Herpangina (enteroviral vesicular pharyngitis, herpetic tonsillitis, herpangina or ulcerous tonsillitis) is an acute infectious disease that is accompanied by a sharp rise in body temperature, swallowing disorder (dysphagia) and pharyngitis. Muscle pain in the abdomen, nausea and vomiting are possible. A distinctive feature of the disease is small reddish bubbles with serous fluid (vesicles) rising above the surface of the mucosa, which appear in the area of ​​the soft palate, palatine arches, tonsils, uvula and posterior wall of the pharynx.

ICD-10	B08.5
ICD-9	074.0
DiseasesDB	30777
MedlinePlus	000969
eMedicine	med/1004 article/218502
MeSH	D006557

General information

Herpetic sore throat was first described in 1920 by T. Zagorsky.

Since this infectious disease resembled a herpetic rash in the type of rash, and the origin of the disease was associated with the herpes virus, this form of sore throat began to be called herpetic. Subsequently, the pathogen was identified - in 1948, the Coxsackie virus of group A was discovered, in 1949 - the Coxsackie virus of group B, and when studying polio, viruses of the ECHO group were discovered in 1941. All these viruses belong to the group of enteroviruses, but herpetic tonsillitis has retained its name unchanged.

Enteroviruses are ubiquitous and infection occurs year-round, but the northern hemisphere is characterized by an outbreak of incidence in the summer-autumn period, and in tropical latitudes there is no such seasonality.

Infection with enterovirus is observed in all age groups, but the frequency of spread depends on age - about 75% of registered cases of enterovirus infection occur in children under 15 years of age. At the same time, herpetic sore throat in children under one year of age is recorded more often than among children of the older age group. Boys suffer from enterovirus infection more often than girls.

Enteroviruses of the same type can cause both mild forms of the disease, in which the respiratory tract is affected, and severe forms, affecting the cardiovascular or nervous system.

Diseases can be either isolated or cause an epidemic.

Reasons for development

Herpangina is caused by human enteroviruses of the following types:

• Coxsackie A (serotypes 2-8,10,12,14,16);
• Coxsackie B (serotypes 3,4);
• ECHO (relatively rare).

Herpangina is most often provoked by the Coxsackie virus group A (serotypes 2-6, 8, 10).

The natural reservoir for viruses of this group are:

• Soil, food and water, since enteroviruses are resistant to many environmental factors. Thus, in wastewater at zero temperature, the virus persists for a month, and to inactivate it in sour cream, milk or butter, products must be kept at a temperature of 56 ° C for at least 30 minutes.
• Human body. The source of infection can be either a patient or a virus carrier - this infection can cause a “healthy virus carrier” in a person, in which the virus is released into the external environment for several weeks.

It is thanks to “healthy virus carriage” that the virus persists in the human population with a high level of natural immunity in people over 5 years of age (the older the age, the more immune individuals in this age group).

Enterovirus infection, manifested in various forms of the disease (herpangina, epidemic exanthema, etc.) is a common cause of nosocomial viral infections.
The level of natural immunity by the age of 5 in some areas is above 90%, but healthy children in 7–20% of cases are carriers of the virus, and in children under one year of age this percentage is 32.6.

Herpangina in adults is extremely rare, since 30-80% of people over 16 years of age have antibodies to the most common serotypes that cause this disease.

The route of transmission of infection can be:

• Fecal-oral. It is realized through contact and household (due to household items), food (infected food) and water (contaminated water) routes. Direct contact with infected feces occurs during diaper changing in infants, making infants one of the most active transmitters of infection.
• Airborne. Seen less frequently. This route is associated with the evacuation of the virus from the respiratory tract into the intestine during the process of swallowing, after which the development of the infectious process, traditional for enteroviruses, occurs.
• Transplacental (from mother to fetus). When infected in this way, herpetic tonsillitis does not develop, and the route of infection itself is observed quite rarely.

For the spread of infection, contact with contaminated objects or hands of a patient (virus carrier) and subsequent introduction of the virus through the mouth, nose or eyes is important.

Infection is possible when sewage enters public bathing areas.

According to research, in half of the cases in family contacts with a patient who is most contagious in the first week of illness, secondary infections are observed (the disease develops against the background of another infectious disease).

Herpangina and other forms of enterovirus infection are more often observed in regions characterized by low social and hygienic levels.

Pathogenesis

The mechanism of development of all diseases caused by enteroviruses is identical.

The infection enters the body, penetrating the mucous membranes of the mouth, upper respiratory tract and intestines. Since this type of virus does not have an outer protein shell, they easily overcome the “gastric barrier” and settle on the mucous membrane in the small intestine. It is thanks to this feature that a large and diverse group of viruses received a single taxonomic name (enterovirus).

