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Herpangina: Causes, Symptoms & Treatment

Last Updated: Apr 11, 2023

What is herpangina?

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Herpangina is a viral infection that primarily affects children, characterized by the formation of small, painful blisters or ulcers at the back of the mouth, on the soft palate, tonsils, and the throat. The illness is typically caused by the Coxsackie virus, a member of the enterovirus family, which spreads from person to person through contact with saliva, feces, or respiratory secretions.

Symptoms of herpangina usually include a sore throat, fever, headache, loss of appetite, and difficulty swallowing. Mouth ulcers can be quite painful, especially when eating or drinking. While the condition can be uncomfortable and painful, it typically resolves on its own within one to two weeks, and there are no long-term complications associated with the illness.

Herpangina, however, can occasionally result in more severe side effects such meningitis, encephalitis, or myocarditis. It is important to seek medical attention if you or someone you know experiences severe symptoms, including high fever, neck stiffness, confusion, chest pain, or difficulty breathing.

It is crucial to maintain proper hygiene, including routine hand washing, avoiding direct contact with infected people, and sanitizing surfaces that can be contaminated with the virus, to stop the spread of herpangina. Vaccines are not currently available for herpangina, but researchers are actively studying the virus to develop effective treatments and prevention strategies.

Who does herpangina affect?

Herpangina primarily affects young children, typically between the ages of 3 and 10 years old, although it can also affect adults. The illness is more common in the summer and fall months and is most prevalent in areas with poor sanitation and crowded living conditions.

Herpangina is a highly contagious illness brought on by the Coxsackie virus, which is also extremely contagious and easily passed from person to person through contact with contaminated saliva, feces, or respiratory secretions. Children who attend daycare or school are at a higher risk of contracting the illness, as are those who live in close quarters with others, such as military personnel or college students living in dormitories.

Herpangina may also be more common among people with compromised immune systems, such as those with HIV or those receiving chemotherapy, and they may also exhibit more severe symptoms.

While herpangina can affect anyone, it is most commonly seen in children and young adults and can be prevented through good hygiene practices, such as frequent hand washing and avoiding close contact with infected individuals. If you or someone you know experiences symptoms of herpangina, it is important to seek medical attention to ensure proper diagnosis and treatment.

How does herpangina affect my child’s body?

Herpangina can cause several uncomfortable symptoms that can affect your child's body. The illness is characterized by the formation of small, painful blisters or ulcers that can develop on the back of the mouth, tonsils, soft palate, and throat.

The Coxsackie virus, which causes herpangina, can also lead to a sore throat, fever, headache, and loss of appetite, which can make it difficult for your child to eat or drink. The ulcers in the mouth can be particularly painful and can make swallowing or speaking challenging, causing discomfort and irritation.

In some cases, herpangina can lead to more severe complications, such as meningitis, encephalitis, or myocarditis, which can cause inflammation of the brain or heart. While these complications are rare, it is important to seek medical attention if your child experiences severe symptoms, such as high fever, neck stiffness, confusion, chest pain, or difficulty breathing.

The good news is that herpangina is typically a self-limited illness that resolves within one to two weeks without long-term complications. However, supportive care, such as adequate hydration and pain management, can help alleviate your child's symptoms and promote a faster recovery.

It is essential to practice good hygiene, such as frequent hand washing, to prevent the spread of herpangina and other viral illnesses. If you suspect that your child has herpangina, it is important to consult with a healthcare provider to ensure proper diagnosis and management of their symptoms.

What are the symptoms of herpangina?

Herpangina is a viral infection that primarily affects children, characterized by the formation of small, painful blisters or ulcers at the back of the mouth, on the soft palate, tonsils, and the throat. In addition to these oral lesions, there are other symptoms associated with the illness that parents should be aware of.

  • Fever: Herpangina can cause a high fever, even as high as 106° F, which may be the first symptom noticed in some children. The fever can be persistent and may last for several days.
  • Lesions in the mouth: The most characteristic symptom of herpangina is the formation of small, painful blisters or ulcers in the mouth. The ulcers are typically red and surrounded by a white border. They can be 2-12 in number and are typically located on the back of the mouth, tonsils, soft palate, or throat. The ulcers can make it painful to eat, drink, or swallow.
  • Pain in the throat: Herpangina can cause severe pain in the throat, which can make it difficult to swallow. This can lead to drooling, particularly in younger children.
  • Other symptoms: Herpangina can result in a number of other symptoms in addition to the oral lesions, such as vomiting, nausea, exhaustion, loss of appetite, sore throat, and decreased urine output. Younger children may experience these symptoms in greater intensity.
  • Signs of Herpangina: There are also several signs that can be observed in children with herpangina. These include swollen lymph nodes in the neck, which may be tender to the touch, as well as redness or inflammation of the tonsils or soft palate. In some cases, children with herpangina may also experience bad breath or halitosis due to the presence of the oral lesions.

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What causes herpangina?

Herpangina is a viral infection caused by a group of enteroviruses, with Coxsackie group A viruses being the most common causative agents. Along with group B coxsackie, enterovirus 71, and echo virus, there are other viruses that might result in herpangina. The infection primarily affects the gastrointestinal tract, leading to symptoms such as lesions in the mouth and throat, fever, and malaise.

