Herpangina (Painful Mouth Infection)

What is Herpangina?

Herpangina also known as mouth blisters is an infectious disease caused due to coxsackie viruses. It was first described in 1920 and the viral etiology was established in 1951. It is characterized by fever and vesicles or ulcers on the roof and the posterior aspect of the mouth. It often affects children less than 10 years of age though it can occur in older children and adults as well. The underdeveloped immune systems of young children are the main risk factors for their susceptibility to this illness.

In the temporal regions, it is seen mostly in the summer and early fall while in tropical regions it is prevalent throughout the year.

Coxsackie infection in young women can cause miscarriages and can affect the fetus.

The disease is quite similar to Hand-Foot-Mouth Disease (HFMD) where lesions are present on the hands and feet as well.

What are the Causes of Herpangina?

Herpangina is due to viral infection. It is caused by 22 enterovirus serotypes, Coxsackie group A viruses are the main causative agents. Coxsackie viruses belong to the enterovirus group which affects the gastrointestinal tract. Some of the other viruses which can cause herpangina are group B coxsackie, enterovirus 71 and echo virus.

Modes of Transmission:

• Fecal-oral route - The virus is excreted in the feces of the infected individual and may infect others via unwashed hands and contaminated food due to poor hygiene practices.
• Droplet - The virus can spread by the respiratory route through droplet infection from an infected person’s cough or sneeze.
• Contact - Contaminated fomites (objects harboring the infectious agent) can also spread the infection.
• It is seen more often in the children who attend daycare facility.

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What are the Symptoms and Signs of Herpangina?

Symptoms of Herpangina

Herpangina may present with the following symptoms:

Fever: The fever due to herpangina has a quick onset and the temperature is persistently high, even as high as 106⁰F.

Lesions in the Mouth: The lesions are initially lumps which progress to vesicles (tiny blisters)and then rupture to form an ulcer, rarely larger than 5 mm. They are located in the posterior aspect of the mouth, near the tonsils, on the tongue, and on the roof of the mouth. These ulcers are extremely painful. Usually, it takes 5-10 days for the oral lesions to heal.

Pain in the throat: The ulcers are extremely painful and children hesitate to eat or drink.

Drooling: Swallowing is painful for patients with herpangina. The children may, therefore, present with drooling.

Others symptoms: The other symptoms in these patients include loss of appetite, headache, sore throat, fatigue, decreased urine output, pain in the abdomen and vomiting.

Signs of Herpangina

Oral lesions, are characteristic in patients with herpangina. The ulcers are small with a red border. They are 2-12 in number. The other areas of the mouth look normal. Lymph nodes in the neck may get enlarged.

How do you Diagnose Herpangina?

The symptom history and the typical lesions of the herpangina help in the diagnosis of the condition. Diagnostic tests are not needed.

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How do you Treat Herpangina?

Herpangina is a self-limiting condition which heals in about 7-10 days The treatment is symptomatic and aims at pain relief. The treatment plan however may be influenced to a certain degree by the patient’s age and symptoms.

Antibiotics are not used as the infection is viral in nature.

Paracetamol or ibuprofen helps to decrease the temperature and soothe the pain.

Aspirin is not used in children below 6 years of age as it is linked to Reye’s syndrome (inflammation of the liver)in them.

Topical anesthetics: Local application of benzocaine and lidocaine gel on the lesions in the mouth helps to reduce the discomfort.

Fluids and Food: Patients with herpangina tend to dehydrate. So, encourage drinking enough fluids to stay hydrated. Non-irritant foods are preferable, like milk and ice cream. Citrus fruit juices are better avoided as they are acidic. Hot liquids, fried and spicy foods must also be avoided.

How do you Prevent Herpangina?

Good hygiene is the cornerstone of herpangina prevention.

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The following hygiene practices may help in the prevention of the spread of the disease:

• Covering the mouth and nose while sneezing.
• Disinfecting the surroundings of a herpangina patient.
• Keeping a sick child away from school/ day care/ playground till the child is infectious, usually for a week after the onset of symptoms.
• Frequent hand washing, especially before eating food.