|An example of herpangina in a child|
|Symptoms||Throat ulcers, fever|
|Complications||Dehydration, aseptic meningitis, encephalitis|
|Usual onset||3 to 5 days post exposure|
|Diagnostic method||Based on symptoms and exam|
|Differential diagnosis||Hand, foot, and mouth disease, Kawasaki disease, Rocky Mountain spotted fever, eczema herpeticum, toxic shock syndrome|
|Medication||Ibuprofen and paracetamol (acetaminophen)|
Herpangina is a type of viral infection that results in small blisters or ulcers in the back of the throat. Other symptoms may include sore throat, fever, lose of appetite, and abdominal pain. Onset is about 4 days after exposure. Complications may rarely include dehydration, aseptic meningitis, or encephalitis.
It is caused by viruses in the enterovirus group. This includes coxsackieviruses A and B, enterovirus 71, and echovirus. The disease often spreads between children in daycare or school. Diagnosis is based on symptoms and examination after ruling out other potential causes. In complicated cases testing the throat may be useful.
Treatment is generally with supportive care such as ibuprofen and paracetamol (acetaminophen). Sufficient fluids by mouth are recommended. There is no specific antiviral. Symptoms generally resolve within 4 days and mouth lesions heal within a week.
Herpangina is relatively common and often occurs as an outbreak. While it occurs most commonly in children, babies and young adults may also be affected. Most cases occur in the summer or during the rainy season. It was first characterized in 1920 by John Zahorsky.
Signs and symptoms
Symptoms include sudden fever with sore throat, headache, loss of appetite, and often neck pain. Within two days of onset, an average of four or five (but sometimes up to twenty) 1 to 2 mm diameter grayish lumps form and develop into vesicles surrounded by redness. Over the next 24 hours, these become shallow ulcers, rarely larger than 5 mm diameter that heal in one to seven days. These lesions most often appear on the tonsillar pillars (adjacent to the tonsils), but also on the soft palate, tonsils, uvula, or tongue.
A small number of lesions (usually two to six) form in the back area of the mouth, particularly the soft palate or tonsillar pillars. The lesions progress initially from red macules to vesicles and lastly to ulcerations, which can be 2–4 mm in size.
A diagnosis can be made from clinical signs and symptoms, and treatment consists of minimizing the discomfort of symptoms. It can be differentiated from herpetic gingivostomatitis by the positioning of vesicles - in herpangina, they are typically found on the posterior oropharynx, as compared to gingivostomatitis where they are typically found on the anterior oropharynx and the mouth.
Treatment is usually supportive only, as the disease is self-limiting and usually runs its course in less than a week.
- Most commonly affects infants and young children
- Typically occurs during the summer
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