Herpetic sore throat in children and adults - symptoms and treatment

Causes of herpangina

Herpangina can be caused by about 70 serotypes of enteroviruses. Most often these are Coxsackie B, Coxsackie A17 viruses and enterovirus 711.

Since the only carrier of enteroviruses is humans, you can become infected through contact with a sick person or with a virus carrier who has no symptoms of the disease1. According to the literature, the number of virus carriers can be up to 46% of people2.

The virus is released into the external environment with feces and droplets of saliva. It is also contained in bubbles that appear in the patient’s throat. Enterovirus infections most often affect children, although the disease also occurs in adults5.

The patient or virus carrier excretes viruses from the upper respiratory tract within 3 weeks after infection, and with feces - up to 8 weeks. In the first two weeks, herpetic sore throat is most contagious1.

You can become infected in the following ways:

• through dirty hands, objects and food if they are exposed to the virus;
• drinking contaminated water from a reservoir;
• upon contact with a patient or virus carrier.

The herpangina virus is also transmitted transplacentally - from mother to fetus3.

Up to contents

How to distinguish herpes from stomatitis?

Many patients try to find an answer on the Internet to the question: “Do I have stomatitis or herpes? How to recognize? Herpes stomatitis can be easily distinguished from ordinary stomatitis by 3 key signs.

1. With herpes infection, the rash is localized in the gum area. Whereas with stomatitis - on the soft tissues of the oral cavity (tongue, cheeks).
2. A herpes rash first appears as blisters, which then ulcerate, while stomatitis begins with the appearance of ulcers.
3. Herpetic stomatitis is characterized by a stable appearance of the rash in the same places, and with ordinary stomatitis its location often changes.

Symptoms of herpetic sore throat

The disease begins acutely. From the moment of infection to the first symptoms, it takes from 2 to 14 days3. The temperature rises to 38-39°C. The patient feels weakness, headache, chills, less often nausea, possible vomiting and enlargement of the submandibular lymph nodes, 1,2,3.

Herpangina goes through several stages2:

• The day before the rash appears in the throat, the patient feels a mild pain. On examination, you may notice redness of the palatine arches and the back wall of the pharynx.
• Then, rashes appear on the mucous membrane of the soft palate, palatine arches, tonsils and uvula - small papules (nodules) up to 5 mm in diameter with a red rim.
• The nodules turn into vesicles, which open after 1-2 days.
• In their place, painful erosions with a gray-white coating form.

Up to contents

Prevention

Viruses are very active. Once in the body of a healthy person, they quickly develop, and he, without even suspecting anything and visiting public places, becomes a carrier of the infection. Therefore, great importance is given to the prevention of herpetic sore throat. And it is quite possible to warn her.

Prevention measures:

• if there is a sick person in the family, he must be isolated;
• You should not visit shopping and entertainment complexes and hypermarkets during an outbreak of infections;
• it is important to wash your hands after going outside, public transport, shopping, etc.;
• thoroughly washing fruits and vegetables, purchasing dairy products only in specialized sealed packaging, and not at the market.

Herpetic sore throat in children

Children usually become infected at school or kindergartens2,3. Due to pain and fever, they are restless, tearful, and often refuse to eat and drink because food irritates erosions on the mucous membrane and causes discomfort. But due to refusal to drink water or juices, children often develop dehydration. At the same time, the child’s tongue becomes dry, and the elasticity of the skin decreases1. Convulsions may occur due to high temperature1.

Blistering rashes in children can appear not only on the mucous membrane of the throat, but also on the hands and feet, and even on the buttocks and forearms. This manifestation of enterovirus infection is called viral pemphigus of the oral cavity and extremities or mouth-hand-foot syndrome. The disease is contagious in 100% of cases, is often mild, and can affect nails3.

Up to contents

It's all the virus's fault!

The term "stomatitis" is derived from the merger of two Greek words: stoma (mouth) and itis (inflammation). There are a great variety of different types of disease - serous, aphthous, allergic, etc. The most dangerous is herpetic, or cold sore, stomatitis caused by a virus. Its main manifestations are painful ulcers covering the oral mucosa. The trigger mechanism of the disease is the activation of herpes simplex virus types 1 and 2. First of all, the disease threatens those who have a weakened immune system and, as a result, the body simply does not have the strength to give a worthy rebuff to viruses.

