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Ailmemts & Remedies Pediatric

Herpangina.

Other Names: Mouth blisters or Hand-foot-and-mouth disease (HFMD).

Description:
Herpangina is often seen in the pediatric population, with occasional outbreaks among adult patients. They are both caused primarily by enteroviral infections. Herpangina presents as a stereotypical vesicular/ulcerative enanthem on the oropharyngeal mucosa. Usually, herpangina is produced by one particular strain of coxsackie virus A (and the term “herpangina virus” refers to coxsackievirus A) but it can also be caused by coxsackievirus B or echoviruses. Most cases of herpangina occur in the summer, affecting mostly children. However, it occasionally occurs in adolescents and adults. It was first characterized in 1920.

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HFMD is identified by a similar rash on the oral mucous membranes, with additional characteristic exanthem on hands and feet. Both syndromes are highly contagious. Although these syndromes are usually benign, their symptoms can cause significant temporary discomfort for patients and distress for their parents. Rarely, they can present as a more severe disease, and patients develop long-term sequelae.

Symptoms:
Symptoms include sudden fever with sore throat, headache, loss of appetite, and often neck pain. Within two days of onset an average of four or five (but sometimes up to twenty) 1 to 2 mm diameter grayish lumps form and develop into vesicles with red surrounds, and over 24 hours these become shallow ulcers, rarely larger than 5 mm diameter, that heal in one to seven days. These lesions most often appear on the tonsillar pillars (adjacent to the tonsils), but also on the soft palate, tonsils, uvula, or tongue.

A small number of lesions (usually 2 – 6) form in the back area of the mouth, particularly the soft palate or tonsillar pillars. The lesions progress initially from red macules to vesicles and lastly to ulcerations which can be 2 – 4 mm in size.

Causes:
Herpangina is usually caused by group A coxsackieviruses. However, it can also be caused by group B coxsackieviruses, enterovirus 71, and echovirus. These viruses are highly contagious and can easily spread from person to person, especially in schools and childcare centers.

People who are infected with herpangina are most contagious during the first week of infection.

Herpangina is typically transmitted through contact with fecal matter. The infection may also be spread through contact with droplets from an infected person’s sneeze or cough.

This means that you can get herpangina if you touch your mouth after touching something that’s contaminated with fecal particles or droplets from an infected person. The virus can live on surfaces and objects, such as countertops and toys, for several days.

Risk Factors:
Herpangina can affect anyone, but it most commonly occurs in children under age 5. It’s particularly common in children who attend school, childcare facilities, or camps. In the United States, the risk of developing herpangina is higher during the summer and fall.

Diagnosis:
The diagnoses of HFMD and herpangina are usually made clinically. In mild cases, no imaging or laboratory testing is required. Laboratory studies are usually obtained to gain additional information about complications such as dehydration or to rule out alternative diagnoses. Confirmatory testing is usually required only in complicated disease, for the collection of epidemiological data during epidemics, or to differentiate herpangina or HFMD from more serious diseases such as eczema herpeticum. Viral culture is the “gold standard” for confirmatory testing. Unfortunately, it can often take longer than 1 week to obtain culture results. This makes it an impractical test for clinical practice. Polymerase chain reaction (PCR) testing is fast and highly sensitive for enteroviruses. Samples may be obtained from the stool, mucocutaneous ulcers, vesicular fluid, or cerebrospinal fluid. Enzyme-linked immunosorbent assays (ELISA) are also available. ELISA testing for enteroviruses is generally less sensitive than PCR and should be utilized only in cases where PCR is not available.

Treatment:
Treatment is usually supportive only, as the disease is self-limiting and usually runs its course in less than a week.

Since herpangina is a viral infection, antibiotics aren’t an effective form of treatment. Instead, your doctor may recommend:

Ibuprofen or acetaminophen: These medications can ease any discomfort and reduce fever. Do not use aspirin to treat symptoms of a viral infection in children or teenagers. This has been linked to Reye’s syndrome, a life-threatening illness that results in sudden swelling and inflammation in the liver and brain.

Topical anesthetics: Certain anesthetics, such as lidocaine, can provide relief for a sore throat and any other mouth pain associated with herpangina.

Increased fluid intake: It’s important to drink plenty of fluids during recovery, especially cold milk and water. Eating popsicles can also help soothe a sore throat. Avoid citrus drinks and hot beverages, as they may make symptoms worse.
With treatment, symptoms should disappear within seven days with no lasting effects.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
https://www.ncbi.nlm.nih.gov/books/NBK507792/
https://www.healthline.com/health/herpangina#causes
https://en.wikipedia.org/wiki/Herpangina

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