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

    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 associatedwith 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 duringthe 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"

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    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 fromone 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 anylaboratory 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 thevirus 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 withantipyretics, 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 beresistant 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 additionalliquids 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 givenin too high a concentration. Remember that since herpangina is caused by a virus, antibioticshave 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 fromoccurring. In addition, enteroviral infections can also cause viral or aseptic meningitis, but even

    these patients usually recover fully.

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    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 atthe 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 nameimplies), 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," CDChttp://www.cdc.gov/ncidod/dvrd/revb/enterovirus/non-polio_entero.htm

    "Viral Exanthems," Dermatology Online Journalhttp://dermatology.cdlib.org/93/reviews/viral/scott.html

    "Herpangina," NIHhttp://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001964

    Medically reviewed Robert Cox, MD; American Board of Internal Medicine with subspecialty inInfectious 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.