http://www.medicinenet.com/herpangina/article.

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Herpangina
Medical Author:
David Perlstein, MD, MBA, FAAP
Medical Editor:
Mary D. Nettleman, MD, MS, MACP
Herpangina facts
What is herpangina?
What causes herpangina?
What are herpangina symptoms and signs?
How is herpangina diagnosed?
What is the treatment for herpangina?
What is the prognosis for herpangina?
What is the difference between herpangina and hand foot and mouth disease?
Can herpangina be prevented?
Where can people find more information about herpangina?
Herpangina facts
Herpangina is a self-limited infection primarily caused by coxsackieviruses.
Herpangina most often affects young children.
Herpangina is associated with fever, sore throat, and blisters in the back of the mouth.
Herpangina is diagnosed based on clinical symptoms alone.
Treatment of herpangina is usually directed toward minimizing the discomfort associated
with the mouth blisters.
Most children with herpangina recover completely after four to seven days.
There is no easy way to prevent herpangina.
What is herpangina?
Herpangina is an acute, virally induced, self-limited illness often seen in young children during
the summer months. Affected children usually complain of mouth sores and fever. It is caused by
a number of viruses, all part of the enterovirus family, coxsackievirus being the most common.
Most children develop a high fever and complain of a sore throat. They then develop vesicles
(blisters) or ulcers (sores) at the back of the throat and palate (called an enanthem). Children,
especially younger children, may refuse to eat or drink because of the pain and are at risk for
developing signs and symptoms of dehydration.
What causes herpangina?
Several common Coxsackie A viruses can cause herpangina, although a number of other
enteroviruses have also been implicated. The viruses are usually spread via the "fecal-oral route"
or via "respiratory route." Contact with mucous of an individual infected with one of these
viruses is usually all that is needed to contract the illness. The normal course of the infection
involves an incubation period which is generally an asymptomatic period lasting anywhere from
one to two weeks. In fact, half of individuals infected with some of these enteroviruses remain
asymptomatic throughout, which makes preventing transmission more difficult.
What are herpangina symptoms and signs?
Typically children with herpangina have the following:
Fever
Sore throat
Small blisters and ulcers may cover the soft palate, uvula, tonsils, and posterior pharynx.
The rest of the mouth is normal appearing. These blisters can last for up to a week.
Enlarged lymph nodes along the neck (lymphadenopathy)
Rash may or may not be present.
How is herpangina diagnosed?
Since herpangina is a clinical diagnosis, and self-limited, there is no real reason to perform any
laboratory studies. Some children (hospitalized or immune-compromised for example) may have
viral studies performed on specimins from the nose or throat. Isolating virus from these samples
takes a long time and generally symptoms will be resolved long before the identification of the
virus is available. Antibodies to coxsackievirus may also be measured if desired.
What is the treatment for herpangina?
Treatment is supportive, just like for most viruses. Fever control and pain control with
antipyretics, such as acetaminophen (Tylenol) or ibuprofen (Advil) is generally the primary
treatment. It is important to keep children well hydrated as well, and often young children will be
resistant to drinking or eating. The aptly named "magic mouthwash" is an alternative treatment
used to control the mouth pain associated with herpangina. There are various recipes, but most
include a topical pain medication such as viscous lidocaine as well as some sort of additional
liquids which function as a barrier. Your child's health-care provider might prescribe one of
these. It is important to remember that these types of medications should always be used as
directed by your provider, since some of the components may have serious side effects if given
in too high a concentration. Remember that since herpangina is caused by a virus, antibiotics
have no role in the treatment, nor do any antiviral medications currently available.
What is the prognosis for herpangina?
The prognosis is usually excellent. This is a self-limited syndrome which resolves on its own
after a week or so. Very rarely, younger patients may refuse to drink or eat and will require
intravenous hydration. It is important to manage a young child's pain to prevent this from
occurring. In addition, enteroviral infections can also cause viral or aseptic meningitis, but even
these patients usually recover fully.
What is the difference between herpangina and hand foot and mouth disease?
Both herpangina and hand foot and mouth (HFM) disease are caused by enteroviruses. Both
cause oral blisters and ulcers. The locations of the blisters differ, with HFM lesions occurring at
the front of the mouth and herpangina lesions occurring at the back of the mouth. Approximately
75% of children with HFM also develop skin lesions on the palms and soles (as the name
implies), but children with herpangina rarely develop any typical rashes.
Can herpangina be prevented?
Prevention of herpangina is dependent upon good hygiene and avoidance with individuals
infected with coxsackievirus. This is easier said than done, since as mentioned earlier, 50% of
infected individuals remain asymptomatic. There is no vaccine.
Where can people find more information about herpangina?
"Non-Polio Enterovirus Infections," CDC
http://www.cdc.gov/ncidod/dvrd/revb/enterovirus/non-polio_entero.htm
"Viral Exanthems," Dermatology Online Journal
http://dermatology.cdlib.org/93/reviews/viral/scott.html
"Herpangina," NIH
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001964
Medically reviewed Robert Cox, MD; American Board of Internal Medicine with subspecialty in
Infectious Disease

REFERENCES:

Dyer, J.A. "Childhood Viral Exanthems." Pediatric Annals. 36.1 Jan. 2007: 21-29.

Lee, T.C. "Diseases Caused by Enterovirus 71 Infection." Ped Infect Dis J. 28.10 Oct. 2009:
904-910.