  • Modes of Transmission: Modes of transmission for herpangina involve fecal-oral route, droplet infection, and contact with contaminated objects. The virus can infect people through the following mediums;
  • Fecal-oral route: The fecal-oral route is a common mode of transmission for enteroviruses, including those that cause herpangina. When someone is infected, the virus is expelled in their feces, where it can contaminate hands, objects, and surfaces. When a person without the virus contacts a contaminated surface or object and subsequently touches their mouth or nose, it might spread if basic hand hygiene is not practiced. Viruses can also be transmitted through tainted food or drink. This mode of transmission is particularly common in settings with poor sanitation and hygiene, such as daycare centers or areas with inadequate access to clean water and sanitation facilities.
  • Droplet infection: Droplet infection occurs when an infected person coughs, sneezes, or talks, producing small droplets that contain the virus. These droplets have the ability to spread through the air and infect nearby individuals. The virus can also land on surfaces and objects, where it can survive for some time and infect people who touch those surfaces and then touch their mouth or nose. This mode of transmission is most likely to occur in crowded settings, such as schools or daycare centers.
  • Contact transmission: When an uninfected individual touches a contaminated surface or object and subsequently touches their mouth or nose, contact transmission takes place. This mode of transmission is common in settings where people share close quarters or frequently touch the same surfaces or objects, such as daycare centers or schools. Contaminated fomites, such as toys, utensils, and other objects, can also spread the infection if they are not properly cleaned and disinfected.

Who is at risk for herpangina?

Anybody can get herpangina, although kids between the ages of 3 and 10 are more likely to get it. Children who attend daycare facilities or other crowded environments are at an increased risk of getting infected. Moreover, persons with compromised immune systems are more vulnerable to the virus. The virus can spread easily through contact with contaminated objects or through respiratory droplets, so people who are in close contact with infected individuals are also at risk.

How is herpangina diagnosed?

Herpangina is typically diagnosed based on the symptoms and clinical examination. In order to look for the distinctive lesions and other indications of the illness, the doctor will do a physical examination of the mouth and throat. In some cases, laboratory tests such as throat swabs or blood tests may be recommended to confirm the diagnosis.

Some of the diagnostic pointers for herpangina include;

  • Symptoms: The doctor will look for the classic symptoms of herpangina such as fever, sore throat, and lesions in the mouth.
  • Physical Examination: The doctor will perform a physical examination of the mouth and throat to check for the characteristic lesions, which are small with a red border and are 2-12 in number. Moreover, they might look for enlarged lymph nodes in the neck.
  • Laboratory Tests: In some cases, laboratory tests such as throat swabs or blood tests may be recommended to confirm the diagnosis. A throat swab can help identify the virus causing the infection, while a blood test can help detect the presence of antibodies to the virus.
  • Differential Diagnosis: The doctor may also rule out other conditions with similar symptoms such as strep throat, hand-foot-and-mouth disease, and tonsillitis.

How is herpangina treated?

Treatment of herpangina primarily involves symptomatic relief and supportive care. Antibiotics are not advised for the treatment of herpangina since they are ineffective against viral infections. Some of the treatment options that may be considered by healthcare providers include;

  • Pain relief: Over-the-counter pain medications such as acetaminophen or ibuprofen can be used to alleviate the pain associated with herpangina. However, aspirin should not be given to children with viral infections as it may lead to a rare but potentially life-threatening condition called Reye's syndrome.
  • Oral care: Keeping the mouth clean and avoiding spicy or acidic foods can help reduce discomfort caused by herpangina. Topical anesthetics or rinsing the mouth with warm saltwater can both relieve discomfort.
  • Rest and hydration: Getting plenty of rest and staying hydrated can help boost the immune system and aid in the recovery process.
  • Hospitalization: Hospitalization may be necessary in severe cases for intravenous fluids, pain relief, and monitoring.

It is important to note that herpangina is a self-limiting disease, and most children recover without any complications within 7-10 days. However, in rare cases, complications such as dehydration, meningitis, or encephalitis may occur, requiring immediate medical attention.

What are some home remedies for herpangina?

Herpangina does not have a specific treatment, however there are several natural therapies that can aid with symptoms and pain.

Here are some home remedies that can be tried;

  • Saltwater gargle: Gargling with warm salt water may help reduce throat pain and inflammation.
  • Cold foods and drinks: Ice cream, popsicles, and other cold foods and drinks may help soothe the throat and mouth.
  • Adequate hydration: Drinking plenty of fluids such as water, juices, and soups can help prevent dehydration and relieve symptoms.
  • Pain relief: Acetaminophen and ibuprofen, both available over-the-counter, are effective painkillers that can also lower fever. But it's crucial to use the dosage that's advised for kids.
  • Rest: The kid has to get enough sleep so that their body can fight against the virus.
  • Soft foods: Soup, yogurt, and mashed potatoes are examples of soft foods that might assist ease swallowing difficulty.

It is crucial to remember that while these treatments could ease symptoms, they shouldn't be used in place of medical care.

How can I prevent the spread of herpangina?

