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Herpangina
is a febrile disorder caused by numerous group A coxsackieviruses
and occasionally other enteroviruses. Infection produces oropharyngeal
mucosal vesicular and ulcerative lesions.
Herpangina tends to occur in epidemics, most commonly in infants and children. It is characterized by sudden onset of fever with sore throat, headache, anorexia, and frequently, neck pain. Infants may vomit. Within 2 days after onset, up to 20 (mean, 4 to 5 per patient) 1- to 2-mm diameter grayish papules develop and become vesicles with erythematous areolae. They occur most frequently on the tonsillar pillars but also on the soft palate, tonsils, uvula, or tongue. During the next 24 h, the lesions become shallow ulcers, seldom > 5 mm in diameter, that heal in 1 to 7 days. Complications are unusual. Lasting immunity to the infecting strain follows, but repeated episodes caused by other group A coxsackieviruses or other enteroviruses are possible.
Diagnosis is based on symptoms and characteristic oral lesions. It is best confirmed by isolating the virus from the lesions or by demonstrating a rise in specific antibody titer, but such testing is not generally recommended. Recurrent aphthous ulcers may appear similar. Bednar's aphthous ulcers rarely occur in the pharynx but generally are not associated with systemic symptoms. Herpetic stomatitis occurs sporadically and produces larger, more persistent and more numerous ulcers throughout the oropharynx than herpangina. Coxsackievirus A10 causes lymphonodular pharyngitis, which is similar except that the papules become 2- to 3-mm whitish to yellowish nodules instead of vesicles and ulcers.
Treatment of herpangina is symptomatic.
Last full review/revision November 2005
Content last modified November 2005
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