Herpangina: A Viral Infection of the Mouth and Throat

Is Herpangina Causing Your Mouth Blisters and Sore Throat?

Sore Throat
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What is herpangina? Also known as vesicular stomatitis and acute lymphonodular pharyngitis, it is a common childhood infection caused by an enterovirus, most commonly the group A coxsackievirus. It is similar to, but not the same thing as, another illness caused by an enterovirus called hand-foot-and-mouth disease.

Herpangina usually causes a sore throat and painful sores (lesions or blisters) inside the back of the mouth and throat.

It is common to have around 5 lesions, however you may notice as many as 15 in the most severe cases.

How Is Herpangina Spread?

There are a few different ways that the enteroviruses that cause herpangina are spread, but one of the most common is the fecal-oral route. This means that it is often spread by individuals who don't wash their hands after using the bathroom or changing diapers, especially if they handle food afterward.

Proper handwashing precautions and staying at home can help decrease the risk of spreading the disease if you have symptoms of this illness.

Who Is at Risk for Herpangina?

Children between the ages of 3 to 10 years old are most commonly affected, with boys and girls being equally affected. While young children are most commonly affected, anyone can be infected regardless of age. Infections are more common in the summer months or in tropical climates.

Symptoms of Herpangina

Most of the time if you have herpangina, you can anticipate a mild illness.

However, occasionally symptoms may be more severe, leading to complications of the central nervous system, heart and lung failure, or even death. Dehydration is a common complication—but remember, it is easily treated as long as it is detected soon enough. When pregnant women become infected with herpangina they are more likely to have a preterm delivery of their infant, an infant with low birth weight or who is small for gestational age.

Once infected, you will likely not have any symptoms for 3 to 5 days while the virus is growing, or incubating. You may be contagious during this time frame and not know that you have herpangina.

If you have herpangina you may experience one or more of the following symptoms with varying severity.

  • fever
  • fatigue
  • blister like painful sores in the mouth and throat, similar sores may appear on the feet, hands, or buttocks
  • throat pain (pharyngitis)
  • decreased appetite
  • difficulty swallowing or pain when swallowing (odynophagia)
  • headache
  • backache
  • nausea, vomiting, abdominal pain

In rare cases an enterovirus infection can affect the central nervous system, causing the following symptoms:

  • headache
  • neck stiffness
  • seizures
  • paralysis
  • difficulty breathing
  • muscle weakness

How Is Herpangina Diagnosed?

The good news is that herpangina is not normally difficult to diagnose. Your doctor will start by reviewing your medical history and performing a physical examination. They will ask you questions about your symptoms and your current illness.

Laboratory tests are not usually necessary but the virus can be detected by taking cultures from the nose, stool, urine, blood, or cerebral spinal fluid. Without laboratory testing, herpangina can occasionally be mistaken for another illness such as:

  • hand-foot-and-mouth disease
  • herpes simplex
  • infectious mononucleosis
  • viral or bacterial pharyngitis
  • aphthous stomatitis - mouth ulcers that are not contagious and noncancerous
  • early symptomatic HIV infections

Treating Herpangina

Herpangina is a viral infection and therefore cannot be cured using antibiotics. Treatment focuses on managing your symptoms until your body fights the infection off.

The good news is that symptoms usually resolve within a week. The bad news is that the mouth and throat sores typical of herpangina are known to be quite painful. Here are some things you can do to ease your symptoms, especially for children.

  • Over-the-counter pain relievers such as acetaminophen and ibuprofen can ease discomfort and reduce a fever. You should not give aspirin to children since it is associated with Reye syndrome.
  • Drink plenty of fluids and eat popsicles to stay hydrated.
  • Cold milk products, including ice cream, can coat the back of the throat and ease some discomfort.
  • Gargle with salt water
  • Throat lozenges can help relieve your sore throat.
  • Avoid food or fluids that can irritate the throat, such as hot beverages, spicy foods, or fruit juices that contain a high amount of citric acid such as orange juice, lemonade, or tomato juice.
  • If you have tried the recommendations listed above and the sores in your mouth are still quite painful your doctor may be able to prescribe a topical anesthetic such as lidocaine.

Your doctor will not prescribe antiviral medications for herpangina for several reasons. In general, antivirals are expensive and in the case of herpangina, ineffective. Use of antivirals also carries side effects and may increase the risk of antiviral resistant viruses.

When to Contact a Medical Professional

Symptoms of herpangina should always be evaluated by a doctor to rule out other more serious illnesses. Additionally, after you have been diagnosed with herpangina you should call your doctor if:

  • You have signs of dehydration such as little urine, no tears in your eyes, dry skin or lips.
  • You have a high fever or a fever that persists after 5 days.
  • You have mouth sores or throat pain that lasts longer than 5 days.
  • You develop symptoms such as muscle weakness, paralysis, neck stiffness, seizures or difficulty breathing.
  • You have any other symptoms that are concerning.

Remember, the best option is to take precautions to prevent herpangina, and if you are infected follow the tips above to ease symptoms while working with your doctor.

Sources:

Abzug, MJ. (2016). Nelson Textbook of Pediatrics. 20th ed. Elsevier. 1561-1568e1.

Fort, GG. (2017). Ferri's Clinical Advisor 2017: Herpangina. Elsevier. 583.

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