophen [Tylenol] and ibuprofen [Advil]) and topical analgesics like lidocaine. Do not use aspirin in infants, children or adolescents. A rare and potentially lethal disease called Reye syndrome is associated with aspirin use in these age ranges.

Rarely, complications such as aseptic meningitis and neurological changes may occur. Low birth weight and/or preterm delivery may occur in pregnant women who develop herpangina. Dehydration is another serious complication that may occur in a few patients.

A medical caregiver needs to see the patient if he or she develops a high fever (over 103 F), becomes dehydrated (for example, lack of tears, dry mouth, and little or no urine output), and/or has mouth sores or a sore throat that does not seem to start going away after more than five days.

For most individuals, the prognosis for herpangina is good. The lesions usually heal within a week, and complications are rare. If complications develop, they may affect the prognosis.

It is possible to decrease the risk of developing herpangina by practicing good hand-washing hygiene, decreasing exposure to crowded public places, and avoiding contact with individuals exhibiting herpangina symptoms. Researchers are developing a vaccine against enterovirus 71, but the vaccine is not commercially available and may not protect against other enterovirus types.