Herpangina - Pictures, Symptoms, Causes, Treatment, Diagnosis
What is Herpangina?
Herpangina also known as "mouth blister" is an acute and viral induced infection of the mouth marked by the development of blister like ulcers at the back of the throat and on the roof of the mouth. It is a common childhood infection that usually occurs during the summer months and is characterized by pain and the onset of fever following infection.
Herpangina is among the manifestation of enterovirus infection that is common during the summer months and is expected all year round in countries with tropical climates. The disease is common in young children with age ranging from 3 to 10 years old without sexual predilection. Adult individuals can also get affected with the disease although this is less common.
Herpangina is also a self-limited disease with most children affected recover fully without any reported morbidity. Mortality accounts for infants below the age of 3 or those on the 6th to 11th month of life and is often due to the association of CNS lesions and cardiopulmonary failure secondary to Herpangina.
Hand-foot-mouth disease is among the enterovirus infection with clinical feature similar to Herpangina only in hand-foot-mouth the rash also develops in the hand. Herpangina on the other hand is a contagious disease that usually resolves on its own after several days following the onset of symptoms.
The onset of Herpangina can be asymptomatic as with the other enterovirus infection. The onset however may have various clinical manifestations depending on the strain of the virus that infected the patient.
The symptoms of Herpangina may include the following and which may vary from one patient to another:
Fever is the most common and apparent symptom among enterovirus infection. In Herpangina, the onset of high fever is usually recorded at a temperature of 101 to 104 degrees Fahrenheit.
Sore throat usually follows the fever which makes swallowing rather painful.
Small blisters and ulcers occur within 2 days following the onset of the symptoms. The blisters may occur on the roof of the mouth or the soft palate. It may also cover the tonsil, uvula and the posterior pharynx. The blisters generally last for several days up to a week.
The lesion initially appears as light gray macules bordered with reddish discoloration. The macules later evolve to papules and later on turn to vesicles until it ulcerate forming an erythematous halo. The lesion formed is usually about 2 to 4mm in diameter and may consist of 2 to more than 10 lesions. The ulcers may persist for several days even after the fever has subsided.
Children suffering from Herpangina usually have the headache and backache and may also have neck pain. Abdominal pain may also be experienced which may be similar to abdominal pain in appendicitis. Weakness or malaise is common that usually persist for 3 to 4 days following treatment while infant may appear listless.
In infants, drooling and vomiting is common during the course of Herpangina and the pain due to the blister formation in the mouth greatly affects their appetite. Vomiting associated with the loss of appetite as a manifestation of Herpangina in infant put them at risk for dehydration which should be carefully observed.
Herpangina is generally non-life threatening but it is advisable to seek medical attention if the following symptoms occur:
- Unrelenting fever or fever that is higher and persists for more than several days.
- Onset of throat and mouth sores that linger for more than several days to a week.
- Decreased urine output, dark colored urine, sunken eyes, dry mouth and lethargy are signs of dehydration which warrants an immediate medical attention to counteract or prevent fluid and electrolyte imbalance that is generally serious or life-threatening.
Herpangina is a self-limited disease that is caused by a group of enterovirus particularly Coxsackievirus group A. Various enteroviruses can cause Herpangina such as Echovirus, Parechovirus 1, Herpes simplex virus and Adenovirus. Coxsackievirus A is the most implicated in Herpangina among the enterovirus strain and Coxsackievirus B is also being implicated.
Coxsackievirus is a virus that belongs to the family Picornaviridae and genus Enterovirus. It generally thrives in the human digestive tract and can be passed on from person to person. The virus commonly survives in tropical climate while it tends to cause an outbreak in cooler climate during the summer months.
Herpangina is highly contagious and can be transmitted via fecal-oral route or via respiratory droplets. Fecal contamination can be transferred orally when there is no proper hand washing observed right after using the toilet. It is why hand washing is deemed before and after food preparation and food ingestion. Hard surfaces previously touched by a contaminated person can also pass on the virus. Respiratory droplets are another mode of transmission such as in sneezing and coughing. The incubation period of the virus usually takes one to two weeks which is usually the asymptomatic period during the course of the disease.
Herpangina is common during the summer months and is highly contagious. It is common among young children and infants who still have a developing immune system making them more prone to acquiring the disease. Close community, social environments and schools are the most common areas to get the disease.
Herpangina is not indicated for laboratory studies as the disease is generally a self-limited disease and is a clinical diagnosis.
If diagnosing the disease is necessary, it is initially achieved through taking the medical history and physical examination of the patient. The history taking of the patient usually includes information on the age of the patient, area of locality and recent exposures of the patient. The clinical manifestations of the disease experienced by the patient are also being taken and evaluated.
Isolation of enterovirus is achieved by obtaining cultures through swab of the nasopharynx and collection of specimens such as stool, urine and serum.
Treatment of Herpangina is mostly supportive as the disease is self-limited and usually run a course of one week or less that treatment is not indicated.
Herpangina is a viral infection that no effective treatment is available and antibiotic is not even an effective treatment.
The goal of treatment however is in managing and reducing the symptoms to provide relief to the patient. Fever is the primary concern of treatment and patient is usually prescribed with ibuprofen or acetaminophen to reduce the fever. Aspirin is not indicated for treatment of symptoms in viral infection among children and young adults due to association with Reye’s syndrome which is a potentially life-threatening illness.
Topical anesthetics may also be given to pacify the pain in the mouth due to lesions although topical anesthetics are rarely given.
Increased fluid intake is encouraged and cold drinks such as milk and water and even ice cream. Citrus drinks and spicy food including hot beverages are discouraged as these can only aggravate the lesions and cause further pain and might cause medical complications.