The virus subsequently multiplies in lymphoid tissue, mesenteric (mesenteric) lymph nodes and in intestinal epithelial cells. On approximately the third day of illness, the virus enters the blood and spreads throughout the body (primary viremia). The cells of muscle tissue and the central nervous system suffer the most, but the vessels of the eyes, tissues of the lungs, heart, intestines, liver, pancreas and kidneys are also involved to varying degrees in the pathological process. In each affected organ, swelling, foci of inflammation and necrosis are detected.

Whether a patient will develop herpetic sore throat when infected with an enterovirus, or whether other clinical manifestations will be observed, depends on the biological properties of a particular type of virus and its ability to infect a certain type of body cell (predominant tropism).

Coxsackie A viruses can provoke not only herpangina, but also muscle damage in combination with flaccid paralysis, and Coxsackie B viruses can cause central paralysis in the absence of muscle pathology.

The form of the disease, its nature and its outcome are influenced by the state of immunity (cellular and humoral).

A person who has suffered an enterovirus infection develops type-specific immunity that lasts for a long time (lifelong immunity is possible).

Symptoms

The onset of the disease is preceded by an incubation period, which is 1-2 weeks, but often this period does not exceed 3 days.

Herpetic sore throat begins acutely. Observed:

• flu-like syndrome, including fever up to 41 °C, body aches, headache and muscle pain, chills;
• decreased appetite;
• weakness and irritability;
• hyperemia affecting the mucous membrane of the soft palate, uvula, tonsils and palatine arches;
• pain in the nasopharynx and pharynx, accompanied by difficulty swallowing;
• runny nose;
• the appearance of rashes in the throat.

First, in the pharynx, papules (1-2 mm in diameter) rise above the mucosa and are surrounded by a red rim, which then transform into vesicles with serous contents (vesicles).

After a day or two, the vesicles open and in their place erosions, covered with a gray-white coating, form. Moreover, the more severe herpangina occurs, the more rashes appear. The elements of the rash gradually dry out and crusts form, but when bacterial infections are attached, suppuration is possible. These pathological changes disappear within 7 days.

Elevated to febrile temperatures with herpangina lasts 1-3 days.

Herpetic tonsillitis is also accompanied by bilateral enlargement of the tonsillar and submandibular lymph nodes.

Severe disease in some cases is characterized by nausea, vomiting and diarrhea.

Diagnostics

Diagnosis for herpetic sore throat includes:

• medical history and general examination;
• pharyngoscopy, which allows you to detect hyperemia of the mucous membrane and rashes in the pharynx area;
• a blood test that reveals moderate leukocytosis;
• virological and serological studies that help identify the pathogen.

For virological and serological studies during the first 3-5 days of the disease (during the period of intensive reproduction of the virus), the following is taken:

• Pharyngeal washes. A sterile saline solution is used, with which the patient must gargle three times, spitting the liquid into a sterile wide-necked jar. Take 10 - 15 ml per rinse. solution. Then the back wall of the throat is wiped with pieces of sterile cotton wool (taken with tweezers), and then this cotton wool is placed in the same jar.
• Feces.

The collected material is sent to the laboratory, where after infecting a cell culture or by infecting newborn white mice, it is possible to identify the type of enterovirus.

The belonging of the virus to serovars is determined using specific neutralizing sera due to:

• RSK (complement fixation reaction). The corresponding antigens and antibodies, thanks to the serum containing complement (C), form an immune complex.
• RTGA (virus neutralization reactions). The presence of antihemagglutinins in serum slows down the activity of viruses.
• IRHA (indirect hemagglutination reaction), based on the ability of erythrocytes with antibodies pre-adsorbed on their surface to agglutinate in the presence of corresponding antigens or homologous sera.

Since herpetic tonsillitis in most cases is caused by Coxsackie viruses, and type A does not adapt well to tissue culture, in the presence of degenerative changes in cells, the type of virus is determined by the immunofluorescent method. With this method, the reagent is labeled with a dye that glows in ultraviolet rays, so that glowing antigen-antibody complexes can be viewed using a fluorescent microscope.

Coxsackievirus group A or B is determined due to pathological changes in mice - type A is characterized by the presence of flaccid paralysis without encephalitis, and with type B paralysis is accompanied by convulsions.

Since herpangina in children resembles a herpetic infection in the nature of the rash, the following must be taken into account in differential diagnosis:

• Age of the sick child.
• Seasonality of the disease.
• Type and localization of the rash in the oral cavity. Herpetic sore throat is not accompanied by bleeding of the mucous membrane and inflammation of the gums, and there are no rashes on the skin of the face.

