What Is Herpangina?
Herpangina is a viral infection. It is characterized by acute febrile illness with small ulcerative or vesicular lesions in the posterior oropharynx. While it mainly affects children, cases have also been reported in newborns, adolescents, and young adults. The disease is highly contagious, with a higher incidence during the summer months. The causative agent is 22 enterovirus serotypes, commonly associated with the Coxsackie B virus serotype. This disease can be linked to an enteroviral exanthem and various neurological conditions like acute flaccid paralysis, aseptic meningitis, and encephalitis. Herpangina predominantly affects toddlers and children below the age of 10, especially those attending daycare or schools with close interactions among children. Though less frequent, adolescents and adults can also contract the condition. Newborns, individuals with compromised immune systems along with pregnant women are at a potentially high risk for life-threatening forms of herpangina.
What Causes Herpangina?
Herpangina was initially identified in the 1920s, but the exact cause was not elucidated until nearly three decades later. The febrile enanthem of herpangina is attributed to various enteroviruses. The most common culprits are Coxsackie A16 virus, Coxsackie B virus, and Enterovirus 71 virus serotypes. Other agents like echovirus, adenovirus, parechovirus, and herpes simplex virus have also been mentioned in different sources. Enteroviruses are small, non-enveloped, single positive-strand RNA viruses with the capability to survive within a broad pH range and remain infectious even at high temperatures, up to 122°Fahreinheit. They can persist in the environment for extended periods and solely infect humans, being the natural host for these viruses.
Typically, enteroviruses spread via the fecal-oral route, but transmission can also occur through ingesting infected saliva, respiratory droplets, or direct contact with vesicle fluid. The incubation period lasts from three to five days, and viral shedding may happen even in asymptomatic patients. Respiratory viral shedding can continue for up to three weeks, while in the stool, it can persist for up to eight weeks. The peak contagiousness occurs during the first one to two weeks of infection.
Of all the enteroviruses involved in causing herpangina, enterovirus 71 is raising concerns in public health. It is due to its association with encephalitis (inflammation of the brain), severe illness, encephalomyelitis (inflammation of the brain and spinal cord that destroys the myelin sheath), and potential fatalities in newborns and young children.
What Are the Serious Health Complications Caused by Herpangina?
Herpangina cannot be treated or cured directly, but medications can help alleviate symptoms and potentially shorten their duration. Typically, the virus and associated symptoms will resolve on their own within a week to 10 days. However, in rare cases, serious complications may arise. If a fever exceeding 103°Fahreinheit (39°Celsius) persists or does not improve, or have mouth sores or a sore throat lasting for more than five days, it is essential to contact a doctor promptly. In particular, be vigilant for signs of dehydration, such as dry mouth, reduced tear production, fatigue, decreased urine output, dark urine, and sunken eyes. Dehydration is a common complication of herpangina. To prevent this, it is crucial to provide proper care and ensure regular hydration. If any concerning symptoms or complications arise, seeking medical attention is crucial for appropriate management.
Herpangina is typically a mild condition, but certain causative microorganisms, like enterovirus 71, can lead to severe complications, which may include:
Acute Flaccid Paralysis - Acute flaccid paralysis (AFP) is a condition characterized by a sudden onset of weakness or loss of muscle tone in one or more limbs. It can affect the arms, legs, or both and can lead to difficulty in moving or performing voluntary muscle movements. AFP can be caused by various factors, including viral infections, neurological disorders, and other medical conditions. One of the notable causes of AFP is poliovirus infection, which can lead to poliomyelitis, a potentially severe and disabling disease. Other viruses, such as enteroviruses and certain strains of adenovirus, can also cause AFP. AFP is a medical emergency, and anyone experiencing sudden weakness or paralysis should seek immediate medical attention. Prompt evaluation and diagnosis are essential to determine the underlying cause and initiate appropriate treatment. In cases where AFP is caused by a viral infection, supportive care, physical therapy, and rehabilitation may be necessary to aid recovery and regain muscle function. Vaccination against poliovirus has been successful in significantly reducing polio-related AFP cases worldwide, but it remains essential to monitor and manage AFP cases effectively to prevent potential outbreaks.
Brain Stem Encephalitis - Brain stem encephalitis is a serious condition characterized by inflammation and swelling of the brain stem. The brain stem is that part of the brain, which connects the cerebrum and cerebellum to the spinal cord. It plays a vital role in controlling many essential functions, such as breathing, heart rate, blood pressure, and consciousness. The condition is typically caused by viral infections, although it can also be triggered by certain bacterial or autoimmune diseases. Common viral causes include enteroviruses, herpes simplex virus, and West Nile virus, among others.
Myocarditis - It is a medical condition characterized by inflammation of the myocardium. Myocardium is the muscular tissue of the heart. The inflammation can affect its ability to pump blood effectively, weaken the heart muscle, and lead to various cardiac complications. Causes of myocarditis may include viral infections, bacterial infections, certain medications, exposure to toxins, autoimmune disorders, or as a result of an allergic reaction to certain substances. Viral infections, particularly from enteroviruses, adenoviruses, or parvovirus B19, are among the most common causes of myocarditis.
Aseptic Meningitis - It is a condition characterized by inflammation of the meninges. They are the protective membranes surrounding the brain and spinal cord. The term aseptic means that the inflammation is not caused by bacteria, as is the case in bacterial meningitis, but rather by viruses or other non-bacterial agents. Causes of aseptic meningitis include various viral infections, such as enteroviruses (e.g., Coxsackievirus, echovirus), herpes simplex virus, mumps virus, and others. It can also be caused by non-infectious factors, including certain medications, autoimmune diseases, or chemical irritants.
Conclusion
Enterovirus 71 (EV71) has been associated with severe neurological complications, including brain stem encephalitis, acute flaccid paralysis, and aseptic meningitis. These complications are rare, but they are more likely to occur with certain strains of enteroviruses. In order to decrease the risk of complications and create a smooth recovery from herpangina, it's essential to provide adequate care, including proper hydration and pain relief, to manage discomfort during swallowing. If a child or individual shows signs of severe illness, neurological symptoms, or signs of dehydration, reaching out to get medical attention is necessary for proper evaluation and management.
