Cough

Herpangina. Evidence-Based Patient Guide

Herpangina (enteroviral vesicular pharyngitis, herpetic tonsillitis, herpangina or ulcerous tonsillitis) is an acute infectious disease that is accompanied by a sharp rise in body temperature, swallowing disorder (dysphagia) and pharyngitis. Muscle pain in the abdomen, nausea and vomiting are possible. A distinctive feature of the disease is small reddish bubbles with serous fluid (vesicles) rising above the surface of the mucosa, which appear in the area of the soft palate, palatine arches, tonsils, uvula and posterior wall of the pharynx.

ICD-10	B08.5
ICD-9	074.0
DiseasesDB	30777
MedlinePlus	000969
eMedicine	med/1004 article/218502
MeSH	D006557

General information

Herpetic sore throat was first described in 1920 by T. Zagorsky.

Since this infectious disease resembled a herpetic rash in the type of rash, and the origin of the disease was associated with the herpes virus, this form of sore throat began to be called herpetic. Subsequently, the pathogen was identified - in 1948, the Coxsackie virus of group A was discovered, in 1949 - the Coxsackie virus of group B, and when studying polio, viruses of the ECHO group were discovered in 1941. All these viruses belong to the group of enteroviruses, but herpetic tonsillitis has retained its name unchanged.

Enteroviruses are ubiquitous and infection occurs year-round, but the northern hemisphere is characterized by an outbreak of incidence in the summer-autumn period, and in tropical latitudes there is no such seasonality.

Infection with enterovirus is observed in all age groups, but the frequency of spread depends on age - about 75% of registered cases of enterovirus infection occur in children under 15 years of age. At the same time, herpetic sore throat in children under one year of age is recorded more often than among children of the older age group. Boys suffer from enterovirus infection more often than girls.

Enteroviruses of the same type can cause both mild forms of the disease, which affect the respiratory tract, and severe forms, affecting the cardiovascular or nervous system.

Diseases can be either isolated or cause an epidemic.

Reasons for development

Herpangina is caused by human enteroviruses of the following types:

Coxsackie A (serotypes 2-8,10,12,14,16);
Coxsackie B (serotypes 3,4);
ECHO (relatively rare).

Herpangina is most often provoked by the Coxsackie virus group A (serotypes 2-6, 8, 10).

The natural reservoir for viruses of this group are:

Soil, food and water, since enteroviruses are resistant to many environmental factors. Thus, in wastewater at zero temperature, the virus persists for a month, and to inactivate it in sour cream, milk or butter, products must be kept at a temperature of 56 ° C for at least 30 minutes.
Human organism. The source of infection can be either a patient or a virus carrier - this infection can cause a “healthy virus carrier” in a person, in which the virus is released into the external environment for several weeks.

It is thanks to “healthy virus carriage” that the virus persists in the human population with a high level of natural immunity in people over 5 years of age (the older the age, the more immune individuals in this age group).

Enterovirus infection, manifested in various forms of the disease (herpangina, epidemic exanthema, etc.) is a common cause of nosocomial viral infections.
The level of natural immunity by the age of 5 in some areas is above 90%, but healthy children in 7–20% of cases are carriers of the virus, and in children under one year of age this percentage is 32.6.

Herpangina in adults is extremely rare, since 30-80% of people over 16 years of age have antibodies to the most common serotypes that cause this disease.

The route of transmission of infection can be:

Fecal-oral. It is realized through contact and household (due to household items), food (infected food) and water (contaminated water) routes. Direct contact with infected feces occurs during diaper changing in infants, making infants one of the most active transmitters of infection.
Airborne. Seen less frequently. This route is associated with the evacuation of the virus from the respiratory tract into the intestine during swallowing, after which the development of the infectious process, traditional for enteroviruses, occurs.
Transplacental (from mother to fetus). When infected in this way, herpetic tonsillitis does not develop, and the route of infection itself is observed quite rarely.

For the spread of infection, contact with contaminated objects or hands of a patient (virus carrier) and subsequent introduction of the virus through the mouth, nose or eyes is important.

Infection is possible when sewage enters public bathing areas.

According to research, in half of the cases in family contacts with a patient who is most contagious in the first week of the disease, secondary infections are observed (the disease develops against the background of another infectious disease).

Herpangina and other forms of enterovirus infection are more often observed in regions characterized by low social and hygienic levels.

Pathogenesis

The mechanism of development of all diseases caused by enteroviruses is identical.

The infection enters the body, penetrating the mucous membranes of the mouth, upper respiratory tract and intestines. Since this type of virus does not have an outer protein shell, they easily overcome the “gastric barrier” and settle on the mucous membrane in the small intestine. It is thanks to this feature that a large and diverse group of viruses received a single taxonomic name (enterovirus).

The virus subsequently multiplies in lymphoid tissue, mesenteric (mesenteric) lymph nodes and in intestinal epithelial cells. On approximately the third day of illness, the virus enters the blood and spreads throughout the body (primary viremia). The cells of muscle tissue and the central nervous system suffer the most, but the vessels of the eyes, tissues of the lungs, heart, intestines, liver, pancreas and kidneys are also involved to varying degrees in the pathological process. In each affected organ, swelling, foci of inflammation and necrosis are detected.

Whether a patient will develop herpetic sore throat when infected with an enterovirus, or whether other clinical manifestations will be observed, depends on the biological properties of a particular type of virus and its ability to infect a certain type of body cell (predominant tropism).

Coxsackie A viruses can provoke not only herpangina, but also muscle damage in combination with flaccid paralysis, and Coxsackie B viruses can cause central paralysis in the absence of muscle pathology.

The form of the disease, its nature and its outcome are influenced by the state of immunity (cellular and humoral).

A person who has suffered an enterovirus infection develops type-specific immunity that lasts for a long time (lifelong immunity is possible).