Treatment

Treatment of herpetic sore throat is exclusively symptomatic, since there is no specific therapy for infection with enteroviruses.

Patients are required to be isolated. Since herpangina in children is accompanied by difficulty swallowing, to avoid additional irritation of the oral mucosa, food must be served to patients in liquid or semi-liquid form.

Conducted:

• Local therapy, including aerosol antiseptics (hexoral, ingalipt) and proteolytic enzymes (trypsin, which has anti-inflammatory, regenerating and decongestant effects, or chymopsin, chymotrypsin).
• Hyposensitizing therapy, in which antihistamines are prescribed (suprastin, diazolin, fenkarol, etc.).

Also assigned:

• antipyretics;
• antiviral drugs (leukocyte interferon);
• 2% lidocaine solution for rinsing (local anesthetic used to treat herpetic sore throat in adults);
• anti-inflammatory and wound-healing agents (panthenol, Vinisol, faringosept);
• vitamins B and C.

Treatment of herpetic sore throat in young children does not require the use of aerosols, so sage decoction and Castellani liquid are used to treat the baby’s mouth.

During treatment it is necessary to maintain a drinking regime.

After treatment:

• rational nutrition should be organized;
• Immunomodulators (Immunal, etc.) are prescribed for preventive purposes.

Possible complications

Herpetic sore throat is not accompanied by relapses due to the developed strong immunity to this type of virus, but the disease, when the inflammatory process generalizes, can cause complications such as:

• myocarditis, in which the heart muscle becomes inflamed;
• meningitis, which is characterized by damage to the membranes of the spinal cord and brain;
• encephalitis, in which inflammation affects the brain.

Prevention

Herpangina is a contagious disease, therefore the main preventive measure is the isolation of the first sick people at the initial stage of the disease.

Since herpetic sore throat is transmitted in most cases through household contact, it is necessary to maintain hygiene, and if there is a patient in the family, use ultraviolet irradiation if possible. You can also do wet cleaning using a chlorine solution at a concentration of 0.3-0.5 mg/l.

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General information

The infectious disease, which is herpetic sore throat, like other representatives of this category of diseases, most actively affects human bodies in the autumn and spring periods. The disease tends to manifest itself in various symptoms, but almost all patients experience problems with swallowing and a high rise in body temperature. Compared to adults, children suffer from herpetic sore throat much more often; the main reason is the child’s body unprotected from exposure to pathogens and a weakened immune system.

What is herpangina?

Herpangina (aphthous, vesicular pharyngitis) or herpetic tonsillitis is one of the types of respiratory tract diseases. Children under 3 years of age have the most difficulty coping with the disease; in general, older children and adults can cope with the disease provided they receive proper treatment and care quickly and without complications.

The disease occurs due to infection with one of the pathogens. It is not uncommon for herpetic sore throat to become an epidemic, spreading most actively in children's institutions and other crowded places.

The causative agent of herpangina

The main causative agent of herpetic sore throat are representatives of enteroviruses, or rather the Coxsackie virus of groups A and B, as well as a group belonging to the category of serotypes (2-4; 6; 8; 10). Less commonly, infection with the disease is provoked by the ESNO virus.

In very rare cases, the causative agent of the disease is a common herpes virus, but this fact must also be taken into account when diagnosing. In other words, any carrier of the herpes virus can provoke infection with the disease.

How does infection occur?

You can become infected with herpangina in three main ways: by consuming food that has not undergone special heat treatment, fecal or oral, and airborne transmission (airborne). Penetrating the surface of the mucous membrane of the respiratory system, the pathogen reaches places with ideal conditions for reproduction, namely areas of the lymph nodes and intestinal walls. The ability to overcome various barriers and settle on the surface of the mucous membrane of the small intestine is characteristic of viruses of the toxonomic group (enteroviruses).

After penetration, which due to the absence of an outer protein shell does not present any particular difficulty for infection, the pathogen, having established itself on the lymphatic and mesenteric nodes, as well as penetrating the epithelial cells of the intestine and lymphoid tissue, begins to actively multiply.

The peak activity of the pathogen occurs on the second or third day, during which the amount of viruses necessary for penetration into the blood is formed. After entering the bloodstream, the final phase of infection begins: the viruses, having gained access to muscle and nervous tissue, enter the active stage of the disease. In rare cases, the incubation period can be prolonged (up to 10 days), but generally on the 3-4th day the disease begins to enter the active phase of development.

Symptoms of herpetic sore throat

In children and adults, the disease may manifest itself differently, but the general symptoms manifest themselves in the same way:

• Swelling of the nasopharyngeal mucosa.
• Pain when swallowing.
• My head hurts.
• A sharp increase in temperature.
• The presence of a red rash in the throat, followed by the appearance of blisters.

