Herpangina – Causes, Pictures, Symptoms, Treatment, in Kids, in Adults, vs HFMD, Virus, Meaning

Herpangina is a common childhood illness caused by a viral infection commonly affecting children and young adults. It’s characterized by acute febrile illness, sore throat, and small ulcers in the mouth. Recognizing herpangina symptoms and understanding the management of this self-limited illness is crucial for parents and healthcare providers.

Key Facts

Herpangina is a sudden acute viral illness, primarily caused by a group of viruses known as enteroviruses. Among them, the most common one is Coxsackievirus

The disease manifests as painful mouth sores or blisters at the back of the throat and is quite contagious

It predominantly affects children, especially those aged between 3 to 10 years. However, it can affect people of all age groups

Herpangina is a seasonal illness that usually occurs in the summer and fall months

Common symptoms of herpangina include fever, sore throat, painful blisters in the mouth, headache, and a general feeling of being unwell

The disease is typically self-limiting, meaning it resolves on its own without the need for specific medical treatment. However, symptomatic treatments are often recommended to manage the discomfort and fever

Since it’s a viral infection, antibiotics are not effective against herpangina

What is Herpangina?

Herpangina, also known as mouth blisters, is an infectious, viral disease characterized by the onset of small, blister-like bumps at the back of the throat or roof of the mouth. These blisters are often painful and may make eating, drinking, and swallowing difficult. The disease is caused by a group of viruses known as enteroviruses, with Coxsackieviruses being the most common culprit.
Symptoms usually appear suddenly, about 3-6 days after exposure to the virus. The initial symptoms are often non-specific and may include fever, sore throat, headache, loss of appetite, and a general feeling of malaise. As the disease progresses, painful blisters or ulcers develop in the mouth. These sores are usually grayish-white in color and surrounded by a red halo.

Who does Herpangina Affect?

While herpangina can affect individuals of any age, it is most commonly seen in children younger, particularly those aged between 3 and 10 years. This is because children of this age group often participate in activities that involve close contact with others, such as daycare or school, which facilitates the spread of the virus. Furthermore, their immune systems are not as mature as those of adults, making them more susceptible to viral infections.
Adults can also contract herpangina, especially if they are in close contact with a child or an individual infected with the virus. However, adults often have milder symptoms and may even be asymptomatic, meaning they show no signs of the illness despite being infected.
Herpangina outbreaks usually occur in the summer and fall months, particularly in tropical and subtropical regions. The virus spreads through contact with an infected person’s saliva, sputum, or feces, or by touching contaminated objects or surfaces. Hence, maintaining good hygiene is the best way to prevent the spread of herpangina.

How Common is Herpangina?

Herpangina is a relatively common disease, especially among children. The exact number of cases per year can vary based on geographic location, season, and population demographics. It is most often seen in summer and fall months, and its incidence may peak in years when certain strains of the Coxsackievirus are particularly active. In many parts of the world, children may experience herpangina or similar enterovirus infections at least once before they reach adolescence.

How Does Herpangina Affect My Child’s Body?

The enteroviruses causing herpangina invade the body through the gastrointestinal tract. Upon entering the body, the virus primarily targets the lymphatic tissue in the throat and the posterior region of the mouth, causing inflammation and subsequent formation of sores or blisters.
The body’s immune response to this viral invasion often results in fever and a general feeling of malaise. Some children might experience abdominal pain and vomiting due to the effect of the virus on the gastrointestinal tract.
However, it’s essential to note that the virus and its associated symptoms are typically cleared by the body’s immune system within a week to ten days. Once a child recovers, they usually gain immunity against that specific strain of the virus. However, they can still contract other strains of enteroviruses causing herpangina.

What are the Symptoms of Herpangina?

Herpangina usually begins with a sudden onset of fever, which can sometimes be high. The fever is often accompanied by a sore throat and a general feeling of being unwell or malaise.
Within a day or two of the fever, painful blisters or sores begin to appear at the back of the mouth or throat. These sores typically start as small red spots that quickly develop into blisters with a grayish-white center and a bright red border. The blisters can be quite painful, and it might hurt the child to swallow, which can lead to decreased appetite or refusal to eat or drink.
Other potential symptoms may include headache, neck pain, and in some cases, abdominal pain or vomiting. The symptoms usually persist for several days, and most children recover completely within a week. However, the sores in the mouth can take slightly longer, up to two weeks, to heal completely.
If your child shows signs of dehydration such as dry mouth, crying without tears, or significantly decreased urine output due to refusal to eat or drink, it’s important to seek medical attention promptly. Similarly, if the fever lasts for more than a few days or if the child seems unusually lethargic or unresponsive, immediate medical care is necessary.

What Causes Herpangina?