Symptoms

The onset of the disease is preceded by an incubation period, which is 1-2 weeks, but often this period does not exceed 3 days.

Herpetic sore throat begins acutely. Observed:

flu-like syndrome, including fever up to 41 °C, body aches, headache and muscle pain, chills;
decreased appetite;
weakness and irritability;
hyperemia affecting the mucous membrane of the soft palate, uvula, tonsils and palatine arches;
pain in the nasopharynx and pharynx, accompanied by difficulty swallowing;
runny nose;
the appearance of rashes in the throat.

First, papules (1-2 mm in diameter) rise above the mucosa and are surrounded by a red rim, which then transform into vesicles with serous contents (vesicles).

After a day or two, the vesicles open and in their place erosions, covered with a gray-white coating, form. Moreover, the more severe herpangina occurs, the more rashes appear. The elements of the rash gradually dry out and crusts form, but when bacterial infections are attached, suppuration is possible. These pathological changes disappear within 7 days.

Elevated to febrile temperatures with herpangina lasts 1-3 days.

Herpetic tonsillitis is also accompanied by bilateral enlargement of the tonsillar and submandibular lymph nodes.

Severe disease in some cases is characterized by nausea, vomiting and diarrhea.

Diagnostics

Diagnosis for herpetic sore throat includes:

medical history and general examination;
pharyngoscopy, which allows you to detect hyperemia of the mucous membrane and rashes in the pharynx area;
a blood test that reveals moderate leukocytosis;
virological and serological studies that help identify the pathogen.

For virological and serological studies during the first 3-5 days of the disease (during the period of intensive reproduction of the virus), the following is taken:

Pharyngeal washes. A sterile saline solution is used, with which the patient must gargle three times, spitting the liquid into a sterile wide-necked jar. Take 10 - 15 ml per rinse. solution. Then the back wall of the throat is wiped with pieces of sterile cotton wool (taken with tweezers), and then this cotton wool is placed in the same jar.
Feces.

The collected material is sent to the laboratory, where after infecting a cell culture or by infecting newborn white mice, it is possible to identify the type of enterovirus.

The belonging of the virus to serovars is determined using specific neutralizing sera due to:

RSK (complement fixation reaction). The corresponding antigens and antibodies, thanks to the serum containing complement (C), form an immune complex.
RTGA (virus neutralization reactions). The presence of antihemagglutinins in serum slows down the activity of viruses.
IRHA (indirect hemagglutination reaction), based on the ability of red blood cells with antibodies pre-adsorbed on their surface to agglutinate in the presence of corresponding antigens or homologous sera.

Since herpetic tonsillitis in most cases is caused by Coxsackie viruses, and type A does not adapt well to tissue culture, in the presence of degenerative changes in cells, the type of virus is determined by the immunofluorescent method. With this method, the reagent is labeled with a dye that glows in ultraviolet rays, so that glowing antigen-antibody complexes can be viewed using a fluorescent microscope.

Coxsackievirus group A or B is determined due to pathological changes in mice - type A is characterized by the presence of flaccid paralysis without encephalitis, and with type B paralysis is accompanied by convulsions.

Since herpangina in children resembles a herpetic infection in the nature of the rash, the following must be taken into account in differential diagnosis:

Age of the sick child.
Seasonality of the disease.
Type and localization of the rash in the oral cavity. Herpetic sore throat is not accompanied by bleeding of the mucous membrane and inflammation of the gums, and there are no rashes on the skin of the face.

Treatment

Treatment of herpetic sore throat is exclusively symptomatic, since there is no specific therapy for infection with enteroviruses.

Patients are required to be isolated. Since herpangina in children is accompanied by difficulty swallowing, to avoid additional irritation of the oral mucosa, food must be served to patients in liquid or semi-liquid form.

Held:

Local therapy, including aerosol antiseptics (hexoral, ingalipt) and proteolytic enzymes (trypsin, which has anti-inflammatory, regenerating and decongestant effects, or chymopsin, chymotrypsin).
Hyposensitizing therapy, in which antihistamines (suprastin, diazolin, fenkarol, etc.) are prescribed.

Also assigned:

antipyretics;
antiviral drugs (leukocyte interferon);
2% lidocaine solution for rinsing (local anesthetic used to treat herpetic sore throat in adults);
anti-inflammatory and wound-healing agents (panthenol, Vinisol, faringosept);
vitamins B and C.

Treatment of herpetic sore throat in young children does not require the use of aerosols, so sage decoction and Castellani liquid are used to treat the baby’s mouth.

During treatment it is necessary to maintain a drinking regime.

After treatment:

rational nutrition should be organized;
Immunomodulators (Immunal, etc.) are prescribed for preventive purposes.

Possible complications

Herpetic sore throat is not accompanied by relapses due to the developed strong immunity to this type of virus, but the disease, when the inflammatory process generalizes, can cause complications such as:

myocarditis, in which the heart muscle becomes inflamed;
meningitis, which is characterized by damage to the membranes of the spinal cord and brain;
encephalitis, in which inflammation affects the brain.

Prevention

Herpangina is a contagious disease, therefore the main preventive measure is the isolation of the first sick people at the initial stage of the disease.

Since herpetic sore throat is transmitted in most cases through household contact, it is necessary to maintain hygiene, and if there is a patient in the family, use ultraviolet irradiation if possible. You can also do wet cleaning using a chlorine solution at a concentration of 0.3-0.5 mg/l.

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Acute infectious diseases caused by intestinal viruses belong to the group of enteroviral infections. The pathology affects various human organs and is manifested by fever and a wide range of clinical signs.

Enterovirus infection is characterized by outbreaks of mass diseases, especially in children's organized groups and families. The risk group includes people with reduced immunity - children, the elderly, people with chronic pathologies.

Enterovirus infection is characterized by high susceptibility of the population and seasonality - an increase in incidence in the summer-autumn season. A feature of enteroviruses is the ability to cause clinical symptoms of varying intensity: from mild discomfort to the development of paralysis and paresis.

