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Herpangina

Related concepts:
Mouth blisters

Introduction:
A mouth filled with painful blistersThis common infection can make kids miserable
for the better part of a week.

What is it?
Herpangina is the name of a painful mouth infection, usually with a fever. Even
though the name sounds like herpes, almost all of the many viruses that cause it are
coxsackieviruses or other enterovirusesnot herpesvirus.

Who gets it?


Herpangina is most common among young children but can occur at any age. Once
people have had a specific strain of coxsackievirus, they are generally immune, but
they could become sick with one of the other strains. Most infections occur in the
summer or early fall, with a peak from August to October in the northern
hemisphere.

What are the symptoms?


This illness starts abruptly, usually with a fever. Often the fever is high (103104F).
Occasionally, children lose their sparkle (and appetite) a few hours before the fever
begins. The mouth sores usually begin at the same time as the fever or shortly
afterward. Children average about five blisters in the mouth. These blisters are
surrounded by red rings and can occur in the back of the throat, on the roof of the
mouth, on the tonsils, on the uvula, inside the cheeks, or on the tongue. The blisters
may start as small red bumps and may go on to become ulcers after the blister
stage. The illness usually lasts 3 to 6 days.

Almost all children with herpangina have a decreased appetite. Other symptoms
might include headache, backache, runny nose, drooling, vomiting, or diarrhea.
Children first become ill 4 to 6 days after being exposed.

How is it diagnosed?
Usually the diagnosis is made based on the history and physical exam. Because the
syndrome is so specific, the diagnosis can be quite clear. Herpangina should be
distinguished from other causes of mouth and throat infections, including strep
throat and adenovirus. Season of the year, exposures in the community, incubation
period, and specific symptoms can all be important clues. Lab tests are available for
the coxsackieviruses and other enteroviruses, but they are not usually necessary.

How is it treated?
Antibiotics do not help with herpangina. The important issues are getting children
plenty of fluids, relieving their pain, and treating their other symptoms as
appropriate.

How can it be prevented?


Coxsackieviruses and other enteroviruses are present both in the stool and in the
respiratory secretions. They can spread by fecaloral transmission, droplet
transmission, contact transmission, and by means of fomites. school or daycare for
the first several days of the illness, but it is not clear this prevents others from
becoming infected. Other children in the class are probably contagious even though
they will never develop symptoms.