Herpangina is a highly contagious infection, and preventing its spread is crucial to avoid its transmission to other individuals. Here are some measures that can help prevent the spread of herpangina;

  • Practice good hygiene: Frequent hand washing with soap and water is the best way to prevent the spread of herpangina. Urge your child to wash their hands regularly and thoroughly, particularly after using the restroom or right before eating.
  • Avoid close contact: Keep your distance from somebody who has herpangina or another viral infection. Do not share utensils, cups, or other personal items with infected individuals.
  • Keep surfaces clean: Disinfect commonly touched surfaces, such as toys, doorknobs, and countertops, regularly to reduce the spread of the virus.
  • Stay home: Keep your child at home until they are no longer contagious if they have herpangina. This may lessen the risk of the virus infecting other kids.
  • Vaccination: Some strains of enteroviruses, which can cause herpangina, can be prevented through vaccination. You should discuss your child's vaccination schedule with your healthcare professional.

When should I see my healthcare provider for herpangina treatment?

It's critical to get medical help as soon as you can if you think your child may have herpangina. You should consult a healthcare provider if your child has a fever that is persistently high, difficulty in swallowing, severe sore throat, or if your child refuses to eat or drink.

In addition, if you notice any unusual symptoms or if your child has a weakened immune system due to a medical condition, you should contact your healthcare provider immediately. To control the symptoms and stop the infection from spreading, it's critical to get medical help right away.

Here are some specific pointers regarding when to seek medical attention for herpangina;

  • If your child has a fever that is persistently high
  • If your child has difficulty in swallowing
  • If your child experiences severe sore throat
  • If your child refuses to eat or drink
  • If your child shows unusual symptoms
  • If your child has a weakened immune system due to a medical condition.

What is the difference between herpangina and hand, foot and mouth disease?

Herpangina and hand, foot and mouth disease (HFMD) are both caused by enteroviruses and share many symptoms, making it difficult to distinguish between the two. However, there are some notable differences;

  • Affected Age Groups: Herpangina is more common in children aged 3-10 years, while HFMD usually affects children under 5 years of age.
  • Symptoms: While both conditions present with fever and blisters or sores in the mouth and throat, the location and appearance of the lesions can differ. Herpangina causes small, red blisters or ulcers on the back of the throat and tonsils, while HFMD usually causes painful blisters or sores on the hands, feet, and around the mouth.
  • Contagiousness: HFMD is generally more contagious than herpangina, as it can spread through contact with contaminated surfaces, fluid from blisters, and even through the air when an infected person coughs or sneezes. On the other hand, herpangina is typically transmitted through contact with feces or saliva from an infected individual.
  • Complications: While both conditions are usually mild and resolve on their own, they can occasionally lead to complications. Herpangina can lead to dehydration due to difficulty swallowing, while HFMD can rarely cause viral meningitis, encephalitis, or heart problems.

Is herpangina permanent?

Herpangina is not a permanent condition. The sickness is self-limiting and typically goes away on its own in a week or two. Once the body's immune system fights off the virus, the symptoms will disappear. However, in some rare cases, complications such as dehydration or bacterial infections may occur, which may require medical attention.

It is important to manage the symptoms of herpangina by getting adequate rest, drinking plenty of fluids, and taking over-the-counter pain medications as advised by a healthcare provider.

However, maintaining appropriate hygiene practices, such as routine hand washing, can lower the risk of acquiring herpangina and stop the virus from infecting others.

What are side-effects of herpangina treatments?

There are different treatment options available for herpangina depending on the severity of the symptoms. These treatments aim to reduce the duration of symptoms and relieve discomfort. However, like any medication, these treatments may have side effects. Some common side effects of herpangina treatments include;

  • Nausea and Vomiting: Certain medications like acyclovir or antibiotics can cause gastrointestinal side effects such as nausea and vomiting.
  • Diarrhea: Diarrhea can be a side effect of some antiviral or antibiotic treatments used for herpangina.
  • Allergic Reactions: Rarely, some individuals may experience an allergic reaction to the medicine, which could result in signs and symptoms like rash, itching, swelling, and breathing difficulties.
  • Oral Thrush: Oral thrush is a fungal infection that can develop after treatment with antibiotics or antivirals, which can disrupt the balance of bacteria in the mouth.

Conclusion

Herpangina is a viral infection that is common among young children. A subset of enteroviruses, primarily Coxsackie group A viruses, are responsible for its development. Painful mouth sores, fever, sore throat, and difficulty swallowing are symptoms of the infection.

Although there is no specific treatment for herpangina, the symptoms can be managed with pain relief medications and home remedies. In order to stop the infection from spreading, it's crucial to maintain good hygiene. While herpangina is generally a self-limiting condition that resolves within a few days to a week, it is advisable to seek medical attention if the symptoms worsen or do not improve with home care measures.

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Written ByDrx Hina FirdousPhD (Pharmacology) Pursuing, M.Pharma (Pharmacology), B.Pharma - Certificate in Nutrition and Child CarePharmacology
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Reviewed ByDr. Bhupindera Jaswant SinghMD - Consultant PhysicianGeneral Physician
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