Etiology

The causative agents of enterovirus infection are RNA-containing viruses, ECHO, polioviruses. Microbes have a relatively high resistance to physical factors - cooling and heating, as well as some disinfectants. Prolonged boiling, disinfectants with chlorine, formaldehyde and ultraviolet radiation have a detrimental effect on viruses.

Enteroviruses remain viable in the external environment for quite a long time. High air temperatures and high humidity increase the lifespan of the virus.

Sources of infection are patients and virus carriers.

Infection occurs:

The fecal-oral mechanism, which is realized by water, nutritional and contact-household routes of infection;
An aerogenic mechanism implemented by airborne droplets,
Transplacental mechanism using a vertical route during transmission of the pathogen from a sick mother to the fetus.

Microbes multiply on the mucous membrane of the pharynx and accumulate in nasopharyngeal discharge, feces, and cerebrospinal fluid. During the incubation period, the virus is released into the environment in small quantities. Patients remain dangerous to others for a month, and in some cases longer.

Microbes enter the mucous membrane of the esophagus and upper respiratory tract, multiply and cause local inflammation, which occurs in the form of respiratory disease and intestinal disorders. The period of reproduction and accumulation of viruses coincides with incubation and ranges from one to three days. Pathogenic biological agents enter the cervical and submandibular lymph nodes. At this time, patients develop pharyngitis and diarrhea. With the blood flow, microbes spread throughout the body, affecting internal organs with the development of another pathology and the appearance of corresponding symptoms.

Symptoms

Enterovirus infection often occurs without any characteristic signs and reminds me of a banal one. Viruses, affecting various organs and systems, usually cause herpangina, hemorrhagic inflammation of the conjunctiva, fever, gastroenteritis, and in rare cases, severe diseases: inflammation of the brain, liver, myocardium.

Symptoms of enterovirus infection:

Intoxication syndrome,
Exanthema,
Qatar of the respiratory system,
Abdominal signs.

Persons with strong immunity and a relatively healthy body rarely suffer from severe enteroviral diseases. Their infection is usually asymptomatic. Newborns, small children, elderly people and those weakened by chronic diseases are more susceptible to the development of enteroviral meningoencephalitis, hepatitis, myocarditis, and paralysis. Herpetic tonsillitis, acute respiratory infections and pharyngitis are less severe, but are accompanied by persistent, painful pain.

Herpangina

– one of the most frequently occurring forms of enterovirus infection. Its causative agents are Coxsackie viruses. The disease manifests itself with symptoms of intoxication and catarrhal syndromes.

Herpetic (herpetic) sore throat

Herpangina begins acutely. The body temperature in patients rises to 40 degrees, nausea, malaise, and headache occur.
Around the second day, signs of catarrhal inflammation of the pharynx appear.
After a couple of days, papules form on the tonsils, arches, tongue and palate, which eventually turn into red blisters. They burst, forming erosions on the mucous membrane, covered with plaque, which resolve without a trace in 5 days.
Regional lymphadenitis is slightly expressed.
Sore throat with herpangina is often absent or appears only during the formation of erosions.

acute respiratory infections

The respiratory form of enterovirus infection manifests itself with symptoms similar to any other etiology. Patients complain of fever, sore throat, hoarseness, dry cough, runny nose and nasal congestion. Usually these signs are combined with symptoms of indigestion.

The temperature remains high for 4-5 days and then gradually decreases. Other signs of the disease remain for another 2-3 weeks.

The catarrhal form is more common than others and occurs as pharyngitis, or a combined pathology. In young children, a symptom occurs that requires special attention. This makes it difficult for the child to breathe, especially at night. Attacks of “false croup” pose a great danger to children's health.

The cold-like form of enterovirus infection usually does not last long and is rarely accompanied by complications.

Enteroviral exanthema

In patients with enterovirus infection, from about 2-3 days of pathology, a rash appears on the skin in the form of pink spots and papules, often with hemorrhages. For two to three days, the rash remains on the body, and then gradually disappears without a trace. Exanthema is often combined with herpangina, stomatitis and meningitis.

Enteroviral exanthema

Rare clinical manifestations of enterovirus infection:

Anicteric hepatitis,
Meningoencephalitis,
Inflammation of the optic nerve
Inflammation of the myocardium and pericardium,
Lymphadenitis,
Nephritis,
Paralysis and paresis.

Complications

Inflammation of the brain and peripheral nerves are the most common and dangerous complications of enterovirus infection.

Patients who consult a doctor late and have a severe form of pathology may develop life-threatening diseases - cerebral edema, respiratory and cardiac arrest.

In young children, ARVI of enteroviral etiology is often complicated by the development of “false croup,” and in adults, by secondary bacterial infection with the development of bronchopneumonia.

Features of pathology in children

Enterovirus infection in children occurs in the form of sporadic diseases, but more often in the form of epidemic outbreaks in organized children's groups. The incidence increases in the warm season. For children of preschool and primary school age, the fecal-oral mechanism of transmission of the pathogen is characteristic.

Enterovirus infection in children usually occurs in the form of sore throat, serous inflammation of the meninges, and paralysis.

The pathology clinic is developing rapidly. The temperature rises sharply, chills, dizziness and headache appear, sleep and appetite are disturbed. Against the background of severe intoxication, characteristic signs begin to appear - catarrhal inflammation of the nasopharynx, myalgia, stool disorder, enteroviral exanthema.

Enteroviral stomatitis

Enteroviral stomatitis develops in children aged 1-2 years after enteroviruses enter the body.

Symptoms of the disease are:

Increased salivation
Low-grade fever,
Arthralgia and myalgia,
Runny nose,
Chills,
Malaise,
Swelling of soft tissues in the mouth.

The child becomes lethargic, restless, and capricious. Typical vesicles with a characteristic red rim appear on the skin and mucous membranes. The rashes hurt and itch. These symptoms intensify with the appearance of new lesions.

