Herpangina

What is Herpangina?

Herpangina is a type of viral infection that usually causes fever and small sores or blister-like spots in the back of the throat. While it’s most common in children, it can also occur in newborns, teenagers, and young adults. The disease is very contagious and is most often seen during the summer months. It can be caused by various types of viruses called enteroviruses, but the Coxsackie B virus type is the most common culprit. Herpangina can also happen alongside a viral skin rash and various nerve-related conditions, such as a type of infection in the covering of the brain (aseptic meningitis), sudden muscle weakness (acute flaccid paralysis), and brain inflammation (encephalitis).

What Causes Herpangina?

Herpangina, identified first in the 1920s, is caused by several types of enteroviruses – particularly Coxsackie B, Coxsackie A16, and enterovirus 71. Other possible causes include the echovirus, adenovirus, parechovirus, and herpes simplex virus. These enteroviruses are small and tough, able to survive in a wide range of environments and temperatures up to 50 Celsius, which allows them to stay infective for extended periods. It’s important to note that we, humans, are the only natural hosts for these viruses.

Risk Factors and Frequency for Herpangina

Herpangina primarily affects children less than 10 years old, commonly due to their exposure at childcare centers or schools. While the condition is not as common in adolescents and adults, severe situations may arise in newborns, individuals with weak immune systems, and pregnant women. It is important to note that herpangina doesn’t discriminate based on gender. In the U.S., these infections mostly occur during summer and fall in places with moderate climates, but in tropical climate regions, they can happen throughout the year. Worldwide, herpangina cases have been reported with the most recent deadly outbreak in Japan in 2007. In tropical regions, these diseases commonly emerge during rainy seasons.

Signs and Symptoms of Herpangina

Herpangina, a viral throat infection, often starts with high fever and discomfort. A full medical history and examination are required to diagnose it and to rule out other diseases with similar symptoms. The signs of herpangina may vary:

High-grade fever
Feeling unwell
Fussy behavior in young children
Poor appetite and reduced feeding in infants
Back pain and headaches in older children
Sore throat that often starts a day before any visible signs appear
Loss of appetite, dehydration, and stomach pain
A skin rash (the type of rash depends on the specific strain of the virus causing the infection)

Herpangina affects the soft palate, tonsils, and back of the throat, causing red patches that blister and can turn into small ulcers less than 5 mm in size. These spots can also appear on the inside cheeks and behind the tongue, and they usually last for up to a week. Some patients may have a throat infection and swollen neck glands.

A different form of herpangina caused by a specific strain of the Coxsackie virus results in nodules in place of blisters or ulcers. Some patients may also develop a body rash that can take various forms. In severe cases, the patient may show signs of neurological issues like neck stiffness or paralysis if the infection leads to complications like meningitis or encephalitis. Signs of dehydration, such as a dry mouth and reduced skin elasticity, are common.

Medical professionals also aim to rule out other critical conditions that share similar symptoms, such as Kawasaki disease, Rocky Mountain spotted fever, eczema herpeticum, and toxic shock syndrome.

Testing for Herpangina

Herpangina, a viral infection causing small blisters in the mouth, is generally diagnosed simply by examining the symptoms. In mild cases, there’s usually no need for any additional testing or imaging. However, if complications such as dehydration occur, or if there’s a need to rule out other possible diseases, a healthcare professional may require further lab tests. For herpangina patients, the count of their white blood cells (cells that fight infection) often falls within the normal range, although in some instances, they may have a higher count of lymphocytes, a specific type of white blood cell.

If the condition seems more serious, more detailed testing may be needed to confirm the diagnosis. It may also be needed to distinguish herpangina from more severe diseases like eczema herpeticum (a viral skin infection), or to collect data during an outbreak of the illness. The most accurate way of confirming this infection is to detect the presence of the enterovirus (the virus causing herpangina) grown in a lab culture, but this can take over a week to show results, making it not the most convenient.

For timely and accurate detection of enteroviruses, a test called Polymerase chain reaction (PCR) is used. This process, which examines samples such as stools or fluid from mouth sores or blisters, is quick and very precise. Another test called ELISA may also be used, although it’s usually less sensitive than PCR, and hence should be used only when PCR testing is not an option. Antibodies specifically fighting against the coxsackievirus (the type of enterovirus causing herpangina) can also be measured in the blood once symptoms have developed. A four-fold rise in these antibodies, measured through samples taken two to three weeks apart, may indicate the presence of the virus.

Treatment Options for Herpangina

Herpangina is an illness that typically resolves by itself, and the main goal of treatment is to alleviate symptoms. The management of this condition can be grouped into three general categories: general care, symptom easing, and antiviral treatment.

