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By Mary T. Caserta, MD, Professor of Pediatrics, Division of Infectious Diseases;Attending Physician, University of Rochester School of Medicine and Dentistry;Golisano Children’s Hospital at Strong, University of Rochester Medical Center

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Herpangina is a febrile disorder caused by numerous group A coxsackieviruses and occasionally other enteroviruses. Infection causes oropharyngeal mucosal vesicular and ulcerative lesions.

Herpangina tends to occur in epidemics, most commonly in infants and children.


Herpangina is characterized by sudden onset of fever with sore throat, headache, anorexia, and frequently neck pain. Infants may vomit.

Within 2 days after onset, up to 20 (mean, 4 to 5) 1- to 2-mm diameter grayish papules develop and become vesicles with erythematous areolae. They occur most frequently on the tonsillar pillars but also on the soft palate, tonsils, uvula, or tongue. During the next 24 h, the lesions become shallow ulcers, seldom > 5 mm in diameter, and heal in 1 to 7 days.

Complications are unusual.

Lasting immunity to the infecting strain follows, but repeated episodes caused by other group A coxsackieviruses or other enteroviruses are possible.


  • Clinical evaluation

Diagnosis of herpangina is based on symptoms and characteristic oral lesions.

Confirmatory testing is not usually required but can be done by

  • Isolating the virus from the lesions

  • Detecting virus by reverse transcriptase–PCR

  • Demonstrating a rise in specific antibody titer

Recurrent aphthous ulcers may appear similar. Rarely, Bednar aphthous ulcers occur in the pharynx but usually without systemic symptoms.Herpetic stomatitis occurs sporadically and causes larger, more persistent, and more numerous ulcers throughout the oropharynx than herpangina. Coxsackievirus A10 causes lymphonodular pharyngitis, which is similar except that the papules become 2- to 3-mm whitish to yellowish nodules instead of vesicles and ulcers.


  • Symptom relief

Treatment of herpangina is symptomatic. It includes meticulous oral hygiene (using a soft toothbrush and salt-water rinses), a soft diet that does not include acidic or salty foods, and topical measures (see Stomatitis : Treatment).

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