The disease develops quickly: blisters appear on the third day of infection, and on the seventh day the patient recovers.

Typically, enteroviral stomatitis is combined with exanthema, gastroenteritis, fever, and sore throat. In more rare cases, stomatitis is asymptomatic.

Due to the abundant symptoms, doctors often misdiagnose patients as ARVI, allergic dermatitis, rotavirus or herpetic infection. Prescribed drugs eliminate the main symptoms of the pathology, but do not cure it completely.

Diagnostics

Diagnosis of enterovirus infection is based on characteristic clinical symptoms, patient examination data, epidemiological history and laboratory test results.

The following clinical signs allow one to suspect enterovirus infection:

Gerpangina,
Enteroviral exanthema,
Enteroviral stomatitis,
meningeal signs,
Nonbacterial sepsis,
respiratory syndrome,
Conjunctivitis,
Gastroenteritis.

Material for research - a swab from the throat, discharge from oral ulcers, feces, cerebrospinal fluid, blood.

Virological research- the main diagnostic method. To detect enteroviruses use:

PCR – polymerase chain reaction. This method is highly specific, highly sensitive and fast. It is designed to identify viruses that are not able to reproduce in cell culture. PCR is used to examine cerebrospinal fluid and respiratory secretions.
Detection of pathogens in cell culture or laboratory animals. This method is longer, but accurately determines the type of microbe.

Serodiagnosis is aimed at determining the antibody titer in paired sera taken from a patient in the first and third weeks of the disease. To do this, a complement binding reaction or a hemagglutination inhibition reaction is performed. A fourfold increase in antibody titer in paired sera is considered diagnostically significant. IgA and IgM are markers of the acute period of the disease, and IgG is a marker of past infection that remains in the blood for a long time. Serological testing is intended to confirm the virological method, since enteroviruses can be detected in the feces of healthy people.

Molecular biological method allows you to determine the serotype of the isolated pathogen.

Immunohistochemistry– immunoperoxidase and immunofluorescence methods.

All of these methods are rarely used in mass examination of patients, since they are lengthy, complex and do not have high diagnostic value, which is associated with a large number of asymptomatic carriers of enteroviruses.

Differential diagnosis of enterovirus infection:

Herpetic sore throat is differentiated from fungal infection of the oropharynx and herpes simplex;
Epidemic myalgia - with inflammation of the pancreas, pleura, gall bladder, appendix, lungs;
Enteroviral fever - with acute respiratory viral infections;
Serous meningitis - with inflammation of the meninges of other etiologies;
Enteroviral exanthema - with, allergies;
Enteroviral gastroenteritis - with salmonellosis and shigellosis.

Treatment

Treatment of enterovirus infection includes:

Compliance with the regime
Balanced and rational nutrition,
Taking multivitamins,
Etiotropic and pathogenetic therapy.

Regime and diet

Mild and moderate forms of pathology are treated at home with strict bed rest. Patients with severe forms, prolonged fever and complications are hospitalized.

Patients are prescribed a diet that reduces intoxication, increases immunity, and spares the digestive organs. The patient's diet should contain sufficient amounts of protein, vitamins, and minerals. Drinking plenty of fluids is recommended to detoxify the sick body.

Etiotropic treatment

Specific therapy for enterovirus infection has not been developed.
Antiviral drugs - Remantadine, Kagocel.
Immunostimulants - “Grippferon”, suppositories “Viferon”, “Kipferon”. These drugs have a dual therapeutic effect: they help get rid of viruses and stimulate cellular and humoral immunity.
Immunomodulators – “Amiksin”, “Cycloferon”, “Tsitovir”. They have a pronounced anti-inflammatory effect and stimulate the body’s production of its own interferon, which increases overall resistance and protects against the destructive effects of viruses.

Pathogenetic therapy

Pathogenetic treatment of enterovirus infection is carried out in a hospital setting.

Detoxification measures are indicated for severe pathology.
With the help of diuretics, dehydration is carried out when complications develop - inflammation of the brain and its membranes.
Cardioprotectors are prescribed for viral heart disease.
For treatment, drugs are used that improve blood microcirculation in the vessels of the brain.
Corticosteroids are used to treat pathologies of the nervous system.
Resuscitation measures and intensive care are necessary when emergency conditions develop.

Symptomatic therapy

Pregnant women and children should be under the supervision of a specialist throughout the entire illness. Only a doctor, after making a diagnosis, should prescribe medications and their dosages allowed for a certain period of pregnancy and age group.

Self-medication of enterovirus infection is strictly prohibited. This is due to the nonspecificity of the symptoms of the disease, the possibility of confusing the pathology and being treated incorrectly.

Prevention

Specific prevention for enterovirus infection has not been developed. Main events:

Video: enterovirus infection, “Live Healthy”

Among enteroviral diseases, the two most common forms are hand-foot-mouth disease and herpangina.

Atypical manifestations of enterovirus rashes are much less common and can imitate rubella, scarlet fever, Kawasaki disease, sudden exanthema and many other diseases, however, even with an atypical course, upon closer examination the child still has aphthae in the mouth or pharynx, and/or typical dense blisters on flexor surfaces of the palms and feet. It is these typical manifestations that allow a correct diagnosis to be made.

The subject of our consideration will be the typical forms of manifestation of these enteroviral diseases.

HAND-FOOT-MOUTH DISEASE

The name of this disease comes from the English Hand, Foot and Mouth Disease (HFMD).

Hand-foot-mouth disease (HFMD) is caused by the Coxsackievirus, a member of the enterovirus family. HFMD most often affects children under 10 years of age, but people of any age can get the infection.

Symptoms

The disease is manifested by fever (high temperature) and red spots with blisters in the center. Most often, the rash with HFMD is located in the mouth (tongue, gums), arms and legs (hence the name of the disease), but can also affect the buttocks, especially the perianal area, and appear as single elements on any part of the body. Typically, HFMD lasts about 10 days, with incidence typically peaking in late summer and fall.