Course of herpetic sore throat

The diagnosis of herpetic sore throat can be made by an otolaryngologist, therapist or pediatrician after examining the patient and clarifying his complaints. To monitor changes characteristic of a viral infection, the doctor may prescribe a general blood test, and to confirm enteroviral sore throat, a specialist may prescribe a pharyngeal smear and a blood test for specific antibodies. The pathogen can also be detected in stool or inflammatory fluid that is released from vesicles1,4.

Manifestations of herpetic sore throat can go away on their own in less than 10 days. But in any case, at the first symptoms of the disease, you should definitely consult a doctor. You cannot self-medicate2,3.

In some cases, herpetic sore throat can cause complications from the nervous system. In this case, 1 appears:

• severe spasm of the neck muscles, due to which the child cannot bend his head;
• weakness of the muscles of the limbs;
• disturbance of consciousness.

A severe complication of herpetic sore throat is damage to the soft membranes of the brain, brain and spinal cord1,3.

Newborns are at highest risk of developing complications, so they need careful treatment and care3. It is important to maintain hydration and give your child enough fluids1.

Up to contents

Complications

Unfortunately, this type of tonsillitis has dangerous negative consequences if the disease is started and left to chance. The greatest danger is from complications of the kidneys, brain and heart. Since the sore throat virus spreads through the flow of lymph and blood, inflammation can overtake certain parts of the brain, causing meningitis and encephalitis. Convulsions, persistent headache, increasing temperature are reasons to seek medical help again.

At the ENT CLINIC in Chertanovo, ENT doctors with extensive experience will carefully examine an adult and a small patient and immediately perform a serological and virological analysis to determine the causative agent. The technical equipment of our medical center allows us to obtain diagnostic results within a couple of hours. Thanks to this, therapeutic therapy is prescribed in a timely manner, with positive dynamics occurring the very next day.

Treatment of herpetic sore throat

Patients with complications require hospitalization in an infectious diseases hospital and treatment under the supervision of specialized specialists - a neurologist and a cardiologist. If the doctor has recommended treatment at home, it is necessary to closely monitor the patient's condition2.

The sick person should be isolated and stay in a clean, well-ventilated area so as not to infect other family members. Quarantine must be observed until symptoms subside1.

For herpangina you should 1,3,4:

• Wash your hands as often as possible, including after feeding and changing a sick child’s diaper.
• Disinfect surfaces and objects with which the patient has been in contact.
• Drink enough fluids to avoid dehydration. At the same time, pay attention to the temperature of the drink: hot, warm drinks irritate the mucous membranes and cause additional discomfort. You can drink cool drinks.
• Consume food in liquid or mushy form. Spicy, salty, sour foods, including fresh fruits even in the form of puree, are not suitable for a patient with herpetic sore throat.
• Rinse your mouth with a saline solution after every meal to maintain oral hygiene and prevent bacterial infections from erosions.
• Use a soft toothbrush to reduce trauma to the mucous membrane.

Currently, there is no proven antiviral drug to treat herpangina by acting on its causative agent. Sometimes a doctor may prescribe medications that support local immunity of the pharyngeal mucosa1. Antibiotics are not prescribed for herpangina6.

The goal of treatment for herpangina is to relieve the symptoms of the disease4.

If the body temperature is above 38.5°C, physical methods such as cold compresses and ice packs may be used. Your doctor may also recommend anti-inflammatory and antipyretic medications1. Local treatment includes agents with anti-inflammatory, analgesic, enveloping and antiseptic effects1.

For the symptomatic treatment of herpetic sore throat, the doctor may prescribe the drugs HEXORAL®7,8,9,10,11. It is convenient to use HEXORAL® spray to irrigate the pharyngeal mucosa. The active substance of the spray is hexethidine. It acts against the main bacteria found in the oral cavity and pharyngeal mucosa8. The drug is also active against some viruses and fungi of the genus Candida8. Thanks to the local anesthetic effect of hexethidine, HEXORAL ® spray helps reduce pain8. HEXORAL®7 solution is suitable for rinsing. The use of HEXORAL ® spray and solution is allowed in children over 3 years of age7,8.

If herpangina causes severe pain and discomfort, adolescents over 12 years of age and adults can benefit from HEXORAL ® TABS EXTRA lozenges, which contain the anesthetic lidocaine10. For children over 4 years of age, HEXORAL ® TABS lozenges may be suitable. The anesthetic benzocaine in their composition helps reduce pain in the throat and mouth9.

All medications for herpetic sore throat should be used only after consultation with a doctor. In case of severe erosions, HEXORAL ® solution and spray are contraindicated7,8, and lozenges can only be prescribed by a specialist after examining the pharynx9,10.

