Herpangina

Herpangina is a self-limited febrile illness caused by enteroviruses, most commonly Coxsackie A. It is characterized by small, painful vesicles or ulcers in the back of the throat, particularly the soft palate and tonsillar pillars, sometimes extending to the uvula. Lesions may rupture to form grayish-white ulcers surrounded by an erythematous base. Feeding and swallowing can be painful.

Epidemiology and course: Herpangina most often affects children, especially those under 10 years old, though it can occur in adults. The incubation period is typically about 3 to 5 days. Illness onset includes fever, sore throat, irritability, malaise, and reduced appetite. Mouth pain can lead to decreased oral intake and dehydration. The illness generally lasts about 3 to 7 days, with recovery without scarring. Seasonally, outbreaks are more common in summer and early autumn in temperate regions.

Diagnosis and differential: Diagnosis is usually clinical, based on the characteristic oropharyngeal ulcers and fever. Viral studies or PCR from throat swabs can detect enteroviruses but are not routinely required. Differential diagnoses include herpetic gingivostomatitis, hand-foot-and-mouth disease (which involves hands, feet, and sometimes buttocks), and other causes of pharyngitis.

Management: Treatment is supportive. Ensure adequate fluid intake and rest. Analgesics such as acetaminophen or ibuprofen can relieve pain and fever. Topical anesthetics may ease throat discomfort. There is no specific antiviral therapy for routine herpangina. Severe dehydration or inability to maintain fluids warrants medical evaluation.

Prevention: Emphasize good hand hygiene and hygiene in communal settings; there is no vaccine for routine prevention. Most cases resolve without complications, though rare impacts on hydration and, infrequently, aseptic meningitis or encephalitis can occur with enterovirus infection.