You are in: eMedicine Specialties > Infectious Diseases > MEDICAL TOPICS HerpanginaArticle Last Updated: Aug 25, 2008AUTHOR AND EDITOR INFORMATIONSection 1 of 10
  Author: Sandra G Gompf, MD, FACP, FIDSA, Associate Professor of Infectious Diseases and International Medicine, University of South Florida College of Medicine; Chief of Infectious Diseases Section, Director, Occupational Health and Infection Control Programs, James A Haley Veterans Hospital Sandra G Gompf is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America Coauthor(s): Beata Catherine Casanas, DO, Assistant Professor, Department of Internal Medicine, Division of Infectious Diseases and International Medicine; University of South Florida, College of Medicine; Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital Editors: Thomas Herchline, MD, Associate Professor of Medicine, Wright State University Boonshoft School of Medicine; Medical Director, Public Health Dayton and Montgomery County, Ohio; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Ronald A Greenfield, MD, Professor, Department of Internal Medicine, Section of Infectious Diseases, University of Oklahoma College of Medicine; Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital; Michael Stuart Bronze, MD, Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center Author and Editor Disclosure Synonyms and related keywords: herpangina, enteroviral herpangina, coxsackievirus herpangina, Picornaviridae, coxsackievirus, coxsackievirus A, coxsackievirus B, echovirus, enterovirus, enteroviruses, enteroviral infection, enterovirus 71 INTRODUCTIONSection 2 of 10
  BackgroundHerpangina is an acute febrile illness associated with small vesicular or ulcerative lesions on the posterior oropharyngeal structures. Herpangina typically occurs during the summer and usually develops in children, occasionally occurring in young adults. Various enteroviruses cause the condition. PathophysiologyHerpangina is usually caused by coxsackievirus A. Less-common causes of herpangina include coxsackievirus B, echovirus, and enterovirus. Enteroviruses that cause herpangina belong to the Picornaviridae family. A distinct phenotype of enterovirus 71 causes herpangina. This is in contrast to the phenotype of enterovirus 71 that causes encephalitis, myocarditis, poliomyelitislike paralysis, and neonatal sepsis. Viruses that cause herpangina are typically spread via the fecal-oral route, although they may spread via the respiratory route or through fomites. Freshwater sources (eg, lakes) may act as a reservoir for transmission. Herpangina typically has an incubation period of 7-14 days. Viremia occurs after inoculation and subsequently results in distant sites of infection. Clinical symptoms at secondary sites of infection occur after viral replication. Bilateral, anterior, cervical lymphadenopathy may occur, resulting from infection of the posterior oropharynx. Coxsackievirus A may be recovered from the nasopharynx, feces, blood, urine, and cerebrospinal fluid (CSF). After clinical symptoms have resolved, asymptomatic enteroviral infection may persist in the gastrointestinal tract. FrequencyUnited StatesEnteroviral infections are most common during the summer and fall in temperate climates and occur year-round in tropical climates. InternationalEnteroviral infections occur worldwide. Acute fatal epidemics have been reported in at least 5 parts of the world, the most recent being described in Kanagawa Prefecture, Japan, in 2007.1 Mortality/MorbidityHerpangina is typically a mild and self-limited illness. Although most children who develop herpangina recover, the disease is occasionally complicated by CNS lesions and cardiopulmonary failure. Fatalities associated with herpangina have been reported, primarily in infants aged 6-11 months. SexHerpangina does not have a gender predilection. AgeHerpangina most commonly affects infants and young children aged 3-10 years. Herpangina is less common in adolescents and adults. CLINICALSection 3 of 10
HistoryApproximately 50% of enteroviral infections are asymptomatic. Clinical manifestations may vary, depending on the strain of the virus.
Physical
Causes
DIFFERENTIALSSection 4 of 10
Coxsackieviruses Early Symptomatic HIV Infection Enteroviruses Hand-Foot-and-Mouth Disease Herpes Simplex Infectious Mononucleosis Pharyngitis, Bacterial Pharyngitis, Viral
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Clinical Manifestations | Herpangina | HSV | Hand-Foot-and-Mouth Disease |
|---|---|---|---|
Causative organism | Enteroviruses | HSV-1 and HSV-2 | Enteroviruses |
Oral vesicular/ulcerative lesions | + | + | +1 |
Anterior pharynx | - | + | + |
Posterior pharynx | + | +/- | - |
Gingivostomatitis | - | +/- | - |
| 1Lesions may also occur on the buccal mucosa | |||
Herpangina is a clinical diagnosis. Laboratory studies are generally not indicated because herpangina is a mild and self-limited illness.
No histopathologic findings are specific to herpangina.
Herpangina is a self-limited illness. As such, no specific therapy is indicated.
Ensure that patients with herpangina maintain adequate hydration and caloric intake during the illness.
Limit patient activity as tolerated.
Because symptoms associated with herpangina are usually short-lived and resolve within one week, patients generally do not need outpatient follow-up care.
Enteroviruses are spread through the fecal-oral route; therefore, practice any measures that may help reduce this mode of spread (eg, washing hands, avoiding contaminated food).
Herpangina is a self-limited viral illness.
Herpangina carries an excellent prognosis.
No known medicolegal implications are associated with the clinical illness of herpangina. This is a self-limited viral illness. A mistaken diagnosis does not change the course of the illness, and treatment is based entirely on symptoms.
| Media file 1: Coxsackievirus B4 virions under electron microscopy. (This image is in the public domain and thus free of any copyright restrictions. Content provider: Centers for Disease Control and Prevention) | |
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Article Last Updated: Aug 25, 2008