Herpangina is caused by a group of viruses known as enteroviruses, specifically the Coxsackieviruses. These viruses are highly contagious and are typically present in an infected person’s nose and throat secretions (such as saliva, sputum, or nasal mucus), blister fluid, and feces.
Infection usually occurs when a person comes in direct contact with an infected individual or touches surfaces contaminated with the virus. The virus can also spread through the air when an infected person coughs or sneezes. Once inside the body, the virus multiplies and triggers an immune response leading to the characteristic symptoms of herpangina.

Is Herpangina Contagious?

Yes, herpangina is highly contagious. The disease can easily spread from person to person, especially in settings with close contact, such as schools, childcare centers, and family households. It spreads through close contact with an infected person’s saliva, mucus, or feces.
Infection can occur when one touches their mouth, nose, or eyes after touching a contaminated surface or object, or when one inhales droplets from a cough or sneeze by an infected person. Furthermore, a person with herpangina is most contagious during the first week of the illness.

Diagnosis: How is Herpangina Diagnosed?

Herpangina is diagnosed via physical examination including throat swab and analysis of patient’s medical history. Here are the details of the procedure:

Complete Health History: Understanding the child’s condition and any recent exposure to viral illnesses. Diagnosis of herpangina is primarily based on clinical examination and patient medical history.
Physical Exam: A child’s healthcare provider will perform a physical examination, focusing on the mouth and throat area, looking for characteristic ulcers. The characteristic blisters or ulcers at the back of the mouth or throat in a child with a sudden onset of fever are often sufficient for a diagnosis.
Throat swab: In some cases, a throat swab may be taken to test for the presence of the virus. This involves swabbing the back of the throat with a cotton-tipped applicator and sending the sample to a lab for testing. However, this test is typically not necessary for diagnosing herpangina as the physical signs and symptoms are often distinct enough for diagnosis.

Additionally, the child’s healthcare provider may inquire about any recent contact with individuals known to have herpangina or related symptoms, as this can further support the diagnosis. The child’s vaccination history may also be reviewed, as certain vaccinations can reduce the risk of enteroviral infections.

Treatment: How is Herpangina Treated?

Herpangina is a self-limiting disease, which means it typically resolves on its own without specific antiviral treatment. The goal of treatment for herpangina is primarily to relieve symptoms and ensure the comfort of the patient.
Over-the-counter (OTC) pain relievers like acetaminophen or ibuprofen can be used to manage fever and relieve the discomfort caused by the mouth sores. However, aspirin should be avoided in children due to the risk of Reye’s syndrome, a rare but serious condition.
Topical oral anesthetics may also be recommended to numb the mouth and throat and reduce pain, making it easier for the child to eat and drink.
It is essential to keep the child well-hydrated. If swallowing is painful, try offering cold foods and drinks such as ice pops or milkshakes which can help soothe the throat.
Antibiotics are not effective against viral infections like herpangina and are therefore not used in treatment.

Home Remedies

Avoid Hot Beverages: Opt for cool drinks to soothe the throat and decrease drooling.
Healthy Diet: Soft, non-irritating foods can help maintain a healthy diet even when swallowing is painful.
Rest and Isolation: Keeping the child home from school to rest and prevent the spread to other children.

What Should My Child Eat if They Have Herpangina?

If your child has herpangina, it’s important to offer them soft, easy-to-swallow foods and ensure they stay hydrated. Cold foods and drinks can also help relieve pain.
Some suitable options include:

Cold milk or dairy-free alternatives
Ice cream or yogurt
Cold fruit purees or applesauce
Smoothies
Cold, well-cooked pasta or noodles
Mashed potatoes

Avoid giving your child salty, acidic, and spicy foods and drinks, as these can irritate the sores. Similarly, hard or crunchy foods like chips or crackers should be avoided, as they can cause further discomfort.

How Long Does Herpangina Last?

The duration of herpangina can vary from person to person. However, the disease generally lasts for about 7 to 10 days.
The initial symptoms usually subside within a few days, while the sores may take a bit longer to heal completely. Most children return to their normal activities within a week to ten days.
It’s important to note that an individual is most contagious during the first week of the illness but can continue to spread the virus even after the symptoms have resolved. Hence, good hygiene practices should be continued even after recovery to prevent the spread of the virus to others.

Prevention: How Can I Prevent Herpangina?

Given the highly contagious nature of herpangina, prevention plays a crucial role in managing the disease. The virus causing herpangina is resistant to many common disinfectants and can live on surfaces for extended periods.
Here are some steps to reduce the risk of spread:

Practice Good Hygiene: Regular handwashing, especially before meals and after using the bathroom, can reduce the risk of infection. It’s important to teach children how to properly wash their hands with soap and water for at least 20 seconds.
Avoid Close Contact: If possible, keep your child at home and avoid close contact with others until they’re no longer contagious. This typically means waiting until the fever has been gone for at least 24 hours without the use of fever-reducing medications.
Clean and Disinfect Regularly: Clean and disinfect frequently touched objects and surfaces using a product that specifically works against viruses.
Avoid Sharing Personal Items: Discourage sharing of personal items such as utensils, cups, toothbrushes, and towels.

