Herpangina: Difference between revisions
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* Characteristic enathem- Punctate macule which evolve over a period of 24 hours to 2-4mm erythematous papules which vesiculate, and then centrally ulcerate. | * Characteristic enathem- Punctate macule which evolve over a period of 24 hours to 2-4mm erythematous papules which vesiculate, and then centrally ulcerate. | ||
* The lesions are usually small in number, and evolve rapidly. The lesions are seen more commonly on the soft palate and uvula. The lesions can also be seen on the tonsils, posterior pharyngeal wall and the buccal mucosa. | * The lesions are usually small in number, and evolve rapidly. The lesions are seen more commonly on the soft palate and uvula. The lesions can also be seen on the tonsils, posterior pharyngeal wall and the buccal mucosa. | ||
===Laborotory Tests===<ref name="Ferri's Clinical Advisor" /> | |||
* The diagnosis of herpangina is clinical | |||
* When unsure of the diagnosis, pharyngeal viral and bacterial cultures to exclude HSV infection and streptococcal pharyngitis | |||
* Approximately 1 week after infection, type-specific antibodies appear in the blood with maximum titer occurring in 3 weeks | |||
==Treatment== | ==Treatment== | ||
Revision as of 18:53, 14 February 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fatimo Biobaku M.B.B.S [2]
Synonyms: Vesicular stomatitis, Acute lymphonodular pharyngitis
Overview
Historical Perspective
The name 'herpangina' was coined by Zahorsky, and he was also the first person to give a full description of the clinical entitity in 1920.[1] The first isolation and description of the coxsackie virus was in 1948 by Dalldorf and Sickles.[1]
Pathophysiology
Causes
Majority of herpangina cases are caused by coxsackie A viruses (commonly A1, A2, A6, A8, A10, A16, and A22) but it can also be caused by other enteroviruses such as some serotypes of coxsackie B virus, echovirus and enterovirus 71.[2][3][4]
Risk Factors
Differential Diagnosis
The following diseases may mimic herpangina:[2][4]
- Herpetic gingivostomatitis- This is caused by herpes simplex virus(HSV) infection, and affects the anterior oral cavity. It commonly affects the inner parts of the lips, the buccal mucosa, and the tongue. Gingivitis and cervical lymphadenitis can be seen in HSV infection but these are usually absent in herpangina.
- Bacterial pharyngitis
- Tonsillitis
- Aphthous stomatitis
- Hand-foot-mouth disease
Epidemiology
Age
Herpangina is seen predominantly in children and summer outbreaks are not uncommon. It occurs more frequently in children between the ages of 3-10yrs.[2][4] Adolescents and young adults are occasionally affected.[4]
Sex
There is no known sex predilection.[2]
Natural History, Complications, Prognosis
Herpangina is a self-limited infection of the upper respiratory tract.[2]
Diagnosis
History and Symptoms
The history and symptoms may include the following:[4][2]
- Fever
- Sore throat and odynophagia- These can occur several hours(up to 24 hours), before the appearance of the enathem
- Vomitting
- Myalgia
- Headache
- Pharyngeal lesions
- Most patients do not appear severely ill
Physical Examination
Examination of the throat can reveal the following:[4]
- Erythema
- Exudate of the tonsils which is usually mild
- Characteristic enathem- Punctate macule which evolve over a period of 24 hours to 2-4mm erythematous papules which vesiculate, and then centrally ulcerate.
- The lesions are usually small in number, and evolve rapidly. The lesions are seen more commonly on the soft palate and uvula. The lesions can also be seen on the tonsils, posterior pharyngeal wall and the buccal mucosa.
===Laborotory Tests===[2]
- The diagnosis of herpangina is clinical
- When unsure of the diagnosis, pharyngeal viral and bacterial cultures to exclude HSV infection and streptococcal pharyngitis
- Approximately 1 week after infection, type-specific antibodies appear in the blood with maximum titer occurring in 3 weeks
Treatment
Prevention
Herpangina (from herp, an itching, and angina, a sore throat, literally "a choking"; also called mouth blisters) is the name of a painful mouth infection caused by coxsackieviruses. Usually, herpangina is produced by one particular strain of coxsackievirus A, but it can also be caused by coxsackievirus B or echoviruses. It is most common in children. Though herpangina can be asymptomatic, symptoms usually associated are high fever and sore throat.
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. The lesions heal in 7 - 10 days.
Histologically, the epithelial cells show signs of intracelular and intercellular edema. A diagnosis can be made from clinical signs and symptoms, and treatment consists of minimizing the discomfort of symptoms. Aspirin is avoided.
References
Template:WH Template:WikiDoc Sources
- ↑ 1.0 1.1 HOWLETT JG, SOMLO F, KALZ F (1957). "A new syndrome of parotitis with herpangina caused by the Coxsackie virus". Can Med Assoc J. 77 (1): 5–7. PMC 1823836. PMID 13437259.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Ferri, Fred (2017). "Chapter:Herpangina". Ferri's Clinical Advisor 2017. Elsevier. pp. 583–583. ISBN 978-0-3232-8048-8.
- ↑ Li W, Gao HH, Zhang Q, Liu YJ, Tao R, Cheng YP; et al. (2016). "Large outbreak of herpangina in children caused by enterovirus in summer of 2015 in Hangzhou, China". Sci Rep. 6: 35388. doi:10.1038/srep35388. PMC 5067559. PMID 27752104.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Durand, Marlene (2015). "Chapter 174:Coxsackieviruses, Echoviruses, and Numbered Enteroviruses(EV-D68)". Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases Updated Edition, Eighth Edition. Elsevier. pp. 2080–2090. ISBN 978-1-4557-4801-3.