During the period of sore throat development, children's appetite decreases, they may almost completely refuse to eat due to difficulty swallowing, and they may develop a cough and runny nose. In adults, some of the symptoms, except for the main ones, may not appear at all. Cases when a patient is bothered only by a sore throat are far from an isolated manifestation.

State

The condition of a patient with herpetic sore throat is conventionally divided into two stages, and this manifestation is very characteristic of the disease. Initially, pain is felt in the areas of inflammation, often the body temperature rises to 400C or higher, and the patient himself has difficulty swallowing solid food. A little later, the pain decreases slightly, this is due to the fact that the red rash in the throat area is independently destroyed. The damaged integrity of the membrane of the vesicles turns into a state of formation of small ulcers, which gradually heal and heal, while simultaneously reducing pain.

When the patient completes the process of destroying the bubbles that were previously filled with liquid, an increase in the volume of saliva secreted is observed. This phenomenon is fraught with consequences for other people, since a patient in this condition is a carrier of infection. Saliva saturated with viruses quickly multiplies when sneezing and coughing, which leads to massive infection of people nearby.

Herpangina rash

One of the symptoms characteristic of herpangina is the presence of rashes in the throat and mouth. The rash, gradually spreading, contributes to the development of an inflammatory process that affects the base of the palate and tonsils.

Almost immediately, in places of redness, a mass of bubbles forms, inside of which there is liquid. The rash makes it difficult to swallow, a sharp increase in temperature is observed, and patients complain of a sore throat. After 30-40 hours, after the first manifestations, the bubbles turn from transparent to dull, which, soon collapsing, release particles of viral infection into the oral cavity, thereby forming a focus of infection that is most dangerous for people around the patient.

Features in children and adults

The disease can affect both children and adults; the virus affects the body of children much more often. According to statistics, boys become infected with the virus twice as often as girls, and this feature is also characteristic of the disease. The general symptoms of the disease are expressed by the presence of fever, difficulty swallowing, and pain in places where inflammatory processes are present.

In children, the disease initially proceeds violently: a jump in temperature and immediate manifestation of other symptoms; in adults, only a slight rise in body temperature can be observed, and then everything takes on a blurred format. Children under three years of age may have flu-like symptoms: body and bone aches, malaise, nausea, diarrhea, vomiting.

Common symptoms of tonsillitis are toxicosis, dyspepsia, and abdominal pain. Manifestations in the form of rashes are observed in all patients, but in children with atypical tonsillitis, the symptom may additionally appear on the palms and soles. Most often, tonsillitis affects children under 10 years of age; the disease is most severely suffered by children under 3 years of age. Infants up to six months old, due to the influence of maternal antibodies, which still protect the child, get sick extremely rarely.

Diagnosis of herpangina

The disease is pre-diagnosed based on the symptoms of the disease; only a therapist or pediatrician can immediately and relatively accurately determine the type of sore throat without undergoing tests. To study and determine the type of virus that has infected the patient, material is collected from the oral cavity using a rinsing procedure or taking a smear.

The first test is scheduled in the first days, blood is given again (up to 3 weeks) to determine the presence of the pathogen and the presence of antibodies. A serological examination will help to accurately determine the patient’s condition. If at the time of the study there is an outbreak of mass herpangina diseases, this factor should be taken into account by the doctor first.

What to pay attention to

If in the observed region the disease has become widespread, or there are individuals in the family or group who have recently had or continue to have tonsillitis, these factors are paid attention to first.

The primary factor that will help to correctly diagnose is the presence of symptoms, and especially those that clearly indicate a particular disease. It is important not to confuse herpangina with other similar diseases: influenza, ARVI, intestinal diseases, due to the similarity of factors and symptoms.

Which doctor should I contact?

When treating herpetic sore throat in infants, the baby is hospitalized for the period of illness, where he and his mother remain until complete recovery. Children aged three years and older at the time of illness are monitored by a children's doctor (pediatrician) who, together with other specialists (allergist and ENT doctor), monitor the child's condition until complete recovery, while the sick person is isolated from contact with other children.

In adults, the disease does not require special treatment; the usual types of medications for this case are used: antiviral, antibiotics, antiallergic. All medications must be prescribed by a specialist, but regardless of this, patients are prescribed constant gargling and mouth rinsing. For children, immunomodulatory drugs are prescribed at the end of treatment.

What tests should I take?

A full diagnosis of the disease is carried out using a number of studies:

• Blood donation. The material is studied for the number of leukocytes in the blood. Moderate leukocytosis indicates the presence of a pathogen in the blood.
• Serological and virological studies to identify and determine the type of pathogen.
• Feces.
• Pharyngeal rinse. Using a special solution, the patient rinses the mouth and spits the material into a sterile glass container.

