Overview

Herpangina is a common viral illness that primarily affects young children, though it can occasionally occur in adolescents and adults. It is characterized by the sudden onset of fever, sore throat, and small, painful ulcers or blisters in the mouth, particularly at the back of the throat and tonsils. Herpangina is typically caused by enteroviruses and is most prevalent during the summer and early fall months. While the condition is generally mild and self-limiting, it can cause significant discomfort, especially in younger children.

Causes

Herpangina is caused by several types of enteroviruses, most commonly:

• Coxsackievirus A: The most frequent cause of herpangina, especially in young children.
• Coxsackievirus B: Less common but can also lead to herpangina.
• Echoviruses and other enteroviruses: Occasionally implicated in outbreaks.

The viruses are spread primarily through direct contact with respiratory droplets, saliva, nasal secretions, or fecal matter from infected individuals. The infection is highly contagious, especially in group settings like daycare centers and schools.

Symptoms

The symptoms of herpangina usually develop abruptly and may include:

• Sudden high fever: Often one of the first symptoms, typically ranging between 101°F and 104°F (38.5°C to 40°C).
• Sore throat: Significant throat pain and difficulty swallowing.
• Mouth ulcers: Small red spots that develop into ulcers with a greyish center, commonly found on the soft palate, tonsils, and back of the throat.
• Loss of appetite: Due to oral pain, children may refuse to eat or drink.
• Drooling: Particularly in infants and toddlers who avoid swallowing because of throat discomfort.
• Headache and body aches: Common flu-like symptoms may accompany herpangina.
• Vomiting or abdominal pain: Some children may experience digestive upset.
• Fatigue and irritability: General tiredness and fussiness due to fever and mouth pain.

Diagnosis

Herpangina is usually diagnosed based on clinical evaluation by a healthcare provider:

• Medical history: Recent exposure to infected individuals and typical symptom patterns guide diagnosis.
• Physical examination: Visual inspection of the mouth revealing characteristic ulcers at the back of the throat and tonsils.
• No laboratory tests: In most cases, no specific tests are needed. Laboratory testing is reserved for atypical cases or outbreaks.
• Throat swabs or viral cultures: Rarely used but may help confirm the virus if necessary.

Treatment

There is no specific antiviral treatment for herpangina, as it is a self-limiting illness. Management focuses on relieving symptoms and preventing dehydration:

• Fever and pain control: Use of acetaminophen (paracetamol) or ibuprofen to reduce fever and alleviate throat pain.
• Hydration: Encourage fluid intake to prevent dehydration. Cold drinks, ice chips, or popsicles can help soothe the throat.
• Soft foods: Bland, non-acidic, and soft foods can reduce discomfort while eating.
• Avoid irritants: Avoid citrus fruits, spicy foods, and acidic beverages that can aggravate mouth sores.
• Rest: Adequate rest aids in quicker recovery.
• Medical attention: Seek prompt medical care if there are signs of dehydration, severe difficulty swallowing, or persistent high fever.

Prognosis

The prognosis for herpangina is excellent in most cases. Symptoms typically resolve within 5 to 7 days without any long-term complications. Children usually recover fully with supportive care at home. Serious complications are rare but can include dehydration or secondary bacterial infections if oral intake is severely reduced.

Preventative measures include good hand hygiene, avoiding close contact with infected individuals, and disinfecting commonly used surfaces, especially in group childcare environments. Since there is no vaccine specifically for herpangina, preventive care and hygiene remain the most effective methods to reduce the spread of infection.