Herpangina


Herpangina is a disease of mouth sores and fever which is virally induced, self limited, often affects the children and infants and is especially widespread during summer.

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The condition is caused by several kinds of viruses that form a part of enterovirus family, among which coxsackievirus is most common.

Children usually develop sore throat and fever which is followed by blisters or vesicles, or ulcers at the hind part of the throat. One may eventually develop an enanthem or palate

The younger children, in particular, may refuse to drink or eat due to pain, leading to increased risk of dehydration. It occurs occasionally in adults and adolescents  the characteristics of herpangina were first reported and noted in 1920.

The difference between herpangina and hand, foot and mouth disease

Both herpangina and hand foot and mouth diseases are caused by enteroviruses and both have blisters and ulcers. But the location of blisters differ. HFM lesions occur in front of the mouth, whereas herpangina lesions occur  at the back of the mouth. Approximately 75% of the children with HFM develop skin lesions on the palms and soles, whereas children with herpangina rarely develop any typical rashes.

Symptoms of herpangina

The affected children may typically show the following signs and symptoms:

  • The symptoms are generally mild and short in duration
  • Sore throat which may lead to difficulties in swallowing
  • Fever which often tends to be high in nature
  • Lymphadenopathy  or swelling of lymph nodes along the neck
  • Blisters and ulcers may cover the uvula, upper lips, posterior pharynx and tonsils and, which may last for nearly a week.
  • A small number of lesions, about two to six, develop in the back area  of the mouth, especially the tonsillar pillars or the soft palate. The lesions progress from red macules to vesicles and can then form ulcerations which can be 2 to 4 mm in size. Such abnormalities in the mouth heal in 7 to10 days. The rest of the mouth may appear normal.
  • Rash may occur.
  • There may be some pain in the ear, particularly while swallowing food or drinks
  • There may be increased tiredness or fatigue which may last for 3 to 4 days even after treatment.

Causes of herpangina

Some of the causes of herpangina are discussed below:

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  • The illness is more prevalent in the summer months
  • Herpangina may be  caused by several common Coxsackie A viruses along with several other kinds of enteroviruses.
  • The condition normally spreads via the ‘respiratory route’ or the ‘fecal-oral route’. Children are often in school playgrounds or day care centers, and hence they are at greater risk to contact the illness.
  • Contact with the mucous  of an infected individual causes the spread of the disease.
  • The duration of the condition involves an incubation period which does not show any symptoms and it may last for about one or two weeks.
  • It should be noted that around fifty percent of the individuals who are affected by the enteroviruses remain asymptomatic throughout the period of the illness. This can make the prevention of transmission of the viruses very difficult.

Diagnosis of herpangina

As herpangina is a clinical diagnosis and self limited, it does not need a laboratory test. For some patients, such as hospitalized children or those with underdeveloped or impaired immune systems, the viral studies are collected from their throat or nose.

Normally the symptoms will be considered for treatment because isolating the virus from samples requires a lot of time, and the illness is usually resolved by then.

Herpangina treatment

Herpangina may be treated in the following ways:

  • Treatment is similar to most conditions that may be caused due to viral infections.
  • Pain and fever are controlled with antipyretics such as acetaminophen or ibuprofen.
  • As the young children are resistant to eating and drinking, care should be taken to keep them hydrated. As an alternative treatment, ‘Magic mouthwash’ may be given to control mouth pain that accompanies herpangina.
  • Topical pain medications such as viscous lidocaine can be used as a pain barrier and may be given along with various other recipes. As some of them have harmful side effects all such medications should be given as per the directions of a doctor.
  • Since herpangina is caused by virus, neither antibiotics nor current antiviral medications have any role to play in its treatment

Prognosis for herpangina

Herpangina is a self limited syndrome, and most patients recover on their own after a week or so.

Younger children require to be guarded from dehydration by giving  intravenous hydration, as they may refuse to drink or eat. Enteroviral infection may cause viral or aseptic meningitis, but these patients also recover to normal health.

Prevention of herpangina

Good hygiene  and avoidance of people infected with coxsackievirus can help in the prevention of contacting herpangina. This may be difficult to practice but definitely not impossible.

Among the infected, 50% of them are asymptomatic. There is no vaccine for the illness.

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