Up to contents

The information in this article is for reference only and does not replace professional advice from a doctor. To make a diagnosis and prescribe treatment, consult a qualified specialist.

Drug therapy

Rinse

To stop the spread of infection throughout the oral cavity, as well as to prevent the occurrence of sore throat, anti-inflammatory drugs such as Stomatidine and Miramistin are prescribed. The greatest effect is achieved by repeating the rinsing procedure every 3 hours, strictly adhering to the instructions for medicinal solutions.

Antiviral drugs

To suppress the reproduction of the herpes virus, the patient is advised to take “Immudon” and “Acyclovir” orally according to the scheme, and for external use - “Viferon” ointment or “Silicea” gel.

Vitamin therapy

Tablet vitamin complexes such as “Complivit” help improve immunity.

Attention!

Before use, consultation with a specialist is recommended!

Sources

1. Corsino CB, Ali R, Linklater DR. Herpangina. 2021 Jun 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29939569. https://www.ncbi.nlm.nih.gov/books/NBK507792/
2. Ter-Baghdasaryan L.V., Ratnikova L.I., Stenko E.A. Clinical and epidemiological aspects of enterovirus infection // Infectious diseases: news, opinions, training. 2021. Vol. 9, No. 1. pp. 88-93. doi: 10.33029/2305-3496-2020-9-1-88-93 https://infect-dis-journal.ru/ru/jarticles_infection/672.html?SSr=2601343bdb01ffffffff27c__07e4040b011a36-9772
3. Alacheva Z. A., Rybalka O. B., Kulichenko T. V. Should everyone escape from Coxsackie?! Or fear has big eyes. Issues of modern pediatrics. 2017; 16 (4): 286–290. doi: 10.15690/vsp.v16i4.1774) https://vsp.spr-journal.ru/jour/article/viewFile/1787/713
4. Herpangina Brenda L. Tesini. University of Rochester School of Medicine and Dentistry // MSD Handbook - 2019 https://www.msdmanuals.com/ru/professional/infectious-diseases/enteroviruses/herpangina
5. Kozlovskaya O.V., Katanakhova L.L., Kamka N.N., Evseeva A.N. Epidemiological, clinical and diagnostic features of enterovirus infection in children and adults. Bulletin of Surgu State University. Medicine. 2018;(2):56-60. https://surgumed.elpub.ru/jour/article/view/140/141
6. Kuo KC, Yeh YC, Huang YH, Chen IL, Lee CH. Understanding physician antibiotic prescribing behavior for children with enterovirus infection. PLoS One. 2021 Sep 7;13(9):e0202316. doi: 10.1371/journal.pone.0202316. PMID: 30192893; PMCID: PMC6128467. https://pubmed.ncbi.nlm.nih.gov/30192893/
7. Instructions for use of the drug HEXORAL® SOLUTION:
8. Instructions for use of the drug HEXORAL® AEROSOL:
9. Instructions for use of the drug HEXORAL® TABS:
10. Instructions for use of the drug HEXORAL® TABS EXTRA:

Up to contents

During pregnancy

The herpetic type of sore throat in pregnant women manifests itself in exactly the same way as in other people.

But during the period when a woman is carrying a baby, such a disease can provoke a lot of consequences:

• intoxication of the child’s body,
• complications,
• fetal hypoxia.

If treatment for the disease is started in a timely manner and fully adheres to the instructions of the treating specialist, then the disease can be cured without consequences for both the expectant mother and the child.

A woman carrying a child under her heart should be calm, eat well and experience the most positive emotions. This is impossible with angina. A sore throat prevents the expectant mother from eating; not only her well-being suffers, but also the physical condition of both. Therefore, it is very important for the herpetic subtype of sore throat not only to follow all the doctor’s prescriptions, but also to monitor the child’s condition.

Diagnostics

Herpes sore throat is treated only as prescribed by a pediatrician based on a simple external examination without additional examinations, since when examining the pharynx it is easy to notice specific rashes on the tonsils. If problems arise with establishing a diagnosis or if the course of the disease is complicated, additional consultation with an otolaryngologist may be required. Herpangina's clinical symptoms are similar to sore throat caused by bacterial infection, stomatitis and chickenpox in a child.

If a herpes sore throat is suspected, a general blood test can be performed, which, if the disease is present, is characterized by a slight increase in the level of leukocytes.

After an illness or for direct indications, if complications arise, a urine test is required to identify kidney pathologies, as well as an ECG to assess the condition of the heart muscle.