Herpangina is a common, highly contagious viral illness typically associated with childhood. It is an infection characterized by the sudden onset of fever and the appearance of small, painful blisters in the back of the throat and mouth. Although it is far less frequent in older populations, adults can contract herpangina. While adults are less likely to experience the infection, cases do occur, sometimes presenting unique challenges compared to pediatric cases. The illness generally resolves on its own, but understanding the cause and potential risks is important for affected individuals.
Adult Susceptibility and Viral Cause
Herpangina is caused by a group of viruses known as enteroviruses, most commonly Coxsackievirus A (particularly the A16 strain), but also other serotypes like Coxsackievirus B and Enterovirus 71. These viruses are highly contagious and transmit primarily through the fecal-oral route, though they can also spread via respiratory droplets. An adult can contract the virus through close contact with an infected individual, such as a child in the household, or by touching contaminated surfaces.
While many adults have developed immunity from previous exposure to one of the numerous enterovirus strains during childhood, this protection is not universal. Immunity is specific to the particular serotype that caused the prior infection, meaning a new strain can still cause illness. Waning immunity or exposure to a highly infectious source can also increase adult susceptibility. The virus can be shed in the stool for several weeks after symptoms disappear.
Distinct Symptoms in Adult Cases
The clinical presentation of herpangina in adults begins with a sudden onset of symptoms, often including a high fever. A severe sore throat is a prominent early sign, frequently accompanied by a headache and general feeling of malaise. The hallmark feature is the appearance of characteristic lesions in the mouth and throat, usually noticed one or two days after the fever starts.
These lesions begin as small, grayish-white vesicles, typically 1 to 5 millimeters in diameter, surrounded by a red border. They are concentrated on the posterior part of the mouth, specifically the soft palate, the tonsillar pillars, and the uvula. These vesicles quickly rupture, leaving behind small, painful ulcers. While the number of lesions is often small (usually between two and six), the pain they cause can be disproportionately severe.
The intense pain associated with swallowing is a significant concern for adults. This severe discomfort can lead to a refusal to eat or drink adequate fluids, which substantially raises the risk of dehydration. In some instances, adult symptoms may be more prolonged or intense compared to the mild, self-limited course often seen in children.
Managing the Infection and Potential Complications
Since herpangina is a viral infection, treatment focuses entirely on supportive care aimed at managing the symptoms until the body clears the virus, which typically occurs within seven to ten days. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can be used to alleviate the fever, headache, and throat pain. Hydration is a top priority, as the pain makes swallowing difficult and increases the risk of fluid loss.
Adults should focus on taking small, frequent sips of cool liquids, such as water, milk, or non-acidic juices, to maintain fluid balance. Consuming soft foods, like gelatin, yogurt, or ice cream, can help provide necessary calories without irritating the painful ulcers. It is advisable to avoid hot beverages, spicy foods, and citrus fruits, as these can aggravate the lesions in the throat.
Potential Complications
While herpangina is generally a mild and self-limiting disease, certain complications, though rare, can occur, especially in vulnerable adults. The most frequent risk is dehydration, which requires close monitoring for signs like decreased urination, dry mouth, or excessive fatigue. In rare instances, the enteroviruses that cause herpangina (particularly Enterovirus 71) have been linked to more severe conditions. These complications can involve the nervous system (aseptic meningitis) or the heart (myocarditis). Seeking immediate medical attention is necessary if an adult experiences neck stiffness, persistent headache, confusion, muscle weakness, or chest pain.