Herpangina is a common, contagious viral illness primarily affecting children, though adolescents and young adults can also contract it. It is most frequently caused by the Coxsackievirus, a type of enterovirus. The infection leads to a sudden high fever and the development of painful sores in the back of the mouth and throat. This condition is generally self-limited, resolving on its own. Understanding its progression and management is important due to the associated discomfort and potential for dehydration.
The Typical Illness Timeline
The typical course of herpangina begins with an incubation period ranging from three to five days after exposure to the virus. During this time, the infected person shows no symptoms but can still shed the virus and be contagious. The illness then starts with an abrupt onset, most notably a sudden, high fever.
The peak of the illness, where symptoms are most severe, usually occurs within the first two to four days after the fever begins. This phase is characterized by the most intense pain from the mouth sores and the highest fever. After this peak, the fever typically subsides, and the painful lesions begin to heal.
The overall duration of herpangina is relatively short-lived, with full recovery generally occurring within seven to ten days from the initial onset of symptoms. The mouth ulcers usually go away on their own within this period. While symptoms resolve quickly, viral shedding in the stool can continue for several weeks, meaning the person can still transmit the virus even after feeling better.
Identifying the Specific Symptoms
The illness is characterized by an abrupt onset of symptoms, often starting with a high fever that can reach up to 106°F. This is frequently accompanied by a sore throat, headache, and general malaise. Young children may also exhibit fussiness, drooling, and a notable refusal to eat or drink due to the pain.
The most specific and diagnostic manifestation of herpangina is the appearance of characteristic lesions in the posterior oropharynx. These lesions initially appear as small, reddish spots that quickly evolve into painful vesicles or blisters. These blisters then rupture, leaving small, shallow ulcers that typically have a whitish-gray base and a red border.
These sores are almost always located in the back of the mouth, specifically on the soft palate, tonsils, uvula, and posterior pharynx. This location is a key difference when comparing herpangina to Hand, Foot, and Mouth Disease (HFMD), which causes sores on the hands, feet, and sometimes the front of the mouth. Although there are usually only a small number of sores, they can be extremely painful, leading to difficulty swallowing.
Home Care and Comfort Measures
Since herpangina is a viral infection, management focuses on supportive care to alleviate symptoms until the illness runs its course. Pain management is accomplished using over-the-counter analgesics such as acetaminophen or ibuprofen to address both the fever and the mouth pain. Follow dosing instructions carefully based on the patient’s age and weight.
Maintaining hydration is a primary concern, as the painful sores often cause a reluctance to drink, increasing the risk of dehydration. Offering small, frequent sips of cool liquids is usually tolerated better than large amounts. Non-acidic, cool, or frozen items like ice cream, sherbet, popsicles, or cold milk products can be soothing and encourage fluid intake.
Dietary modifications should focus on non-irritating, soft foods that do not require much chewing. Avoid hot, spicy, or acidic foods and beverages, such as citrus juices, as these can sting and worsen the pain from the mouth ulcers. Adequate rest is also important to allow the body to recover from the infection.
Recognizing When to Seek Medical Help
While herpangina is usually a mild, self-limiting illness, certain signs indicate the need for professional medical evaluation. One of the most common complications is dehydration, so seek immediate care if there is decreased urination, a dry mouth with little saliva, sunken eyes, or excessive lethargy.
Medical attention is warranted if the fever is persistently high (over 104°F) or if it lasts for more than three to five days. In rare instances, the virus can affect the nervous system, so seek immediate help for severe headache, neck stiffness, confusion, or unusual sleepiness. Finally, if the mouth ulcers or other symptoms do not begin to resolve after ten days, a medical consultation is necessary.