Coxsackievirus herpangina is a common and contagious viral illness that primarily affects infants and young children. It results from infection with certain strains of the coxsackievirus, a type of enterovirus. This condition presents as a mild, self-limiting illness, meaning it usually resolves on its own without specific treatment. The infection often occurs during warmer months, though cases can appear year-round.
Identifying Symptoms and Appearance
Herpangina symptoms are sudden, beginning with a high fever that can reach 102 to 105 degrees Fahrenheit. This fever is accompanied by a severe sore throat, which can make swallowing painful. Within a day or two of the fever starting, small, distinct blisters appear in the mouth and throat.
These characteristic sores measure about 1 to 2 millimeters in diameter and are most commonly found on the soft palate, the back of the throat, the tonsils, and the uvula. The blisters quickly rupture, forming shallow, grayish-white ulcers with a red border. Children experiencing herpangina may also develop a headache, and infants may exhibit increased fussiness or irritability due to discomfort. Loss of appetite and increased drooling, particularly in younger children, are common due to painful swallowing.
Transmission and Contagious Period
Herpangina spreads primarily through person-to-person contact, often via the fecal-oral route. This is common in environments where young children are in close contact, such as daycare centers and toddler groups, largely due to inadequate hand hygiene after diaper changes. The virus can also spread through respiratory droplets released when an infected person coughs or sneezes.
Direct contact with fluid from the blisters, though less common, can also transmit the virus. An individual is most contagious during the first week of the illness. However, the virus can continue to shed in stool for several weeks after symptoms have disappeared, meaning a person can still transmit the infection even if they feel better. Outbreaks occur in communal settings like schools, summer camps, and childcare facilities.
At-Home Management and Relief
Since there is no specific antiviral treatment for herpangina, managing symptoms at home focuses on supportive care to alleviate discomfort. Over-the-counter medications can help reduce pain and fever. Acetaminophen or ibuprofen, when administered according to age and weight guidelines, can provide relief for fever and throat pain. It is advisable to consult a healthcare provider or pharmacist for appropriate dosing instructions, especially for young children.
Maintaining hydration is a primary concern, as painful swallowing can lead to decreased fluid intake and potential dehydration. Offering small, frequent sips of cool liquids, such as water, diluted juices, or electrolyte solutions, helps. Cold items like ice pops, gelatin, and smoothies can be soothing for a sore throat and help encourage fluid consumption.
Regarding diet, soft, bland foods that are easy to swallow are recommended to minimize irritation to the mouth sores. Options such as yogurt, applesauce, mashed potatoes, and ice cream are well-tolerated. Foods that are acidic, salty, spicy, or crunchy should be avoided, as they can further irritate the inflamed areas in the mouth and throat.
Differentiating from Hand, Foot, and Mouth Disease
Both herpangina and Hand, Foot, and Mouth Disease (HFMD) are caused by enteroviruses, most commonly different strains of coxsackievirus. This shared viral origin leads to confusion between the two conditions, as they present with similar symptoms. The most distinguishing factor between herpangina and HFMD lies in the specific location of the characteristic sores and rashes.
Herpangina is defined by the presence of small blisters and ulcers that are strictly confined to the back of the mouth and throat, specifically on the soft palate, tonsils, and uvula. In contrast, while HFMD also causes sores inside the mouth, it is further characterized by a distinctive non-itchy rash or blisters that appear on the palms of the hands and the soles of the feet. This rash can also be present on the buttocks or groin area, which helps differentiate it from herpangina.
When to Seek Medical Attention
While herpangina is a mild illness, there are specific signs that indicate a need for medical evaluation. You should contact a doctor if there are signs of dehydration, such as reduced urination, a lack of tears when crying, or sunken eyes. Another indicator for concern is a fever that persists for more than three to four days or reaches a high temperature.
Seek immediate medical attention if the child develops symptoms that suggest neurological involvement, including a stiff neck, a severe headache, drowsiness, or confusion. Similarly, if the child is unable to drink any fluids due to pain or discomfort, seek medical attention to prevent complications. Prompt evaluation can help ensure appropriate care if the illness progresses beyond typical symptoms.