Herpangina in Children - An Overview

Introduction

Herpangina is a common viral infection that primarily affects children, causing painful sores and blisters in the mouth and throat. The condition is caused by a group of viruses known as enteroviruses, with coxsackievirus being the most common culprit. Although herpangina can be distressing for both children and parents, it is generally a self-limiting illness that resolves on its own within a week. In this article, we will explore the various aspects of herpangina, including its symptoms, causes, risk factors, and treatment options.

What Are the Symptoms of Herpangina in Children?

The hallmark symptoms of herpangina typically begin to manifest within 3 to 6 days after exposure to the virus. The child may initially experience a sudden onset of fever, often reaching high temperatures, accompanied by general malaise and fatigue. Soon after, the characteristic mouth and throat sores develop. These sores are small, shallow, and grayish-white in appearance, often surrounded by a reddened area. They may hurt, which makes it difficult for the child to eat, drink, or even speak. Sometimes, the sores may also extend to the back of the throat or the tonsils, causing further discomfort.

What Are the Causes of Herpangina?

Herpangina is primarily caused by enteroviruses, particularly coxsackievirus A and, less commonly, coxsackievirus B. These viruses are highly contagious and can spread through various means, such as:

• Direct Contact: Direct contact with an infected person is the most typical method of transmission. This can happen by contact with saliva, nasal discharge, fecal matter, or through respiratory droplets from coughing or sneezing.

• Contaminated Objects: The virus can survive on surfaces and objects for some time. Children can contract herpangina by touching contaminated toys, doorknobs, or other objects and then touching their mouths or faces.

• Fecal-Oral Route: In some cases, the virus can be transmitted through the fecal-oral route, especially when proper hygiene practices are not followed after using the restroom.

What Are the Risk Factors for Herpangina?

Certain factors may increase the likelihood of a child contracting herpangina. These include

• Age: Herpangina primarily affects children between the ages of 3 and 10 years. Younger children may be more susceptible due to their still-developing immune systems.

• Season: The incidence of herpangina tends to be higher during the summer and early fall months.

• Group Settings: Children attending daycare centers, preschools, or schools may have a higher risk of exposure to the virus due to the close proximity and shared objects.

How to Diagnose Herpangina?

A medical expert can typically identify herpangina based on the recognizable symptoms and the emergence of ulcers in the mouth and throat. Laboratory tests are not typically necessary unless the doctor needs to rule out other similar conditions. However, the doctor may prescribe testing, including throat swabs or blood tests, to confirm the virus' presence if the child's symptoms are severe or persistent or if consequences are feared.

What Are the Complications of Herpangina?

In the majority of cases, herpangina is a mild and self-limiting condition that resolves without any complications. However, in some instances, complications may arise, especially if the child's immune system is weakened. Potential complications include the following:

• Dehydration: Painful sores in the mouth can make it difficult for a child to eat and drink, leading to dehydration. Parents should monitor their child's fluid intake and seek medical attention if signs of dehydration, such as dry mouth, decreased urine output, or lethargy, are observed.

• Febrile Seizures: High fever associated with herpangina can, in rare cases, trigger febrile seizures in susceptible children. These seizures are usually brief and do not cause long-term harm, but immediate medical attention is required.

• Viral Meningitis: Although rare, viral meningitis, an infection and inflammation of the membranes protecting the brain and spinal cord, can occasionally result from the herpangina virus. Symptoms of viral meningitis include severe headache, neck stiffness, sensitivity to light, and altered mental status. Prompt medical evaluation is crucial if these symptoms occur.

What Is the Treatment for Herpangina?

As herpangina is caused by a viral infection, antibiotics are ineffective as they only target bacterial infections. The main goals of treatment are to control the symptoms and reduce the child's pain. Some actions that can be helpful are:

• Pain Relief: Acetaminophen or Ibuprofen, two over-the-counter painkillers, can help lower fever and ease the discomfort brought on by mouth sores. However, it is crucial to adhere to the dosing instructions given by the child's doctor.

• Adequate Hydration: Encouraging the child to drink plenty of fluids is crucial to prevent dehydration. Cold, soothing liquids, such as water, milk, ice pops, or ice cream, can be helpful.

• Soft Diet: Offer soft, non-spicy foods that are easier to swallow and less likely to irritate the mouth sores.

• Oral Hygiene: To avoid secondary infections during herpangina, maintaining proper dental hygiene is crucial. However, gentle care should be taken to avoid causing more discomfort.

• Rest: Ensure the child gets plenty of rest to support their immune system during recovery.

How to Prevent Herpangina in Children?

Preventing the spread of herpangina is essential, especially in group settings where children are in close contact with one another. Some preventive measures include the following:

• Hand Hygiene: Encourage kids to often wash their hands with soap and water, particularly after using the lavatory and before eating.

• Avoiding Close Contact: Keep children with herpangina away from others, especially if they have a fever or active mouth sores.

• Disinfecting Commonly Touched Surfaces: Regularly disinfect toys, doorknobs, and other frequently touched objects to minimize the risk of transmission.

• Covering Mouth and Nose: To stop the spread of respiratory droplets, teach kids to cover their mouth and nose with a tissue or elbow while coughing or sneezing.

Conclusion

Herpangina is a common viral infection that affects children, causing painful sores in the mouth and throat. Although it can be distressing for both children and parents, the condition is typically mild and resolves on its own within a week. Proper management of symptoms, including pain relief and ensuring adequate hydration and rest, can help ease the child's discomfort during the recovery process. By implementing preventive measures and promoting good hygiene practices, parents and caregivers can reduce the risk of transmission and create a healthier environment for children in group settings. If a child develops herpangina with severe symptoms or complications, seeking medical attention promptly is essential for appropriate evaluation and care.