Mouth

Herpangina

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Herpangina, Enteroviral Vesicular Pharyngitis

  • See Also
  1. Hand Foot and Mouth Disease
  2. Oral Ulcer
  • Epidemiology
  1. Occurs in summer months (may be epidemic)
  2. Preschool children and their siblings
  • Pathophysiology
  1. Caused by Enteroviruses in the Picornaviridae family
    1. Echovirus
    2. Coxsackie Virus A
      1. Also causes Hand Foot and Mouth Disease
  2. Picornaviridae
    1. Picornaviridae are a family of non-enveloped (naked) RNA Viruses with an icosahedral capsid
    2. Picornaviridae are linear, Message Sense RNA Viruses (Positive Stranded, +ssRNA)
      1. Message sense RNA (+ssRNA) are identical to Messenger RNA (mRNA)
      2. Like mRNA, +ssRNA may be immediately translated by host ribosomes into Protein
  3. Enterovirus
    1. Enteroviruses infect small intestinal epithelial cells (peyer's patches) and lymphoid cells (Tonsils)
    2. Enteroviruses may also infect other tissue (e.g. Neurons) depending on the specific virus
    3. Transmission in pharyngeal secretions and via fecal-oral route
  • Symptoms
  1. Fever
  2. Dysphagia
  3. Drooling
  4. Vomiting
  5. Headache
  • Signs
  1. Non-toxic appearance
  2. Multiple small 1-2 mm Vesicle or ulcers
    1. Soft Palate, posterior pharynx, Tonsillar Pillars and uvula
    2. Spares the anterior pharynx
    3. Contrast Hand Foot and Mouth Disease which spares the posterior pharynx
  3. No skin lesions
    1. Unlike Hand Foot and Mouth Disease
  • Differential Diagnosis
  1. See Oral Ulcer
  2. Hand Foot and Mouth Disease
    1. Vesicles in anterior pharynx, sparing posterior pharynx
  3. Aphthous Ulcer
  4. Primary Herpetic Gingivostomatitis
    1. External Vesicles are only seen with HSV (not with Herpangina or Hand Foot and Mouth Disease)
  • Course
  1. Illness of 1 week duration with rare complication