Herpangina

  • Medical Author:
    David Perlstein, MD, MBA, FAAP

    Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Is herpangina contagious?

Coxsackievirus infections are extremely contagious and can easily pass from child to child through contaminated surfaces, unwashed hands, and through sneezing and coughing. Typically, people infected with the virus are most contagious during the first week of illness.

How long is the incubation period for herpangina?

The normal course of the infection involves an incubation period, which is generally an asymptomatic period, lasting anywhere from one to two weeks.

What are herpangina symptoms and signs?

Typically children with herpangina have the following:

  • Fever
  • Sore throat
  • Small blisters and ulcers may cover the soft palate, uvula, tonsils, and posterior pharynx. The rest of the mouth is normal in appearance. These blisters can last for up to a week.
  • Enlarged lymph nodes along the neck (lymphadenopathy)
  • Rash may or may not be present.

How is herpangina diagnosed?

Since herpangina is a clinical diagnosis, and the illness is self-limited, there is no real reason to perform any laboratory studies. Some children (hospitalized or immune-compromised for example) may have viral studies performed on specimens from the nose or throat. Isolating virus from these samples takes a long time and generally symptoms will be resolved long before the identification of the virus is available. Antibodies to coxsackievirus may also be measured if desired but is generally unnecessary.

What is the treatment for herpangina?

Treatment is supportive, just like for most viruses. Fever and pain control with acetaminophen (Tylenol) or ibuprofen (Advil) is generally the primary treatment. It is important to keep children well hydrated as well, and often young children will be resistant to drinking or eating. The aptly named "magic mouthwash" is an alternative treatment used to control the mouth pain associated with herpangina. There are various recipes, but most include a topical pain medication such as viscous lidocaine as well as some sort of additional liquids which function as a barrier. A child's health-care provider might prescribe one of these. It is important to remember that these types of medications should always be used as directed by a provider, since some of the components may have serious side effects if given in too high a concentration. Remember that since herpangina is caused by a virus, antibiotics have no role in the treatment, nor do any antiviral medications currently available.

Medically Reviewed by a Doctor on 7/21/2015

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