Contrary to popular belief, your child cannot get HFMD from animals.

Treatment

A child's fever can be relieved with drugs based on ibuprofen or paracetamol, and they can also be taken to relieve pain in the mouth. You just need to consult your doctor about the optimal dose and method of administering the drug.

Never give your child aspirin without a doctor's permission - aspirin provokes the development of an extremely serious disease - Reye's syndrome.

Daily regime

If your child feels tired or sick, you should allow him to rest as much as possible. If the child is energetic and cheerful, then you should not insist on rest; let him play and spend the day as usual.

Nutrition

If a child has painful mouth sores, he or she will likely eat less or stop eating and drinking completely. It is important not only to relieve pain from the rash, but also to offer him pureed, easily digestible foods that do not irritate the oral mucosa. These include yoghurts, puddings, milkshakes, jellies, purees, etc. It's best to eat these foods cool or at room temperature, not hot.

Do not give your child spicy, salty or sour foods. There is no need to feed him citrus juices and carbonated drinks. These fluids can make your child's mouth feel worse. Offer to drink from a cup rather than a bottle—negative sucking pressure also increases pain and promotes mucosal trauma and bleeding. Drinking through a straw is safe - it can be a complete alternative to a bottle, especially for aphthae on the lips and tip of the tongue.

Children's institutions

The child can return to the children's group after normalization of body temperature and general condition, but the main indicator will be the disappearance of elements of the rash. Until this moment, going out in public is not advisable, since the child may be contagious to others.

Contact your doctor if:

The blisters filled with pus or became sharply painful. This may be a sign of a secondary infection.
Your child's mouth sores are so painful that he won't open his mouth and completely refuses to eat or drink.

See a doctor immediately or call an ambulance if:

Your child is dehydrated due to complete refusal to eat or drink. You can talk about dehydration if:
- the child has not urinated for more than 8 hours
- the baby can feel a sharply sunken fontanel on the head
- baby crying without tears
- his lips are cracked and dry.
Also, don't waste another minute if your child has a stiff neck (difficulty bringing the chin to the chest), severe headache or back pain, and these symptoms are combined with a fever above 38°C.

GERPANGINA

Herpangina is a viral disease that is caused by the same Coxsackie viruses and is manifested by the formation of painful ulcers (ulcers) in the throat and mouth, as well as severe sore throat and fever.

Herpangina is one of the common childhood infections. It most often occurs in children aged 3 to 10 years, but can affect people in any age group.

Herpangina symptoms:

Usually no additional diagnostic methods are required - the doctor makes a diagnosis based on a physical examination and medical history.

Treatment

Treatment and care are similar to those described for hand-foot-mouth disease. Herpangina usually goes away within a week.

As with hand-foot-mouth disease, and with herpangina, the main complications are considered to be dehydration and aseptic meningitis. Therefore, you should closely monitor your child for signs of dehydration and headache levels, and consult a doctor immediately if complications are suspected.

Fortunately, complications are quite rare and most children recover within 10 days.

During a child’s illness, all family members must maintain careful hygiene: wet cleaning more often than usual, using dishes separately, frequently washing their hands and treating them with antiseptics.

Herpetic sore throat is an acute viral disease, manifested mainly by inflammation of the mucous membranes of the pharynx and oral cavity with the subsequent appearance of papules similar to a herpetic rash. Most often, the disease occurs in children; due to the high contagiousness of herpetic sore throat in childhood, most people manage to get sick, after which they have a long-lasting immunity (according to some sources, for life). There are currently no means of etiological treatment for herpetic sore throat (one that allows you to destroy pathogenic viruses in the body), and therefore the treatment itself only involves the correction of symptoms until the patient’s immune system copes with the disease on its own.

The name of this disease is a double misnomer. Herpetic sore throat has nothing to do with herpes infections or tonsillitis. Its scientific medical name is enteroviral vesicular stomatitis, synonyms are enteroviral vesicular pharyngitis, Zagorsky disease, ulcerous tonsillitis. In common parlance it is also called herpetic sore throat, herpangina, and sometimes they say, quite illiterately, “herpetic sore throat.”

The popular name “herpetic” itself is associated with the similarity of the rash in the patient’s throat with the rash associated with herpes infections. The disease is called sore throat because of severe sore throat, similar to that of typical streptococcal sore throat. At the same time, the treatment of herpetic sore throat differs from the treatment of both herpes viral diseases and streptococcal sore throat, and therefore the correct differential diagnosis of herpetic sore throat is very important.

On a note

The code for herpetic sore throat according to ICD-10 is B08.5.

Photo and view of the throat with herpetic sore throat

Local manifestations of herpetic sore throat in the throat are quite characteristic. The photo shows the pharynx and oral cavity of a child with this disease:

The most obvious sign of the disease is small papules with a diameter of 1-2 mm on the surface of the palate, pharyngeal ring, tonsils, and tongue. In the initial stages, they are reddish in color and appear to be filled with blood. In the photo this is exactly what they look like:

Approximately a few hours (up to a day) after the appearance of the papules lighten and become transparent (but not cloudy), as if filled with water. Each of them is surrounded by a reddish corolla. At this stage they look like a herpetic rash:

Doctors call these formations vesicles. They are very painful in themselves and add to the pain of the inflamed tissues on which they are located. Approximately 2-4 days after the appearance of the blisters, they open with fluid flowing out of them; painful ulcers form in their places, which then become covered with crusts. This can be clearly seen in the photo:

It is typical that the more severe the disease, the more blisters appear in the patient’s mouth. In normal cases there are 6-12 vesicles, in severe cases there are up to 20. Vesicles located next to each other can merge to form larger vesicles. Approximately 5-6 days after ulceration and scab formation, the crusts at the sites of the ulcers are washed off with saliva without any traces of lesions.

