What Is Herpangina?

Overview

Herpangina is a name that you may have come across if you have young children or work in a childcare setting. This highly contagious viral infection is common in infants and children and can spread rapidly in schools, daycare centres or playgroups. Although most cases of herpangina are not serious and go away on their own within a week, some children may develop complications or severe symptoms that require medical attention. Therefore, it is advisable to consult a doctor if you notice any signs of herpangina in your child or yourself. The good news is that there are ways to prevent and treat herpangina, and we will discuss them in this article. If you want to know more about this common childhood illness, keep reading.

Before we explain how you can identify the symptoms of herpangina, it is important to understand what this condition is and how it affects your body.  Herpangina is a viral illness characterised by fever and exanthemas or ulcers at the back of the mouth. It is highly similar to hand, foot, and mouth disease (HFMD), since both are widespread, have comparable origins, and have more epidemic occurrences in nations like South Korea, Thailand, Vietnam, and China, even though they are caused by different viruses.1 

Although it most frequently affects children, the viral infection known as herpangina may affect anybody, from infants to adults. This illness usually occurs throughout the summer and autumn months in temperate areas, or all year in tropical settings as the weather conditions are favourable for the viruses to survive and spread.2

Causes of herpangina

The cause of herpangina is a group of viruses that are called Enteroviruses, such as Enterovirus 71 (EV-71) and Coxsackievirus A16 (CV-A16). These viruses are part of a larger family of viruses that are called Picornavirus, which means “small virus”. These viruses have a single strand of RNA as their genetic material and can survive in different environments and tolerate significant pH changes. They can also remain infectious at high temperatures above 50ºC, which is about 122ºF.2, 3, 4

People who are infected with these viruses can spread them to others in the first 1 to 2 weeks after they get infected, which is the most contagious period. The infection usually takes 3 to 5 days to develop, this is known as the incubation period. These viruses can be transmitted in several ways, also known as the oral-faecal route, because they can be found in the mouth and the stool of infected people. Some of the common ways to transmit herpangina’s viruses include:

  • Direct contact with infected people
  • Contact with contaminated surfaces
  • Respiratory droplets.5

Signs and symptoms of herpangina

Herpangina is a disease that usually does not cause any symptoms and goes away by itself but can be recognized by the appearance of exanthemas, which are skin eruptions that look like rashes or ulcers on the back part of the mouth, the tonsils, or the upper part of the throat. These exanthemas do not spread to other parts of the skin, unlike for example with HFMD.2, 6

This condition can also have other symptoms that may be very similar to those of other diseases that mainly affect children such as:

  • High fevers
  • Lack of appetite
  • Agitation
  • Stomach discomfort
  • Dehydration
  • Muscular weakness
  • Difficulty breathing.7, 8

In more extreme cases, convulsions, and anorexia in younger children and backache and headache in older children. Despite mild symptoms, sometimes these viral infections can also cause complications, and their prognosis may not be as favourable. They may lead to encephalitis, meningitis, acute paralysis, pulmonary oedema or even haemorrhage. Additionally, a small number of severely affected children may also experience  myocarditis.7, 8

Management and treatment for herpangina

Most people who get infected with this illness do not show any signs or symptoms, and the infection goes away on its own within a week or two. However, some people may experience mild symptoms that usually last for 5 to 7 days and then disappear.

The main goal of the treatment is to relieve these symptoms and make the patient feel more comfortable. Therefore, doctors may recommend taking medications such as acetaminophen or ibuprofen, which can reduce fever and pain. These medications are called antipyretics because they lower the body temperature.7 In addition, some doctors may suggest using an antiviral spray on the affected area of the mouth and throat, even though there are no specific antiviral drugs that can cure herpangina viruses.8,9 Another way to lower the fever and soothe the soreness is to apply cold compresses on the forehead and neck and to rinse the mouth with saline solution. This can help to clean the blisters and ulcers and prevent bacterial infection.

Herpangina is contagious and can spread easily among children, especially in daycare centres and schools. Therefore, it is important to isolate the infected person for one to two weeks until the infection clears up. This can help to prevent outbreaks and protect other people from getting sick.

Diagnosis

Herpangina is a disease that causes mild symptoms such as fever and exanthemas in the mouth and throat. Usually, a doctor can diagnose this disease by looking at the symptoms and examining the mouth and throat of the patient, without the need for any tests in the laboratory. These tests are only required in more severe situations, such as malnutrition or dehydration, or when the doctor needs to rule out other diseases that may have similar symptoms.8

In some cases, herpangina may cause more severe symptoms and the doctor may request to do a confirmatory test for herpangina using a technique called PCR, which stands for polymerase chain reaction. This technique can detect the genetic material of the virus causing herpangina in different samples from the patient, which may include:

  • Faeces
  • Mucus or vesicular fluid from the exanthemas.6, 10

FAQs

How can I prevent herpangina?

Herpangina prevention begins with good hygiene. The following precautions could aid in limiting the spread of disease like covering the mouth and nose while sneezing, washing hands frequently, disinfecting toys or isolating infected children from school.

How common is herpangina?