For general care, patients should be put in clean, well-ventilated rooms to prevent the disease from spreading. It’s important for patients to eat a healthy diet and drink plenty of fluids. Their food should be easy to eat, high in calories, and not irritating (avoiding hot or spicy foods). Oral hygiene is vital as well; patients should rinse their mouth with normal saline after eating, or for younger children, their mouth can be gently wiped with it. If normal saline isn’t available, salted water can be an alternative. Special attention should be given to keeping well-hydrated, particularly for kids who have a high fever or find it difficult to eat. These patients should be closely monitored while undergoing treatment.

High fever is the main symptom associated with herpangina. Patients with temperatures exceeding 101.3 F (38.5 C) can be given fever-lowering medications, like ibuprofen or acetaminophen. Dosage and timing of these medicines depend on the patient’s age and the severity of symptoms and should be administered based on the doctor’s instructions. There are also natural ways to lower body temperature; for instance, using a cool forehead compress, fever cooling patches, or sleeping with a cold pack underneath the head. It’s of utmost importance to ensure enough fluid intake while taking these drugs. It’s not usually advisable to use lidocaine or diphenhydramine to relieve symptoms associated with the oral lesions in herpangina due to potential risks of toxicity and not enough supportive evidence. For young children who may experience fever-induced seizures, their condition should be promptly attended to and treated.

At present, there are no specific antiviral drugs designed for herpangina treatment. That being said, a spray containing the substance interferon-alpha has shown some promise. Its primary function is to boost the body’s defensive reaction against infections on the mucosal surfaces of the body. This spray is beneficial because it’s easy to use, safe, and makes it simpler for children to stick to a medication routine. Generally, broad-spectrum antiviral treatments such as acyclovir and gancyclovir are not effective for treating herpangina since they are designed to work on DNA viruses, but the viruses causing herpangina are RNA viruses. Similarly, ribavirin is not routinely recommended for herpangina treatment, though it may be used in the early stages of the condition.

Herpangina, a common disease in children, can often be confused with several other conditions due to its similar symptoms. To ensure a correct diagnosis, it’s important for a medical professional to rule out the following conditions:

Eczema triggered by herpes virus
Toxic shock syndrome (a severe response to a bacterial infection)
Measles (a viral disease causing a rash and fever)
Chickenpox (also known as Varicella)
Kawasaki disease (a condition that causes inflammation in the walls of some blood vessels in the body)
Insect bites
Rocky Mountain spotted fever (a bacterial infection transmitted by a tick)
Drug eruption (abnormal skin reactions to medications)
Erythema multiforme major (a type of hypersensitive reaction to infections or medications)

Distinguishing between these conditions is crucial for choosing the right treatment approach. For this reason, healthcare providers will always conduct comprehensive examinations in case of suspected herpangina.

What to expect with Herpangina

Herpangina is usually a mild illness that goes away on its own. By taking the right care in isolating the patient, ensuring they eat well and stay hydrated, the illness typically clears up in less than ten days. Treatments to relieve the patient’s fever and mouth sores and close monitoring of young children with high fever for any signs of fever-induced seizures can also help improve the condition faster.

However, it should be noted that patients who develop serious brain-related complications may have a varying course of the disease, and in some instances, the outcome may not be favorable. So, it’s crucial to closely monitor patients for signs of complications such as muscle weakness, meningitis or total inflammation of the brain, and inflammation of the heart muscle.

Possible Complications When Diagnosed with Herpangina

Herpangina is usually a mild condition, but it can lead to severe complications if caused by certain microorganisms like enterovirus 71. The complications can include:

Brain stem encephalitis
Acute flaccid paralysis
Aseptic meningitis
Myocarditis

Patients experiencing these complications are usually considered critical and require hospitalization, and in some cases, care in the intensive care unit (ICU).

Preventing Herpangina

Patients and their families need to know that herpangina, a disease that mostly affects children, usually gets better on its own. It can cause a lot of worry for families, so reassurance is important. Families should understand that this disease can spread easily, so keep the patient in a well-ventilated room until their symptoms get better. It’s also important to help the patient eat well, drink plenty of fluids and to keep a close eye on their symptoms.

Washing hands often is crucial to prevent the disease from spreading. This is particularly important for family members taking care of the patient, especially after things like changing the patient’s diaper or feeding them. It’s also a good idea to clean objects and surfaces that the patient may touch frequently.

While home care is usually the way to go, care-givers should keep in regular touch with the doctor and watch the patient closely for any changes in symptoms. This disease is typically short-lived, so often there’s no need for further check-ups once the patient has recovered.

Frequently asked questions

Herpangina is a type of viral infection that causes fever and small sores or blister-like spots in the back of the throat.

Herpangina is not as common in adolescents and adults, but severe situations may arise in newborns, individuals with weak immune systems, and pregnant women.