With herpetic sore throat, the mucous membranes of the pharynx themselves become inflamed and acquire a pronounced painful red color and a swollen appearance.

There are also non-standard cases in which:

There is no papular rash observed at all, there is only swelling and inflammation of the mucous membranes of the mouth and pharynx;
The rash develops several times (typical for patients with weakened immune systems).

Severe case involving the back of the throat

Herpetic sore throat in children and adults is characterized by a similar clinical picture. Adults tolerate the disease somewhat easier.

Associated symptoms of the disease

The most characteristic symptoms of herpetic sore throat are:

High temperature - up to 40-41°C. Herpetic sore throat is characterized by a very sharp increase in the temperature itself - usually the jump occurs literally in 3-4 hours;
Severe sore throat. They are somewhat different from those with bacterial sore throat: the throat itself does not squeeze, the pain does not shoot into the ear, but causes a characteristic “stabbing” sensation. The pain intensifies significantly when touching the inflamed areas of the pharynx or vesicles, as well as when irritated by food and water;
Runny nose, nasal congestion, often cough;
Malaise, weakness in the body;
Enlarged lymph nodes near the ears, on the neck behind the lower jaw.

Also, with herpetic sore throat, digestive disorders are common, especially in children. This is due to the fact that herpetic sore throat is caused by enteroviruses, which, affecting the mucous membranes of the stomach and intestines, disrupt their functioning. The patient (usually a child) may feel pain in the abdomen, have diarrhea, and may feel nauseated.

Coxsackie enterovirus is the causative agent of herpes sore throat.

Very rarely, the symptoms of herpetic sore throat are supplemented by quickly passing rashes on the arms, legs and torso.

Herpetic sore throat in children under one year of age and in patients with weakened immunity (or with very high activity of the virus and its spread through the bloodstream) may be accompanied by more severe and dangerous symptoms:

Unilateral conjunctivitis;
Serous meningitis with its characteristic symptoms: trismus of masticatory muscles, Kernig syndrome, headaches;
Pyelonephritis;
Muscle pain;
Pain in the heart;
Encephalitis.

These symptoms develop relatively rarely, but sometimes they turn out to be more dangerous than herpetic sore throat itself and can turn into complications. If they are present, consultation with a doctor is required. More often, such symptoms are accompanied by herpetic sore throat in a child aged 1-2 years.

If a patient develops convulsions against the background of a sore throat, this is a sign of the development of meningitis and requires hospitalization of the patient, and further observation by a neurologist.

Child at an appointment with a neurologist

In most cases, herpetic sore throat occurs like a typical acute respiratory viral infection, but with characteristic clinical manifestations in the form of blisters on the surface of the pharynx and mouth.

Diagnosis and differential diagnosis

Typically, diagnosing herpetic sore throat is not difficult. It is enough for the doctor to assess the general condition of the patient and see the rashes in the throat characteristic of the disease in order to accurately make a diagnosis. Differential diagnosis and the use of laboratory research methods are required mainly in cases of atypical course of the disease, when the symptom complex and clinical picture of the disease may resemble diseases of a different nature:

Herpes stomatitis, often occurring in children with fever. It differs from herpangina by the predominant localization of vesicles on the tongue and gums, while with herpangina the rashes mainly appear in the pharynx and on the palate. In children under 3-4 years of age, herpangina occurs much more often than stomatitis. In the photo - stomatitis:
And here is herpangina:
Purulent sore throat - many people mistake vesicles in herpetic sore throat for pus. With a typical purulent sore throat, ulcers never appear outside the tonsils; they do not appear on the palate or tongue. Also, with a typical sore throat, a runny nose, characteristic of herpetic sore throat, does not develop. Here in the photo is a child’s herpetic sore throat: And here - streptococcal follicular;
Catarrhal sore throat, which resembles herpangina that occurs without rashes. Similar to purulent tonsillitis, catarrhal tonsillitis is never accompanied by a runny nose. If it is present, the patient has a viral infection, most likely herpetic sore throat.

The diagnosis is usually confirmed by slight leukocytosis detected by a general blood test. Sometimes when you are sick you need to take a blood test.

Video: Doctor Komarovsky explains the difference between herpangina and streptococcal sore throat

In cases where an accurate determination of the causative agent of the disease is required, the following diagnostic methods are used:

Serological research methods designed to identify antibodies to pathogens of herpetic sore throat - ELISA, RNGA, complement fixation reaction;
Virological diagnostic methods that make it possible to detect and identify the pathogen itself in a liquid taken from vesicles - PCR, the addition of diagnostic immune fluorescent sera.

However, the need for such research methods arises very rarely.

In case of severe manifestations of symptoms from various internal organs, the patient must be examined by an appropriate doctor. In case of meningitis and encephalitis, the patient should be examined by a neurologist, in case of heart pain - by a cardiologist, in case of kidney damage - by a nephrologist.

Pathogens

Herpetic sore throat is caused by intestinal Coxsackie viruses types A and B, and much less commonly by some ECHO viruses (echoviruses). The entry gates for the virus in the body are the mucous membranes of the mouth and intestines, where rapid replication of the virus begins and from where it can penetrate the blood and spread throughout the body. Viremia usually occurs on days 2-8 of illness

Coxsackievirus type A21

In the mucous membranes of the mouth, the virus, replicating in a cell, causes the development of vesicles (vacuoles), which turn into swelling of the entire cell, from the beginning of which the cell dies. In the area of necrosis, fluid from the blood accumulates, promoting the formation of vesicles. After opening, their liquid flows out and the viral particles partially die and partially enter the stomach, where they are destroyed by already formed components of the immune system.

After suffering from the disease, a person develops a stable type-specific immunity to viruses that cause herpetic sore throat. Hypothetically, it is possible to get a second disease during life (either when infected with another type of virus, or after a long period of time - when specific immunity is lost); in fact, there is no information on the frequency of repeated cases of the disease.

