Summary about Disease
Herpangina is a common, typically mild, viral illness that primarily affects infants and children, but can also occur in adults. It is characterized by small, painful blisters or sores in the mouth, particularly on the soft palate (back of the roof of the mouth), tonsils, and throat. It's caused by enteroviruses, most commonly Coxsackievirus A.
Symptoms
The most common symptoms of herpangina include:
Sudden high fever (typically 101°F to 104°F or 38.3°C to 40°C)
Sore throat
Painful swallowing (odynophagia)
Small, gray-white blisters/ulcers with a red halo in the mouth and throat
Loss of appetite
Headache
Irritability
Drooling (in young children)
Neck pain (less common)
Abdominal pain
Vomiting
Causes
Herpangina is caused by enteroviruses, most frequently Coxsackievirus A, but can also be caused by other enteroviruses such as Coxsackievirus B, and echoviruses. These viruses are highly contagious.
Medicine Used
There is no specific antiviral medication to treat herpangina. Treatment focuses on managing symptoms:
Pain relievers: Over-the-counter pain relievers such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can help reduce fever and pain. Aspirin should NOT be given to children or teenagers due to the risk of Reye's syndrome.
Mouthwashes/Sprays: Topical anesthetics or mouthwashes/sprays (containing lidocaine, benzocaine, or similar ingredients) can provide temporary relief from mouth pain, but should be used with caution in young children due to potential side effects. Follow a physician's recommendations on this as some anesthetics are not recommended for young children.
Hydration: Ensuring adequate fluid intake is crucial to prevent dehydration, especially due to painful swallowing. Offer cool, clear liquids such as water, popsicles, or diluted juice. Avoid acidic or citrus beverages that can irritate the sores.
Is Communicable
Yes, herpangina is highly communicable (contagious). It spreads through:
Direct contact with saliva, nasal discharge, or blister fluid of an infected person.
Respiratory droplets produced when an infected person coughs or sneezes.
Fecal-oral route (poor handwashing after using the toilet or changing diapers).
Contact with contaminated surfaces.
Precautions
To prevent the spread of herpangina:
Frequent handwashing: Wash hands thoroughly and often with soap and water, especially after using the toilet, changing diapers, and before eating.
Avoid sharing: Do not share eating utensils, cups, towels, or other personal items.
Disinfect surfaces: Regularly disinfect frequently touched surfaces like toys, doorknobs, and countertops.
Cover coughs and sneezes: Teach children to cover their mouth and nose with a tissue or their elbow when coughing or sneezing.
Stay home: Keep infected children home from school or daycare until the fever is gone and mouth sores have healed significantly.
Good hygiene: Practice good general hygiene.
How long does an outbreak last?
The typical duration of a herpangina outbreak is about 7 to 10 days. The fever usually subsides within 2 to 3 days, and the mouth sores typically heal within a week.
How is it diagnosed?
Herpangina is usually diagnosed based on a physical examination by a doctor. The characteristic appearance and location of the mouth sores, along with other symptoms like fever and sore throat, are typically sufficient for diagnosis. Lab tests are generally not required but may be performed in rare cases to confirm the presence of an enterovirus.
Timeline of Symptoms
Day 1-2: Sudden onset of high fever, sore throat, headache, loss of appetite.
Day 2-3: Development of small, gray-white blisters/ulcers in the mouth and throat. Fever may start to decrease.
Day 4-7: Mouth sores become more prominent and painful. Difficulty swallowing.
Day 7-10: Mouth sores gradually heal, and other symptoms subside.
Important Considerations
Dehydration: Closely monitor for signs of dehydration due to painful swallowing. Encourage frequent sips of cool liquids.
Secondary Infections: While rare, secondary bacterial infections of the mouth sores can occur. Seek medical attention if the sores worsen or show signs of infection (increased redness, swelling, pus).
Differentiation: Herpangina can sometimes be confused with hand, foot, and mouth disease (HFMD), which is also caused by enteroviruses. HFMD typically involves sores on the hands and feet, in addition to the mouth.
Medical Advice: Contact a doctor if your child develops symptoms of herpangina, especially if they are very young, have a weakened immune system, or show signs of dehydration.