What Can I Expect If My Child Has Herpangina?

If your child has herpangina, they will likely experience a sudden onset of fever and sore throat, followed by painful blisters or ulcers in their mouth within a day or two. The sores might make it difficult for your child to eat or drink, and they may refuse food or drink due to the pain.
Typically, the disease resolves on its own within a week to ten days, and your child should be back to their usual activities once the fever and sores are gone. However, it’s important to remember that they can still spread the virus to others for a while after their symptoms have resolved.

How Do I Take Care of My Child with Herpangina?

If your child has been diagnosed with herpangina, here are some care tips:

Relieve Discomfort: Over-the-counter pain relievers can help manage fever and discomfort. Topical oral anesthetics may be used to reduce the pain of mouth sores, allowing your child to eat and drink more comfortably.
Encourage Fluid Intake: Ensure your child drinks enough to stay well-hydrated. If swallowing is painful, offering cold foods and drinks like ice cream, smoothies, or ice pops can help.
Provide Soft, Non-Irritating Foods: When your child feels like eating, offer soft, bland foods that are easy to swallow, such as mashed potatoes, yogurt, or cold pasta.
Monitor Symptoms: Keep a close eye on your child’s symptoms. If they become dehydrated or if their symptoms worsen, seek medical help immediately.
Rest: Your child may feel weak and unwell due to the infection. Ensure they get plenty of rest to support their recovery.

Remember, your healthcare provider is your best resource for managing your child’s illness. If you have any concerns about your child’s symptoms or recovery, don’t hesitate to reach out to them.

When Should I See My Healthcare Provider?

While herpangina is typically a mild illness, there are certain situations where medical attention is necessary.
Contact your healthcare provider if your child:

Has a high fever or a fever that lasts more than a few days
Is unable or unwilling to eat or drink, or has signs of dehydration such as significantly decreased urine output, dry mouth, or crying without tears
Seems unusually tired, lethargic, or unresponsive
Has a severe headache or stiff neck
Has severe abdominal pain or persistent vomiting

What Questions Should I Ask My Doctor?

When consulting with your healthcare provider about your child’s herpangina, consider asking the following questions:

What over-the-counter treatments do you recommend for my child’s symptoms?
How can I prevent the spread of the virus to other family members?
When will my child be able to return to school or daycare?
What signs or symptoms should prompt me to seek immediate medical attention?
Are there any complications that can arise from herpangina?

What is the Difference Between Herpangina and Hand, Foot, and Mouth Disease?

Herpangina and hand, foot, and mouth disease (HFMD) are both illnesses caused by enteroviruses, primarily Coxsackieviruses, and they share many similar symptoms, including fever, sore throat, and mouth sores.
However, there are a few key differences:

Location of Sores: In herpangina, sores typically appear at the back of the mouth or throat. In contrast, HFMD is characterized by sores or rashes on the hands, feet, and inside the mouth.
Age Groups Affected: Both diseases commonly affect children, but HFMD is usually seen in younger children under 5 years old, while herpangina more often affects older children and adolescents.
Seasonality: Both diseases occur most commonly in the summer and fall, but Hand, Foot, and Mouth outbreaks can also occur in the spring.

In many instances, distinguishing between these two diseases can be challenging, and laboratory tests may be required for definitive diagnosis. Nonetheless, the treatment for both conditions is largely supportive, aimed at managing symptoms and ensuring patient comfort.

What is the ICD Code for Herpangina Viral Infection?

The International Classification of Diseases (ICD) code for herpangina is B08.5. This code is used in medical record keeping for the classification of diseases and other health problems.

Bottom Line

Herpangina, a contagious viral infection caused by enteroviruses such as Coxsackieviruses, is a common disease, particularly among children. The disease is characterized by a sudden onset of fever and sore throat, followed by painful sores or blisters in the mouth and throat.
Herpangina typically resolves on its own within a week to ten days, and treatment focuses on relieving symptoms and ensuring the child stays hydrated. Parents should seek immediate medical attention if the child shows signs of dehydration, if the fever lasts more than a few days, or if the child seems unusually lethargic or unresponsive.
Preventive measures include practicing good hygiene, avoiding close contact with infected individuals, disinfecting regularly, and avoiding the sharing of personal items. Parents and caregivers should consult with their healthcare providers for appropriate advice and treatment if they suspect their child has herpangina. It’s important to remember that while herpangina is typically a mild disease, it can sometimes lead to serious complications if left untreated or not properly managed.

This article is complete and was published on July 15, 2023, and last updated on December 29, 2023.

Key Facts