Methods of transmission of the virus

The causative agents of herpetic sore throat are transmitted in many ways:

Fecal-oral - through food, dirty hands, toys, pacifiers;
Airborne;
Contact - through saliva and nasal mucus.

Of these, airborne is considered the most significant and widespread. It is most often implemented in children's groups.

Children's groups are an ideal place for the spread of enteroviruses

On a note

It is assumed that Coxsackie viruses can be transmitted through water and infection with them can occur when swimming in open water near sewerage discharge sites.

The spreaders of the virus are patients in the acute phase of the disease and at the convalescent stage. After completion of the illness, the patient is quarantined for at least two weeks.

Incubation period and chronology of the disease

The incubation period of herpetic sore throat from the penetration of the virus into the body until the appearance of symptoms of the disease lasts 7-10 days, sometimes longer. The onset of the disease is sudden, the patient’s body temperature can jump literally within a few hours. Then:

On the second or third day from the onset of symptoms, rashes appear on the mucous membranes of the pharynx and palate; after another day they change color from reddish to transparent white;
On the second day, the temperature may drop slightly, but remain high. The patient develops a whole range of symptoms - muscle pain, indigestion, sore throat;
On the third day, the temperature usually rises and reaches its maximum. Various symptoms also reach a climax. At this stage the patient feels the worst.
On the 3-4th day of illness, blisters on the palate begin to open, the temperature drops somewhat;
On days 5-6, the patient’s condition improves, symptoms of intoxication disappear, sore throat subsides, and temperature decreases;
On the 7-8th day, the inflammation of the pharyngeal tissues subsides, the crusts at the site of the ulcers disappear;
On days 9-10, the enlarged lymph nodes stop hurting. Their inflammation goes away within 14-15 days.

The acute period of herpes sore throat lasts 4-5 days.

Normally, herpetic sore throat lasts 8-10 days in children, and 6-7 days in adults. Herpetic sore throat cannot be chronic or.

Dangers, consequences of the disease and general prognosis

In most cases, herpetic sore throat is not a dangerous disease and passes without consequences. The prognosis for it is favorable: the vast majority of patients recover completely without any consequences. Inflammatory diseases that develop when the pathogen infects various body tissues can pose a danger:

Meningitis - there are known cases of its recurrence after the end of herpangina in children; cases with a fatal outcome in children of the first year of life have also been recorded;
Encephalitis;
Inflammation of the heart muscle;
Pyelonephritis;
Bacterial complications.

When these complications develop, the patient complains of pain in the corresponding parts of the body. With bacterial complications, typical ulcers appear in the areas of the vesicles, which can increase in size.

The consequences of herpetic sore throat are more likely, the weaker the patient’s immunity. In immunodeficiency states, internal multiple organ lesions often occur, which can cause death. In adults, herpetic sore throat is dangerous primarily for patients with HIV.

Video: If you consult a doctor in a timely manner, the risk of developing herpangina complications will be significantly lower...

Epidemiology: who, when and how often suffers from herpetic sore throat?

Most often, herpetic sore throat is diagnosed in children 3-10 years old. Due to its high contagiousness, the disease easily spreads in children's groups, or is transmitted from adults, and therefore, normally, a child gets sick in childhood, and as an adult, remains reliably protected from the pathogen by the formed immunity.

Less commonly, herpetic sore throat develops in children during the first 2 years of life. But in them the disease is most severe and more often causes complications. In a child under six months old, this disease is unlikely, since he is protected by maternal antibodies received before birth.

Immunoglobulin is a protein responsible for recognizing and binding detected viral particles

Unlike most respiratory diseases, herpetic sore throat most often occurs in the summer months, since it is at high air temperatures that enteroviruses themselves spread more easily and quickly. In some cases, the disease occurs in the form of local outbreaks, affecting entire families or various groups. A person caring for a sick person can easily become infected and get sick.

Herpetic sore throat is not chronic or recurrent. Repeated episodes of it are isolated and extremely rare. When a recurrent disease is suspected, we are most likely talking about herpes stomatitis. In almost all patients, herpetic sore throat occurs only once in a lifetime.

Is herpetic sore throat dangerous during pregnancy?

Herpetic sore throat does not pose a serious danger to the pregnant woman herself. As in most adult patients, during this period the disease goes away in the expectant mother without complications.

The causative agent of herpangina, Coxsackie virus type B, has the potential to overcome the placental barrier, penetrate the fetus and lead to developmental abnormalities. Due to the rarity of the disease itself in pregnant women, there are no statistics demonstrating the frequency of such effects and the danger of the virus.

If the mother herself is healthy and leads a normal lifestyle, the likelihood of herpangina affecting her unborn child is minimal. Her illness will most likely pass without consequences.

Treatment of herpetic sore throat

Treatment of herpetic sore throat consists of alleviating the patient’s condition and relieving the most severe symptoms.

To date, there are no means that would destroy the causative agent of herpetic sore throat, if it is already located and multiplying in the tissues of the body. It means that No medications can influence the duration of the disease, and it will end when the body develops an immune response against it and destroys all viral particles. This usually takes 7-10 days.

Symptomatic treatment of herpangina usually includes:

Use of antipyretics. In children, Nurofen, Efferalgan and Paracetamol are usually used, in adults - the same, or additionally Aspirin;
Drinking plenty of fluids is even more important than bringing down the temperature with antipyretics. The more the patient drinks, the easier it is for his body to regulate temperature and the sooner it will be possible to stop taking antipyretic drugs. Drinking also helps to reduce the symptoms of intoxication;
The use of painkillers - Hexoral Tabs, Tantum-Verde, Theraflu Lar, 2% lidocaine solution. They allow you to relieve sore throat for several hours;
Gargling with herbal decoctions - chamomile, sage, calendula - as well as a simple soda and saline solution. Such rinses help reduce inflammation and ease pain. They also have some disinfecting effect, which helps protect against bacterial complications of herpangina.