The signs and symptoms of Herpangina include: - High-grade fever - Feeling unwell - Fussy behavior in young children - Poor appetite and reduced feeding in infants - Back pain and headaches in older children - Sore throat that often starts a day before any visible signs appear - Loss of appetite, dehydration, and stomach pain - A skin rash (the type of rash depends on the specific strain of the virus causing the infection) Herpangina affects the soft palate, tonsils, and back of the throat, causing red patches that blister and can turn into small ulcers less than 5 mm in size. These spots can also appear on the inside cheeks and behind the tongue, and they usually last for up to a week. Some patients may have a throat infection and swollen neck glands. In some cases, a different form of herpangina caused by a specific strain of the Coxsackie virus results in nodules in place of blisters or ulcers. Some patients may also develop a body rash that can take various forms. In severe cases, the patient may show signs of neurological issues like neck stiffness or paralysis if the infection leads to complications like meningitis or encephalitis. Signs of dehydration, such as a dry mouth and reduced skin elasticity, are common. It is important for medical professionals to rule out other critical conditions that share similar symptoms, such as Kawasaki disease, Rocky Mountain spotted fever, eczema herpeticum, and toxic shock syndrome.

Herpangina is primarily caused by several types of enteroviruses, including Coxsackie B, Coxsackie A16, and enterovirus 71. Other possible causes include the echovirus, adenovirus, parechovirus, and herpes simplex virus. These viruses can be transmitted through close contact with infected individuals or contaminated surfaces.

The doctor needs to rule out the following conditions when diagnosing Herpangina: - Eczema triggered by herpes virus - Toxic shock syndrome (a severe response to a bacterial infection) - Measles (a viral disease causing a rash and fever) - Chickenpox (also known as Varicella) - Kawasaki disease (a condition that causes inflammation in the walls of some blood vessels in the body) - Insect bites - Rocky Mountain spotted fever (a bacterial infection transmitted by a tick) - Drug eruption (abnormal skin reactions to medications) - Erythema multiforme major (a type of hypersensitive reaction to infections or medications)

The types of tests that may be needed for diagnosing Herpangina include: 1. White blood cell count: This test can help determine if there is an increase in lymphocytes, a specific type of white blood cell, which may indicate Herpangina. 2. Polymerase chain reaction (PCR): This test is used to detect the presence of the enterovirus (the virus causing Herpangina) in samples such as stools or fluid from mouth sores or blisters. It is quick and very precise. 3. ELISA: This test may be used when PCR testing is not an option. It is less sensitive than PCR but can still help in diagnosing Herpangina. 4. Antibody measurement: Antibodies specifically fighting against the coxsackievirus (the type of enterovirus causing Herpangina) can be measured in the blood once symptoms have developed. A four-fold rise in these antibodies, measured through samples taken two to three weeks apart, may indicate the presence of the virus.

Herpangina is typically a self-resolving illness, so the main goal of treatment is to alleviate symptoms. Treatment for herpangina can be grouped into three general categories: general care, symptom easing, and antiviral treatment. General care includes putting patients in clean, well-ventilated rooms to prevent the spread of the disease, ensuring they eat a healthy diet and drink plenty of fluids, and maintaining good oral hygiene. Symptom easing involves managing high fever with fever-lowering medications, using natural methods to lower body temperature, and promptly attending to and treating fever-induced seizures in young children. Antiviral treatment options are limited, with no specific antiviral drugs designed for herpangina. However, a spray containing interferon-alpha has shown promise in boosting the body's defensive reaction against infections on mucosal surfaces. Broad-spectrum antiviral treatments like acyclovir and gancyclovir are not effective for herpangina, as the viruses causing it are RNA viruses, not DNA viruses. Ribavirin is also not routinely recommended for herpangina treatment, though it may be used in the early stages of the condition.

There are no specific side effects mentioned when treating Herpangina in the given text. However, it is important to note that lidocaine and diphenhydramine are not usually advisable for relieving symptoms associated with the oral lesions in Herpangina due to potential risks of toxicity and lack of supportive evidence. Additionally, it is mentioned that antiviral treatments such as acyclovir and gancyclovir are not effective for treating Herpangina since the viruses causing it are RNA viruses, not DNA viruses. Ribavirin is also not routinely recommended for Herpangina treatment, though it may be used in the early stages of the condition.

The prognosis for Herpangina is usually favorable, as it is a mild illness that typically goes away on its own within ten days. However, patients who develop serious brain-related complications may have a more uncertain outcome. It is important to closely monitor patients for signs of complications such as muscle weakness, meningitis, inflammation of the brain, and inflammation of the heart muscle.

A medical professional or healthcare provider.

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