Herpangina is a common, acute viral illness that most frequently affects young children, particularly during the summer and early fall months. This highly contagious infection is characterized by the sudden onset of fever and painful sores at the back of the throat. While uncomfortable, Herpangina is generally a self-limiting condition that resolves on its own without specific medical treatment. The primary concern during the illness is managing discomfort and ensuring adequate fluid intake to prevent dehydration.
Identifying the Symptoms
The illness often begins abruptly with a high fever, sometimes reaching 106°F, which can precede the development of throat symptoms. A severe sore throat is a hallmark symptom, often accompanied by pain when swallowing, medically known as odynophagia. This discomfort can lead to a refusal to eat or drink, especially in infants and toddlers.
The most distinctive sign is the appearance of characteristic lesions. These lesions start as small, reddish spots that quickly evolve into blister-like bumps (vesicles) measuring only a few millimeters across. These then rupture, leaving behind shallow, grayish-yellow ulcers typically surrounded by a red border.
These painful ulcers are almost exclusively located on the posterior structures of the mouth, including the soft palate, the uvula, the tonsils, and the back wall of the throat. This specific location helps distinguish Herpangina from other mouth-sore illnesses. Associated symptoms can include headache, neck pain, and a general feeling of malaise.
Understanding the Cause and Spread
Herpangina is caused by a group of viruses known as enteroviruses. The most common agents are various serotypes of Coxsackievirus A (such as A16, A4, A5, and A10), though Coxsackievirus B and Enterovirus 71 can also be responsible. Since multiple viral strains cause Herpangina, a person can contract the illness more than once.
The virus is highly contagious and spreads primarily through the fecal-oral route, often due to poor hygiene, making it common in daycare centers and schools. Transmission also occurs through respiratory droplets released when an infected person coughs or sneezes. Direct contact with contaminated surfaces (fomites) or blister fluid can also spread the infection.
The incubation period, the time between exposure and the onset of symptoms, typically ranges from three to five days. The highest rate of infection occurs in children under the age of ten, reflecting the common routes of transmission in this age group. The strong seasonality of Herpangina, with peaks in the summer and early autumn, is characteristic of enteroviral infections.
Diagnosis and Supportive Care
Diagnosis of Herpangina is clinical, relying on a healthcare provider’s visual examination of the throat and the characteristic symptoms. The unique appearance and location of the ulcers on the posterior oropharynx, combined with the presence of a sudden high fever, are usually sufficient to confirm the illness. Laboratory tests are rarely needed unless symptoms are severe or atypical.
There is no specific antiviral medication to cure Herpangina, and because it is a viral illness, antibiotics are not effective and should be avoided. Treatment focuses on supportive care to manage the fever and pain until the body’s immune system clears the infection. Pain relief is a top priority, often managed with over-the-counter medications like acetaminophen or ibuprofen to reduce both fever and throat discomfort.
Maintaining hydration is the single most important aspect of care, as the painful sores can make swallowing difficult and lead to dehydration. Offer cold liquids frequently in small amounts, and use soothing options like popsicles, ice chips, or cold milk products to numb the throat. Avoid acidic or spicy foods and drinks, such as citrus juices, which can irritate the sensitive ulcers. A soft, bland diet is recommended until the ulcers begin to heal.
Expected Duration and When to Seek Emergency Care
Herpangina is a self-limited infection; the fever usually lasts for two to four days and the mouth sores resolve completely within seven to ten days of the initial onset. The period of contagiousness is highest during the acute phase of the illness, particularly the first week. However, the virus can continue to shed in the stool for several weeks after all symptoms have disappeared.
While Herpangina is mild, parents and caregivers should watch for signs requiring immediate medical attention. The most frequent complication is dehydration, which becomes a concern when pain prevents drinking. Seek care if a child shows signs of dehydration, including:
- Decreased urination
- A lack of tears when crying
- Excessive lethargy
- A dry mouth and tongue
Medical attention is also warranted for a high fever that remains unmanageable or lasts longer than five days. Although rare, complications involving the central nervous system can occur with some enterovirus strains. Seek emergency care for symptoms such as:
- A stiff neck
- Severe headache
- Confusion
- Muscle weakness