Herpangina is a very contagious viral infection in childhood, which can be very bothersome for children because it causes fever and sores in the mouth and tonsils. Learn to identify its symptoms and how to treat them.

The Herpangina is one of the most common childhood infections, especially among children aged two to eight years. It is a type of viral pharyngotonsillitis produced by the Coxsackie A virus characterized by high fever and the appearance of vesicles in the oral cavity (hard and soft palate, tonsils, and sometimes also on the tongue and inner face of the cheeks). 

These vesicles later ulcerate, giving rise to sores (also called canker sores ), which are very painful and can cause difficulties for the child to swallow normally, liquids and solids, and a sore throat.

How is herpangina spread in children

The Coxsackie A virus is a very common virus among children, which circulates mainly during the autumn and spring months. It is spread very easily through saliva and respiratory secretions, making it very contagious among children of young people who continually put things in their mouths. It is frequent that several cases occur in the same class of kindergarten or school.

The virus responsible for this infectious disease is from the same family as the one that causes hand, foot, and mouth disease, a widespread pathology during spring in nursery schools. Unlike the previous one, in Herpangina, the ulcers and canker sores are limited to the oral cavity and do not affect the rest of the body.

Herpangina symptoms

The incubation period of the disease lasts about 5-7 days, in which the child may have symptoms of Herpangina similar to a cold: dry cough, some mucus and tenths of fever, and the acute phase of the disease are characterized by :

  • Fever: it does not usually give a very high fever, less than 39ºC, and that goes down well with antipyretics.
  • Vesicles, ulcers, and canker sores in the mouth: what parents can see in the early stages of the disease is the appearance of little red dots on the palate’s upper part and near the uvula (uvula). When ruptured, the vesicles leave a very painful ulcer, so children may refuse to eat or drink, as it is very painful for them to swallow.
  • Lymph nodes or nodes around the neck, usually less than 1.5 cm in diameter.
  • In addition to the above, the child may be irritable with fever, a refusal to eat, muscle aches, headaches, general malaise.
  • Unlike other viral diseases, there is no skin rash, but the lesions are limited to the oral cavity.

Herpangina itself is not dangerous, but in cases where there are many canker sores and adequate hydration of children is not monitored (giving them serum or water in small quantities, and foods that are easy to chew) there is a risk that can become dehydrated, especially in the little ones. 

Diagnosis of herpangina

The diagnosis of Herpangina is clinical; that is, complementary tests are not necessary to establish it. Therefore, in a child with a fever, exploration of the oral cavity with a flashlight and a depressor (the ‘stick’ for the throat) is part of the routine examination, so it is very easy for the pediatrician to establish that this is the origin of the fever, since the lesions associated with this infection are very recognizable.

On some occasions, depending on the evolutionary phase of the disease, if the canker sores and vesicles have not yet emerged and only red spots are seen on the palate in a child with a very high fever, it will be necessary to distinguish Herpangina from another type of bacterial tonsillitis (caused by streptococcus), which is treated with an antibiotic.

Bacterial or streptococcal tonsillitis is more common in five-year-old children, and to diagnose it, a throat sample is taken with a swab. It is sent to the laboratory to verify if the marker of bacterial infection is positive. It should be emphasized that this is not the norm, since herpangina vesicles and ulcers are not usually confused with other causes of pharyngotonsillitis.

Finally, only in the most advanced cases of the disease in which dehydration has occurred due to lack of fluid intake, or in children with some underlying pathology (such as immunosuppressed patients or undergoing chemotherapy treatments), may blood tests to check the extent of the infection, and prescribe intravenous rehydration.