Herpangina

Every now and then, we do come across clusters of cases of Herpangina or Hand Foot and Mouth Disease in Maldives.

Herpangina Ulcer in the mouth. (Picture shared by a parent).

What is it?
It is an acute viral illness in children that causes sudden onset high-grade fever and appearance of painful blisters and/or ulcers over the palate and back of throat. It occurs most frequently in children younger than age 5 but can affect bigger kids too.
It is quite similar to Hand Foot and Mouth Disease (HFMD), in which, in addition to the fever and oral ulcers, there are vesicular rash on hands, (elbows), feet, (around the knees, over thighs and buttocks).

What causes it?
It is caused by a virus. The most commonly identified viruses are Coxsackie A (A16, A6), Coxsackie B, Enterovirus (A71) and Echovirus.

How do you get it?
It’s highly contagious and is spread by droplets and via contact with droplet contaminated surfaces. An uninfected child gets the illness when respiratory droplets from an infected child are inhaled. Respiratory droplets are formed during coughing, sneezing and during speech. The virus also gets transmitted when spit or sputum contaminated objects (Eg: Toys) are handled by an uninfected child. Stool contamination (feco-oral) of food and drinking water has also been documented as a transmission mode.

Can we prevent it?
Good hand hygiene; with frequent sanitizer use or hand washing, transmission may be restricted. Also, isolating and keeping affected kids away from others, can limit transmission opportunities.

What are it’s signs and symptoms?
After an incubation period of 3 to 6 days druing which the newly infected child remains well, the illness begins with sudden onset moderate to high-grade fever ranging from 38° to 41° C. Painful swallowing, sore throat, drooling, headache, loss of appetite and generalized un-wellness are common. Small children may become fussy or irritable.

Oral lesions are often present starting day 1-2 of illness and could be used by healthcare workers to identify the illness during an outbreak. They are generally 3 to 7 mm in diameter and surrounded by a narrow zone of redness.

How do you diagnose it?
Diagnosis is clinical, from the symptoms and signs. Blood tests are not required.

Home care:
Hydration and symptomatic treatment are important. Lets the child take plenty of fluids. It may help child to tolerate the fluid better, if it is not warm. Acidic fluids such as citrus juices may sting and cause discomfort.

Paracetamol can be used for fever. Oral pain relieving gels may help transiently reduce severe pain.

As this is a contagious disease, where possible, affected kids can be kept separate from those unaffected.

How long does it take to recover?
Fever usually subsides after 2-5 days. The lesions usually resolve in 1 week without any treatment.

Similar to Hand Foot and Mouth Disease, some nail changes have been seen few weeks after recovery. They recover without treatment.