Herpangina (Pediatrics - PEDS)

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Herpangina is a very common viral infection caused by the Coxsackie A or B virus. It has a 3-6 day incubation period. It particularly affects children younger than 4 years, although it may affect any age group.

It has an incubation period from infection to the start of symptoms of 3-6 days. The most common symptoms, which usually last 4-7 days, are: vesicles or aphthae in the mouth and/or throat, of 1-2 mm of diameter (0.03 - 0.06 inch), throat pain and congestion, drooling in lactating patients and fever.

The diagnosis is clinical (i.e. through medical questioning and physical exploration).

Treatment is symptomatic with antipyretics for fever and/or analgesia for pain. There is usually significant pain in the mouth and/or throat, for which a diet with cold, fluid or soft foods is advised. It is important to maximize hygiene measures to avoid contagion as well.

Bibliographic references
  1. Romero JR, Modlin JF. Introduction to the human enteroviruses and parechoviruses. In: Mandell, Douglas, and Bennet's Principles and Practice of Infectious Diseases, 8th ed, Bennett JE, Dolin R, Blaser MJ (Eds), Saunders, Philadelphia 2014.
  2. de Crom SC, Rossen JW, van Furth AM, Obihara CC. Enterovirus and parechovirus infection in children: a brief overview. Eur J Pediatr 2016; 175:1023.
  3. Puenpa J. et al. . Prevalence and Characterization of Enterovirus Infections among Pediatric Patients with Hand Foot Mouth Disease, Herpangina and Influenza Like Illness in Thailand. PLoS One9, e98888 (2014).
  4. Lee C. J. et al. . Clinical features of coxsackievirus A4, B3 and B4 infections in children. PLoS One9, e87391 (2014).
  5. Zong W, He Y, Yu S, Yang H, Xian H, Liao Y, Hu G: Molecular phylogeny of Coxsackievirus A16 in Shenzhen, China, from 2005 to 2009. J Clin Microbiol. 2011, 49: 1659-1661.
Author
Dr. Maria Trabazo
Copyright
© TeckelMedical 2026

Symptoms

    Fever / Feel very hot


    Mouth ulcer or sore


    Pain when swallowing


    Sore throat


    Loss of appetite

Symptoms to watch out for

Signs of dehydration: more tiredness than usual, dizziness, dry mouth and tongue.
Pain that does not subside with analgesics.
If symptoms affect their quality of life

Self-care

Drink milk, cold water, eat ice cream or cold desserts.
Avoid eating citrus fruits or drinking soft drinks.
Rinse the mouth with lukewarm water after meals.
Take over-the-counter pain relievers or anti-inflammatories.