Possible complications

Self-treatment of such diseases is widely practiced among the people, often even without proper diagnosis by a specialist. Like other infectious diseases, herpangina, if the patient is not cared for correctly and treatment is not carried out in a timely manner, is fraught with complications:

• Pyelonephritis. Children, especially girls, are most often affected by the disease.
• Meningitis. This implies the development of a viral type of disease, as a consequence of inflammatory processes caused by exposure to group A Coxsackie viruses.
• Encephalitis. The complication has similar symptoms, the repeated manifestation of which at the very beginning is occasionally perceived instead of a complication as a secondary phase of angina.
• Rheumatism. The disease develops against the background of inflammatory processes, which in essence is a kind of allergic reaction to the activity of infection in the body.

Treatment of herpetic sore throat

Children diagnosed with herpetic sore throat are placed on inpatient treatment only if the child has not reached 3 years of age; in most cases, children are treated on an outpatient basis, at home.

Medicines should be prescribed by a specialist; the basis of treatment is the following categories of medicines:

• Antiviral. Drugs are prescribed from the onset of the first moments of the disease. In early manifestations of tonsillitis, the drug group is especially good at inhibiting the further development of viruses.
• Antipyretic. The medicine helps improve the child's general condition by controlling symptoms.
• Antiallergic. The drug is prescribed by a specialist based on the characteristics of the treatment of sore throat.
• Medicines for topical use. It is intended to use solutions to wash out the infection by rinsing.
• Use of physical therapy.
• Immunomodulatory drugs. Prescribed at the end of treatment.

Antibiotics for the treatment of sore throat are prescribed only if the sore throat threatens to change from viral etiology to diseases that are caused by complications.

When treating herpetic sore throat in adults, the following types of drugs are used:

• Desensitizers and antigestamines. To relieve pain and improve the condition, it is recommended to use “Diazolin”, “Suprastin”.
• “Viferon, or “Acyclovir”, both drugs are drugs from the group of drugs that counteract the formation of ulcers with subsequent treatment of manifestations.

During the treatment process, it is recommended to drink plenty of fortified drinks: juices, compotes. For both adults and children, when treating a sore throat, it is recommended to eat soft, easily digestible foods. In addition to making it difficult to swallow, solid food can cause mechanical damage to the back of the throat in the form of scratches, so it is recommended to cook liquid porridges, jelly, light soups, rich meat and chicken broths at the time of treatment.

Preventive measures

A contagious disease, which includes herpangina, requires the use of a period of isolation of the patient in relation to other family members.

The main preventive action is strict adherence to the rules of personal hygiene. The room where the patient is located must be regularly ventilated and wet cleaned. There are a number of folk remedies that can be used to cleanse a room of harmful microorganisms. Traditional healers advise placing finely chopped garlic in the room; this remedy actively fights viruses.

Every year, hundreds of Ukrainian children become infected with enterovirus infections, which manifest themselves in the form of rashes and sores on the hands, soles of the feet, mouth and throat against the background of a rise in body temperature to +38°C or more. Infection occurs most often in the summer at beach resorts. Many people infected with enteroviruses experience the disease with minimal complaints or are completely asymptomatic, but can remain carriers of the viruses for several months. An infection that has entered the body usually disappears within 5-10 days on its own without any special treatment. Enterovirus infections are transmitted by airborne droplets or fecal-oral routes. Most often they affect children under the age of 10 years (children under the age of 5 are especially susceptible to these diseases).

There are typical and atypical forms of enteroviral infections. Typical forms of infection include herpangina, exanthema, epidemic myalgia and aseptic serous meningitis. Atypical - uveitis, pancreatitis, nephritis, encephalomyocarditis of newborns, mixed infections.

Symptoms of enterovirus infection

They begin to appear approximately 3-7 days after the first contact with the virus. The symptoms are quite varied: nausea, vomiting, watery stools up to 10 times a day, various rashes. Body temperature is high, sometimes up to 40 degrees. Usually 1-2 days after the end of the fever, a rash appears on the arms, legs, and mouth in the form of red spots with blisters (vesicles).

The rash on the skin may resemble chickenpox, and in the mouth - (it is important to remember that these diseases are caused by various pathogens, and the herpes virus has nothing to do with enterovirus infection, so in the latter case it is useless to lubricate the blistering rashes with acyclovir ointment). Other symptoms of this disease: loss of appetite, headache, ulcers in the mouth, tongue, and throat. Sometimes patients may have almost no symptoms of the disease, but at this time they are still a source of infection of the virus to other people.

Most often, enteroviruses cause diseases in children, as well as in patients with weakened immune systems. In both cases, patients may have a fever and sore throat, followed by mouth sores a few days later.