Herpangina is a type of infectious disease that affects many people around the world, but it is more common and severe in young children. The occurrence of herpangina varies depending on the climate and season of the region where the infection happens. In regions with temperate climates, herpangina usually occurs during the summer and fall months, when the weather is warm and humid. In regions with tropical climates, herpangina can happen throughout the year, as the temperature and humidity are constantly high.

Who is at risk of herpangina?

The people who are more at risk of being infected with herpangina are people of any age group, from babies to elderly people, but it is more common among children, especially those who are in close contact with other children.

Is herpangina contagious?

Herpangina's viruses are most contagious in the first 2 weeks of infection and can spread through direct contact, respiratory droplets, or contaminated surfaces. The infection takes 3 to 5 days to develop after exposure.

When should I see a doctor?

If you experience symptoms that are indicative of herpangina, such as throat or mouth rashes and high fevers, you should visit a doctor.

Summary

Herpangina is an infectious disease caused by Enteroviruses that are part of the Picornavirus family, which affects mainly infants and children between 3 and 10 years old. It is possible to get infected with herpangina by contact with infected people and surfaces or by respiratory droplets.

The main symptoms include mostly exanthemas or ulcers in the mouth, throat and tonsils, and sometimes high fevers. Usually, the disease resolves within 1 to 2 weeks, but there may be rare complications. This disease is managed with the help of prescribed medication such as ibuprofen, acetaminophen, or antiviral sprays. As for the diagnosis, it is performed by looking at the symptoms and sometimes doctors may require a confirmatory test, by identifying the virus using a PCR technique.

References

  1. Liu J, Chen Y, Hu P, Gan L, Tan Q, Huang X, et al. Caregivers: the potential infection resources for the sustaining epidemic of hand, foot, and mouth disease/herpangina in Guangdong, China? Archives of Public Health. 2021 Apr 23;79(1):54. Available from: https://doi.org/10.1186/s13690-021-00574-8
  2. Yao X, Bian LL, Lu WW, Li JX, Mao QY, Wang YP, et al. Epidemiological and etiological characteristics of herpangina and hand foot mouth diseases in Jiangsu, China, 2013–2014. Hum Vaccin Immunother. 2016 Oct 21;13(4):823–30. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5404359/
  3. Zhang X, Jia W, Li P, Song C. Severe Pulmonary Hemorrhage in Herpangina. The Pediatric Infectious Disease Journal. 2023 Apr;42(4):e135. Available from: https://journals.lww.com/pidj/Fulltext/2023/04000/Severe_Pulmonary_Hemorrhage_in_Herpangina.33.aspx
  4. Hu P, Liu J, Gan L, Chen Y, Su K, Chen Y, et al. Lack of effective home quarantine: The cause of the continuing prevalence of hand, foot, and mouth disease in China? Journal of Infection and Public Health. 2020 Jul 1;13(7):963–9. Available from: https://www.sciencedirect.com/science/article/pii/S1876034120304779
  5. de Graaf M, Beck R, Caccio SM, Duim B, Fraaij PL, Le Guyader FS, et al. Sustained fecal-oral human-to-human transmission following a zoonotic event. Current Opinion in Virology. 2017 Feb 1;22:1–6. Available from: https://www.sciencedirect.com/science/article/pii/S1879625716301687
  6. Li W, Gao H hui, Zhang Q, Liu Y jie, Tao R, Cheng Y ping, et al. Large outbreak of herpangina in children caused by enterovirus in summer of 2015 in Hangzhou, China. Sci Rep. 2016 Oct 18;6(1):35388. Available from: https://www.nature.com/articles/srep35388
  7. Kadarikota A, Priyanka JN, Prabhat TS, Chowdhary A, Chaitanya NCSK, Ratna MP, et al. Oral Vesicular Eruptions of Viral Origin in Children - A Medical Management Update. Journal of Datta Meghe Institute of Medical Sciences University. 2021 Dec;16(4):806. Available from: https://journals.lww.com/dmms/Fulltext/2021/16040/Oral_Vesicular_Eruptions_of_Viral_Origin_in.50.aspx
  8. Yu H, Li XW, Liu QB, Deng HL, Liu G, Jiang RM, et al. Diagnosis and treatment of herpangina: Chinese expert consensus. World J Pediatr. 2020 Apr 1;16(2):129–34. Available from: https://doi.org/10.1007/s12519-019-00277-9
  9. Mangan NE, Fung KY. Type I interferons in regulation of mucosal immunity. Immunology & Cell Biology. 2012;90(5):510–9. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1038/icb.2012.13
  10. Park K, Lee B, Baek K, Cheon D, Yeo S, Park J, et al. Enteroviruses isolated from herpangina and hand-foot-and-mouth disease in Korean children. Virology Journal. 2012 Sep 17;9(1):205.  Available from: https://doi.org/10.1186/1743-422X-9-205
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Inês Dias

Mestrado, Biologia Molecular e Genética, Faculdade de Ciências da Universidade de Lisboa

Inês is a scientist in the field of Biomedical Sciences, with a wealth of experience in various laboratory procedures. Her expertise is evident in her work as clinical analysis technician, performing puncture procedures for the collection of biological samples. She has also played a key role in COVID-19 sample processing in a laboratory setting. Recently obtained her master’s in Molecular Biology and Genetics from the Faculty of Sciences at the University of Lisbon.

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