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This infectious disease characteristically produces vesicular lesions on the mucous membranes of the soft palate, tonsillar pillars, and throat. Herpangina usually affects children under age 10 but seldom occurs in neonates (who are protected by maternal antibodies). It occurs slightly more often in late summer and fall and can be sporadic, endemic, or epidemic.


Herpangina is caused by Coxsackie virus, typically Coxsackie group A viruses. Herpangina is characterized by mouth ulcers, but a high fever, sore throat, and headache may precede the appearance of the lesions. The lesions are generally ulcers with a white to whitish-gray base and a red border -- usually on the roof of the mouth and in the throat. The ulcers may be very painful. Generally, there are only a few lesions.

Symptoms and Signs

The following are the most common symptoms of herpangina. However, each child may experience symptoms differently. Symptoms may include:

  • blister-like bumps in the mouth, usually in the back of the throat and on the roof of the mouth
  • headache
  • quick onset of fever
  • high fever, sometimes up to 106 º F
  • pain in the mouth or throat
  • drooling
  • decrease in appetite

Diagnostic tests

The virus may be isolated from mouth washings or stool. Elevated specific antibody titers confirm herpangina, but these tests seldom are done. Other laboratory test findings are normal except for slight leukocytosis.


Symptomatic treatment to relieve discomfort includes measures to reduce fever, prevent seizures, and promote hydration.


Coxsackieviruses and other enteroviruses are present both in the stool and in the respiratory secretions. They can spread by fecal–oral transmission, droplet transmission, contact transmission, and by means of fomites. school or daycare for the first several days of the illness, but it is not clear this prevents others from becoming infected. Other children in the class are probably contagious even though they will never develop symptoms.

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