Complications resulting from enterovirus infection occur rarely, and the disease usually goes away on its own, but there are exceptions. Sometimes dehydration occurs and a secondary bacterial infection develops. Very rarely, meningitis, encephalitis, acute flaccid paralysis, and heart damage may develop

Treatment and prevention of enterovirus infection

There are no special medications for the treatment of enterovirus infection. There is also no vaccine against these diseases. The disease goes away on its own in 3-10 days (sometimes two weeks). It is not recommended to use antibiotics, antivirals, etc., since in this case they do not bring benefit, but, on the contrary, can even cause harm. Therefore, doctors advise that in case of enteroviral exanthemas, relieve pain, ease the patient’s well-being with the help of non-steroidal anti-inflammatory drugs and rinsing the mouth with a special solution, prevent dehydration (drink plenty of fluids), and also monitor for complications (if they appear, consult a doctor immediately). The best prevention of enterovirus infection is to avoid contact with infected people, disinfect objects that may have the virus and, of course, drink only boiled or bottled water. You should also wash your hands regularly with soap and hot water.

Herpangina is one of the infectious diseases of a viral nature caused by a group of enteroviruses, in particular Coxsackie viruses, along with hand-foot-mouth syndrome. Often, in this regard, misunderstandings arise between patients and doctors when a diagnosis of herpangina is made, and the patient insists on a second diagnosis. Let's figure out what the difference is and what treatment will be prescribed.

Causes of herpangina

The direct cause of herpetic sore throat is not the herpes virus, as the name might suggest, but enteroviruses, most often the Coxsackie A viruses (serotypes 2, 3, 4, 6, 7) and Coxsackie B (serotype 3).

The source of infection is a sick person or a virus carrier. Transmission of infection occurs through airborne droplets and fecal-oral routes.

The patient is contagious from the onset of the disease until the 7-8th day of illness. Further, virus shedding decreases sharply. A couple of days after all symptoms of the disease have disappeared, the patient is considered not dangerous to others.

The disease is widespread, especially in crowded places (resorts), and both sporadic cases and outbreaks and epidemics are observed.

Mostly children and young people are affected.

Immunity after an illness is stable, long-lasting, but type-specific. That is, it is possible to be re-infected with a Coxsackie virus of another group or another serotype.

Herpangina symptoms

Clinical symptoms of diseases caused by the Coxsackie virus are extremely diverse, but at the same time, methods of diagnosis, treatment, prognosis and prevention have much in common.

Herpangina begins suddenly with a rise in body temperature to 39-40°C. The temperature can persist for 2-3 days, and then drops critically below normal. Sometimes, during the peak of the rise in temperature, vomiting appears, and there may be cramping pain in the abdomen. At this stage, herpangina is confused with ARVI or intestinal infection.

Along with the temperature, a sore throat appears. On the 1st-2nd day of illness, small papules with a diameter of 1-2 mm appear on the hyperemic mucous membrane of the palatine arches, uvula, tonsils, soft and hard palate, and tongue, which quickly turn into vesicles. After 2-3 days, the bubbles burst, and erosions, covered with a grayish-white coating, form at their bottom. Around them there is a narrow border of hyperemia (redness). The appearance of bubbles and erosions is accompanied by moderate pain when swallowing, but in some cases these pains are excruciating and are accompanied by profuse salivation, especially in children. Possible enlargement of regional lymph nodes.

By the 4-7th day of illness, in most patients, changes in the pharynx disappear, and spontaneous recovery occurs. Erosion in the oral cavity does not leave any traces after disappearing.

Among Russian doctors, there is confusion in differentiating herpangina directly from hand-foot-mouth syndrome. If the rash in the mouth is accompanied by skin rashes on the feet and hands, and the mouth ulcers do not extend to the surface of the tonsils, this is most likely hand-foot-mouth syndrome, caused by the same viruses, but of different serotypes. In the oral cavity, blisters and ulcerations are localized on the tongue, gums, soft palate, and buccal mucosa. In some cases, rashes are also accompanied by a rise in body temperature. The disease, like herpangina, is usually mild and ends on the 6-7th day. True, the damaging effect of the disease on the nails has been noticed, which manifests itself weeks after recovery.

A severe clinical picture and high mortality are observed only with neonatal myocarditis caused by the Coxsackie virus.

Diagnosis of herpangina

Diagnosis of herpangina is difficult due to the fact that many viral diseases of the pharynx have similar symptoms in the initial stages, and only as the disease develops do they acquire their own characteristics, which are also not always easily distinguishable.

