Herpangina is a febrile disorder caused by enteroviruses, particularly group A coxsackieviruses. Infection causes vesicular and ulcerative lesions of the posterior oropharyngeal mucosa.
Herpangina tends to occur in epidemics, most commonly in infants and children. (See also Overview of Enterovirus Infections.)
Symptoms of Herpangina
Herpangina is characterized by sudden onset of fever with sore throat, headache, anorexia, and frequently neck pain. Infants may have drooling or vomiting.
Within 2 days after onset, up to 20 (mean, 4 to 5) 1- to 2-mm diameter grayish papules develop and become vesicles with erythematous areolae. They occur most frequently on the tonsillar pillars but also on the soft palate, tonsils, uvula, or tongue. During the next 24 hours, the lesions become shallow ulcers, seldom > 5 mm in diameter, and heal in 1 to 7 days.
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Difficulty swallowing, drooling, and refusal of foods/liquids by mouth can lead to dehydration, but complications of herpangina are unusual.
Lasting immunity to the infecting strain follows, but repeated episodes caused by other enteroviruses are possible.
Diagnosis of Herpangina
History and physical examination
Diagnosis of the clinical syndrome of herpangina is based on symptoms and characteristic oral lesions.
Confirmatory testing of an enterovirus as the cause is not usually required but can be done by
Detecting virus from the lesions by reverse transcriptase–polymerase chain reaction
Less commonly, isolating the virus from the lesions by culture, or demonstrating a rise in specific antibody titer
Recurrent aphthous ulcers may appear similar but, unlike with herpangina, rarely occur in the pharynx and are not typically accompanied by systemic symptoms. Herpetic stomatitis occurs sporadically and causes larger, more persistent, and more numerous ulcers, more commonly in the anterior oropharynx than herpangina. Coxsackievirus A10 causes lymphonodular pharyngitis, which is similar except that the papules become 2- to 3-mm whitish to yellowish nodules instead of vesicles and ulcers.
Treatment of Herpangina
Symptom relief
Treatment of herpangina is symptomatic and includes pain control, topical measures (see treatment of stomatitis), and hydration. Meticulous hand hygiene, particularly surrounding diaper changes and stooling, and avoiding contact with open skin lesions and oral secretions (drool) can help limit spread.
