Herpangina and Hand, Foot, and Mouth Disease (HFMD) are frequently confused because they are both common, acute viral illnesses that primarily affect young children. The two conditions are closely related infections that share many initial symptoms, leading to common misidentification. Both diseases are highly contagious and spread easily in settings like daycares and schools, usually presenting with fever and painful mouth sores. Understanding the distinct differences between them is important for parents and caregivers.
Shared Viral Family, Different Causative Agents
Both Herpangina and HFMD are caused by non-polio enteroviruses, which belong to the Picornaviridae family. This shared viral lineage explains why the symptoms and course of the two illnesses feel so similar. The specific strains of the virus, however, dictate the resulting disease presentation.
HFMD is most commonly associated with Coxsackievirus A16, though it can also be caused by Enterovirus 71 (EV-A71). Herpangina is typically caused by different Coxsackievirus A strains, such as A10 or A6. The key biological distinction lies in which specific viral strain is responsible, leading to distinct patterns of where the body develops lesions.
Symptom Comparison: Location and Presentation
The most reliable way to differentiate Herpangina from HFMD is by examining the location and presentation of the lesions. Both illnesses typically begin with a sudden onset of high fever, followed by a sore throat. This initial phase of fever and general malaise is largely indistinguishable between the two conditions.
Herpangina is characterized by small, painful ulcers or lesions confined almost exclusively to the back of the mouth and throat. These lesions start as tiny red spots and are found specifically on the soft palate, the tonsils, and the uvula. The painful nature of these sores can make swallowing extremely difficult, and Herpangina does not produce a rash anywhere else on the body.
In contrast, Hand, Foot, and Mouth Disease involves a more widespread distribution of lesions. While HFMD causes painful sores in the mouth, these are usually located on the front, including the tongue and inside of the cheeks. Its defining feature is the characteristic non-itchy rash or small, fluid-filled blisters that appear on the palms of the hands and the soles of the feet. This rash may also appear on the buttocks or groin area. The presence of lesions on the hands and feet alongside mouth sores is the clinical marker that points to HFMD, a symptom absent in Herpangina.
Managing Both Conditions
Since both Herpangina and HFMD are viral illnesses, treatment is primarily supportive, focusing on managing symptoms until the infection resolves. Antibiotics are ineffective against these viruses. A primary concern for both conditions is maintaining adequate hydration, especially because the painful mouth sores can cause children to refuse to drink.
Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can be used to manage fever and reduce the pain associated with the mouth sores. Offering cold, soft foods like yogurt, applesauce, or popsicles can be soothing and help encourage fluid intake. Acidic, spicy, or salty foods should be avoided as they can irritate the oral lesions further.
Both conditions are highly contagious, transmitted through respiratory secretions, direct contact, and the fecal-oral route. Consistent and thorough handwashing is the most effective preventative measure against spreading the virus.
When to Seek Medical Attention
You should seek medical attention if the fever lasts for more than three days, or if the child shows signs of dehydration like significantly reduced urination or lethargy. Seek help if they develop severe symptoms like a stiff neck or persistent headache, which could indicate a rare complication.