Definitive diagnosis is possible only by isolating the virus from feces and swabs from the patient’s throat and determining the titer of antibodies to this virus in the blood, as well as using the immunofluorescence method, which is used to determine the presence of specific viral antigens in the test materials, as well as serological studies (neutralization reaction, complement fixation reaction, hemagglutination inhibition reaction).

But since there is no fundamental difference in the serotype of the virus for treatment, such tests become meaningless and are only applicable for collecting medical statistics on viral diseases, and without analysis, the doctor is only authorized to write a diagnosis of herpangina.

Treatment of herpetic sore throat

Treatment of herpangina is practically no different from the treatment of any other uncomplicated viral tonsillitis and pharyngitis.

Treatment is mainly symptomatic: rinses, painkillers, vitamins.

Patients with severe symptoms of intoxication, Coxsackie meningitis or myocarditis are subject to hospitalization; other patients are isolated at home. A gentle regimen, easily digestible food rich in vitamins, and plenty of fluids are prescribed.

For severe headaches and muscle pain, analgesics are prescribed; for high body temperature, antipyretics are prescribed. Prescribe B vitamins, high doses of vitamin C, antihistamines (diphenhydramine, pinolfen, suprastin, calcium supplements). The effect of immunomodulators in enterovirus infections has not been studied in detail, but they may be prescribed at the discretion of the physician.

In case of severe intoxication, detoxification treatment is carried out, but only in a hospital setting (intravenous water-salt solutions and glucose).

Recovery prognosis

The prognosis, with the exception of complications with encephalitis and myocarditis of newborns, is favorable.

Prevention of herpangina

Prevention of herpangina includes generally accepted collective and individual measures to prevent infection from getting into food products, contact of healthy people with sick people, and identification of virus carriers. The rules are simple: wash your hands before eating, wash fruits and vegetables well, do not swallow water in ponds and swimming pools. No specific prevention has been developed.

Acute, virus-induced damage to the lymphoid tissue of the pharynx, caused by the Coxsackie and ECHO viruses. Herpetic sore throat in children occurs with a rise in temperature, sore throat, lymphadenopathy, hyperemia of the pharynx, vesicular rashes and erosions on the tonsils and the back wall of the pharynx. Herpetic sore throat in children is diagnosed by a pediatric otolaryngologist based on examination of the pharynx, virological and serological examination of nasopharyngeal swabs. Treatment of herpetic sore throat in children includes taking antiviral, antipyretic, desensitizing drugs; local treatment of the oral mucosa, ultraviolet radiation.

General information

Herpangina in children (herpangina, herpetic tonsillitis, vesicular or aphthous pharyngitis) is a serous inflammation of the palatine tonsils caused by Coxsackie enteroviruses or ECHO. Herpetic sore throat in children can be a sporadic disease or an epidemic outbreak. In pediatrics and pediatric otolaryngology, herpetic sore throat is predominantly found in children of preschool and primary school age (3-10 years); Herpangina is most severe in children under 3 years of age. In children in the first months of life, herpetic sore throat occurs less frequently, which is associated with the receipt of appropriate antibodies from the mother along with breast milk (passive immunity).

Herpetic sore throat in a child can occur either in isolated form or in combination with enteroviral serous meningitis, encephalitis, epidemic myalgia, myelitis, also caused by these viruses.

Causes of herpetic sore throat in children

Herpangina in children is one of the viral diseases caused by enteroviruses from the picornavirus family - Coxsackie group A (usually viruses of serovars 2-6, 8 and 10), Coxsackie group B (serotypes 1−5) or ECHO viruses (3, 6, 9 , 25).

The mechanism of transmission of pathogens is airborne (when sneezing, coughing or talking), less often fecal-oral (through food, pacifiers, toys, dirty hands, etc.) or contact (through nasopharyngeal discharge). The main natural reservoir is a virus carrier or a sick person; less often, infection occurs from domestic animals. Convalescents can also serve as sources of infection, since they continue to release the virus for 3-4 weeks. The peak incidence of herpetic sore throat in children occurs in June-September. The disease is highly contagious, so in the summer-autumn period there are often outbreaks of herpetic sore throat in children within families or organized groups (camps, kindergartens, school classes).

Penetrating into the body through the mucous membranes of the nasopharynx, the causative agents of herpetic sore throat in children enter the intestinal lymph nodes, where they actively multiply and then penetrate into the blood, causing the development of viremia. The subsequent spread of viral pathogens is determined by their properties and the state of the child’s body’s defense mechanisms. Together with the bloodstream, viruses spread throughout the body, fixing themselves in certain tissues, causing inflammatory, dystrophic and necrotic processes in them. Enteroviruses Coxsackie and ECHO have high tropism for mucous membranes, muscles (including myocardium), and nervous tissue.

