Herpes angina in children – causes, symptoms, diagnosis and treatment

Herpes angina in children is an acute, virally induced lesion of the pharyngeal lymphoid tissue caused by Coxsackie and ECHO viruses. Herpes angina in children occurs with an increase in temperature, pain in the throat, lymphadenopathy, hyperemia of the throat, blistering and erosions on the tonsils and the posterior wall of the throat. Herpes angina in children is diagnosed by a pediatric otolaryngologist based on data from a throat examination, virological and serological examination of nasopharyngeal washes. Treatment of herpes sore throat in children includes taking antiviral, antipyretic, desensitizing drugs; local treatment of the oral mucosa, UFO.

Herpes angina in children

Herpangina children (gerpangina, herpetic tonsillitis, vesicles or aphthous pharyngitis) – serous inflammation of the tonsils caused by enteroviruses Coxsackie or ECHO. Herpangina children can be in the nature of sporadic diseases and outbreaks. In pediatrics and pediatric otolaryngology herpetic sore throats occur especially in preschool and primary school children (3-10 years); The most severe herpagina occurs in children under 3 years of age. Children of the first months of life with herpetic angina experience the corresponding antibodies from mothers with breast milk less often (passive immunity).

Herpangina child in isolated form or in combination with serous enteroviral meningitis, encephalitis, epidemic myalgia, myelitis, also caused by these viruses can occur.

Causes of herpes sore throat in children

Herpangina in children refers to the number of diseases virally caused by enterovirus from the Picornaviridae family – coxsackie virus group A (most viruses Serovare 2-6, 8 and 10), group Coxsackie B (serotipami1-5) or ECHO virus (3 , 6, 9, 25).

The mechanism of transmission of pathogens – air (through sneezing, coughing or speaking), at least the fecal-oral (via food, nipples, toys, dirty hands and so on.) Or the contact pathways (via nasopharynx secretions). The main nature reservoir is a virus carrier or a sick person, the infection of pets is less common. Reconvalvescents can also serve as sources of infection, as they secrete the virus within 3-4 weeks. The main incidence of herpes sore throat in children falls from June to September. The disease is highly contagious, so in summer and autumn it is often characterized by the outbreak of herpes sore throat in children within families or organized groups (camps, kindergartens, school classes).

Penetration into the body through the mucous membranes of the nose and throat, tonsillitis pathogens of herpes in children fall into the intestinal lymph nodes, where the race is active, and then penetrate into the blood, causing the development of viraemia. The later spread of viral pathogens is determined by their properties and the state of the protective mechanisms of the child’s organism. Together with the bloodstream, viruses are spread through the all Body transported, where they settle in certain tissues and cause inflammatory, dystrophic and necrotic processes in them. Coxsackie and ECHO enteroviruses are highly tropic for the mucous membranes, muscles (including myocardium) and nerve tissue.

Herpes angina in children often develops against the background of an influenza or adenovirus infection. After the transferred herpetic neck, the children develop permanent immunity to this strain of the virus, but if another type of virus is infected, then herpangina may return.

Symptoms of herpes sore throat in children

The latency period of the infection is 7 to 14 days. Herpes angina 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, abdomen; Headache, vomiting, diarrhea. After the usual symptoms there is pain in the throat, salivation, difficulty swallowing, acute rhinitis, cough.

With herpes angina in children, local changes are increasing rapidly. Already in the first two days, against the background of hyperemic mucosal tonsils, palate arches, tongue and palate, small papules are found in the oral cavity, which quickly become vesicles up to 5 mm in diameter with serous contents. After 1-2 days, the vesicles are opened and white-gray wounds form in their place, which are surrounded by a hyperaemic corolla. Sometimes wounds are put together and turn into superficial drainage defects. The resulting erosion of the mucous membrane is very painful, and the children refuse to eat and drink in this connection. Children with herpetic angina pectoris have bilateral mandibular, neck and parotid lymphadenopathy.

Along with the typical forms of herpetic angina in children, I can see deleted manifestations that are only characterized by catarrhal changes in the oropharynx, with no mucosal defects. In children with weakened immunity, rashes can fluctuate every 2-3 days, which is associated with the resumption of fever and symptoms of intoxication. In some cases, with herpetic angina, the child has a papular and vesicular rash on the distal parts of the limbs and trunk.

In typical cases, fever in herpetic angina in children falls in 3-5 days and defects in the mucous membrane of the mouth and throat are epithelized after 6-7 days. With a low reactivity of the organism or a high level of viraemia, it is possible to generalize the infection with the development of meningitis, encephalitis, myocarditis, pyelonephritis, hemorrhagic conjunctivitis.

Diagnosis of herpes sore throat in children

In a typical herpes neck and throat clinic in children, a pediatrician or a pediatric otolaryngologist can do without additional Make a correct diagnosis in the laboratory. In the examination of pharyngoscopy and pharyngoscopy, a localization typical of herpesangina (back of the throat, tonsils, soft palate) and the type of rashes (papules of vesicles, wounds) are found. A small leukocytosis is shown in the general blood test.

Virological and serological research methods are used to identify the causative agents of herpetic angina in children. Flushes and smears from the nasopharynx are examined using the PCR method; With the help of ELISA an increase in the titer of antibodies against enteroviruses 4 and more times is detected.

To rule out serous meningitis, a child’s neurologist should be examined; in the case of complaints from the heart, a consultation with a pediatric cardiologist is shown; in case of detection of changes from the general analysis of urine – the nephrologist of the children.

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

Treatment of herpes sore throat in children

Complex therapy for herpes sore throat includes isolation from sick children, general and local treatment. The child has to drink a lot and eat liquid or semi-liquid food, which prevents irritation of the oral mucosa.

When Herpangina children prescribed hyposensitization (loratadine, mebhydrolin, hifenadina), antipyretic drugs (ibuprofen, nimesulide), immunomodulators. To prevent secondary bacterial infection stratification recommended oral antiseptics, hourly antiseptics (Furacilinum, miramistinom) and decoction of herbs (calendula, sage, eucalyptus, oak bark), followed by pharyngeal posterior wall treatments and tonsil gargling. With herpes sore throat, children receive topical aerosols that have an analgesic, antiseptic and enveloping effect.

A good therapeutic effect is achieved by endonasal / endopharyngeal instillation of leukocyte interferon, treatment of the oral mucosa with antiviral ointments (acyclovir, etc.). To stimulate the epithelization of erosive defects in the mucosa, it is recommended that the UFO be a nasopharynx.

Categorically, in herpetic sore throats in children, holding inhalations and making compresses is prohibited because heat increases blood circulation and promotes the spread of viruses throughout the body.

Prognosis and prevention of herpes sore throat in children

In children with herpes sore throat and contact persons, the quarantine is set for 14 days. A continuous and final disinfection is carried out in the epidostatic zone. In most cases, herpetic angina ends children in recovery. Multiple organ failure is possible when generalizing a viral infection. Lethal results are usually observed in children of the first years of life with the development of meningitis.

Specific vaccine prevention is not provided; Children who have come into contact with a sick herpes sore throat receive a specific gamma globulin. Non-specific measures aim at the timely detection and isolation of sick children and increase the responsiveness of the child’s body.


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Christina Cherry
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