Often, herpetic sore throat in children develops against the background of influenza or adenovirus infection. After suffering from herpangina, children develop stable immunity to this strain of the virus, but when infected with another type of virus, herpangina may occur again.

Symptoms of herpetic sore throat in children

The latent period of infection ranges from 7 to 14 days. Herpetic sore throat in children begins with a flu-like syndrome: malaise, weakness, loss of appetite. Characterized by high fever (up to 39−40°C), pain in the muscles of the limbs, back, and abdomen; headache, vomiting, diarrhea. Following the general symptoms, sore throat, drooling, pain when swallowing, acute rhinitis, and cough appear.

With herpetic sore throat in children, local changes quickly increase. Already in the first two days, against the background of hyperemic mucosa of the tonsils, palatine arches, uvula, and palate, small papules are found in the oral cavity, which quickly turn into vesicles with a diameter of up to 5 mm, filled with serous contents. After 1-2 days, the blisters open, and in their place whitish-gray ulcers are formed, surrounded by a halo of hyperemia. Sometimes the ulcers unite, turning into superficial drainage defects. The resulting erosions of the mucous membrane are sharply painful, and therefore children refuse to eat and drink. With herpetic sore throat in children, bilateral submandibular, cervical and parotid lymphadenopathy is detected.

Along with the typical forms of herpetic sore throat, children may experience blurred manifestations characterized only by catarrhal changes in the oropharynx, without mucosal defects. In children with weakened immune systems, the rash may recur in waves every 2-3 days, which is accompanied by a resumption of fever and symptoms of intoxication. In some cases, with herpetic sore throat, a child experiences the appearance of a papular and vesicular rash on the distal limbs and torso.

In typical cases, fever with herpetic sore throat in children subsides after 3-5 days, and defects in the mucous membrane of the oral cavity and pharynx epithelialize after 6-7 days. With low reactivity of the body or a high degree of viremia, generalization of entroviral infection with the development of meningitis, encephalitis, myocarditis, pyelonephritis, hemorrhagic conjunctivitis is possible.

Diagnosis of herpetic sore throat in children

In a typical clinical picture of herpetic sore throat in children, a pediatrician or pediatric otolaryngologist can make a correct diagnosis even without additional laboratory examination. When examining the pharynx and pharyngoscopy, a typical location for herpetic sore throat is revealed (posterior wall of the pharynx, tonsils, soft palate) and type of rash (papules, vesicles, ulcers). A general blood test reveals slight leukocytosis.

To identify the causative agents of herpetic sore throat in children, virological and serological research methods are used. Washings and swabs from the nasopharynx are examined by PCR; Using ELISA, an increase in the titer of antibodies to enteroviruses is detected by 4 or more times.

Herpetic sore throat in children should be distinguished from other aphthous diseases of the oral cavity (herpetic stomatitis, chemical irritation of the oropharynx, thrush), chickenpox.

Treatment of herpetic sore throat in children

Complex therapy for herpetic sore throat includes isolation of sick children, general and local treatment. The child needs to drink plenty of fluids and take liquid or semi-liquid food to avoid irritation of the oral mucosa.

For herpetic sore throat, children are prescribed hyposensitizing drugs (loratadine, mebhydrolin, hifenadine), antipyretic drugs (ibuprofen, nimesulide), and immunomodulators. In order to prevent the accumulation of a secondary bacterial infection, oral antiseptics, hourly gargling with antiseptics (furacilin, miramistin) and herbal decoctions (calendula, sage, eucalyptus, oak bark) are recommended, followed by treatment of the back wall of the pharynx and tonsils with drugs. For herpetic sore throat in children, aerosols that have an analgesic, antiseptic, and enveloping effect are used topically.

A good therapeutic effect is achieved with endonasal/endopharyngeal instillation of leukocyte interferon and treatment of the oral mucosa with antiviral ointments (acyclovir, etc.). In order to stimulate the epithelization of erosive defects in the mucosa, ultraviolet irradiation of the nasopharynx is recommended.

In case of herpetic sore throat in children, it is strictly unacceptable to carry out inhalations and apply compresses, since heat increases blood circulation and promotes the spread of viruses throughout the body.

Forecast and prevention of herpetic sore throat in children

For children with herpetic sore throat and contact persons, quarantine is established for 14 days. Current and final disinfection is carried out in the epidemiological site. In most cases, herpetic sore throat in children ends in recovery. With the generalization of a viral infection, multiple organ damage is possible. Fatal outcomes are usually observed among children in the first years of life with the development of meningitis.

Specific vaccine prophylaxis is not provided; children who have been in contact with a patient with herpetic sore throat are given specific gamma globulin. Non-specific measures are aimed at timely detection and isolation of sick children, increasing the reactivity of the child’s body.