Video: Doctor Komarovsky explains why rinses are used for ARVI

Sometimes, for the treatment of herpetic sore throat in children, it is recommended to irrigate the throat with antiseptics, as well as lubricate the papules themselves with solutions of iodine or brilliant green. In reality, these measures are redundant, ineffective and sometimes traumatic for the patient. If bed rest is observed during illness, the likelihood of contracting a bacterial infection in the patient is minimal and such preventive measures are not necessary. At the same time, spreading Lugol's solution or brilliant green onto a very painful surface of the pharynx is more difficult for a sick child to tolerate than the disease itself. That is, the use of such drugs is useless and painful for the patient.

In very rare cases, it may theoretically be advisable to use hyposensitizing agents, for example, Claritin or Suprastin. Inflammation in herpangina almost never reaches such severity that it may require the use of systemic antihistamines.

It is almost always possible to treat herpetic sore throat in both children and adults at home (with the exception of situations where signs of meningitis appear). In this case you need:

Maintain bed rest;
Adhere to diet No. 13 according to Pevzner, feed the patient with soft boiled semi-liquid dishes;
Ensure a normal microclimate in the room in which the patient is located - a temperature of about 20°C and a humidity of 50-70%, regular ventilation.

Paracetamol is an antipyretic and analgesic, which is quite sufficient for symptomatic therapy for herpes sore throat.

At the same time, it is impossible to treat herpetic sore throat with the following means and methods:

Antiherpetic agents. Since this disease is not caused by herpes viruses, Valacyclovir and their analogues are completely useless for it, but due to the risk of side effects they can be dangerous;
and compresses - these methods lead to heating of inflammation and a more active spread of viral infection in the body;
Universal antiviral and immunomodulatory agents - their effectiveness in herpetic sore throat has not been proven, and side effects can be quite severe;
- this procedure is completely useless for fighting viruses in the body, but it is also dangerous due to the risk of burns.

For the majority of patients and parents of sick children, it is extremely important to come to terms with the fact that with herpetic sore throat, with all the severity of its course, it is impossible to shorten the duration of the disease and there is no need to take any pills other than antipyretics. However, almost all drugs except antipyretics and anesthetics are placebos for herpetic sore throat and either do not have a therapeutic effect at all, or this effect is much less pronounced than the dangers of the drugs themselves. Such remedies are taken only for self-soothing.

Disease prevention

There are no specific means of preventing herpetic sore throat today. You can reduce the likelihood of getting sick:

Taking measures to generally strengthen the immune system - eating right, observing a proper work and rest regime, hardening, maintaining physical activity;
Avoiding communication with sick or recovering people;
Complying with sanitary rules and maintaining normal microclimate conditions in living and working areas.

In medical and educational practice, to reduce the incidence of diseases, patients diagnosed with herpetic sore throat are prescribed quarantine for at least 2 weeks; health workers themselves, employees of children's educational and educational institutions undergo regular medical examinations. In the institutions themselves, strict sanitary standards are observed for this purpose.

Video: Doctor Komarovsky explains the rules for treating herpangina

Acute, virus-induced damage to the lymphoid tissue of the pharynx, caused by the Coxsackie and ECHO viruses. Herpetic sore throat in children occurs with a rise in temperature, sore throat, lymphadenopathy, hyperemia of the pharynx, vesicular rashes and erosions on the tonsils and the back wall of the pharynx. Herpetic sore throat in children is diagnosed by a pediatric otolaryngologist based on examination of the pharynx, virological and serological examination of nasopharyngeal swabs. Treatment of herpetic sore throat in children includes taking antiviral, antipyretic, desensitizing drugs; local treatment of the oral mucosa, ultraviolet radiation.

General information

Herpangina in children (herpangina, herpetic tonsillitis, vesicular or aphthous pharyngitis) is a serous inflammation of the palatine tonsils caused by Coxsackie enteroviruses or ECHO. Herpetic sore throat in children can be a sporadic disease or an epidemic outbreak. In pediatrics and pediatric otolaryngology, herpetic sore throat is predominantly found in children of preschool and primary school age (3-10 years); Herpangina is most severe in children under 3 years of age. In children in the first months of life, herpetic sore throat occurs less frequently, which is associated with the receipt of appropriate antibodies from the mother along with breast milk (passive immunity).

Herpetic sore throat in a child can occur either in isolated form or in combination with enteroviral serous meningitis, encephalitis, epidemic myalgia, myelitis, also caused by these viruses.

Causes of herpetic sore throat in children

Herpangina in children is one of the viral diseases caused by enteroviruses from the picornavirus family - Coxsackie group A (usually viruses of serovars 2-6, 8 and 10), Coxsackie group B (serotypes 1−5) or ECHO viruses (3, 6, 9 , 25).

The mechanism of transmission of pathogens is airborne (when sneezing, coughing or talking), less often fecal-oral (through food, pacifiers, toys, dirty hands, etc.) or contact (through nasopharyngeal discharge). The main natural reservoir is a virus carrier or a sick person; less often, infection occurs from domestic animals. Convalescents can also serve as sources of infection, since they continue to release the virus for 3-4 weeks. The peak incidence of herpetic sore throat in children occurs in June-September. The disease is highly contagious, so in the summer-autumn period there are often outbreaks of herpetic sore throat in children within families or organized groups (camps, kindergartens, school classes).

Penetrating into the body through the mucous membranes of the nasopharynx, the causative agents of herpetic sore throat in children enter the intestinal lymph nodes, where they actively multiply and then penetrate into the blood, causing the development of viremia. The subsequent spread of viral pathogens is determined by their properties and the state of the child’s body’s defense mechanisms. Together with the bloodstream, viruses spread throughout the body, fixing themselves in certain tissues, causing inflammatory, dystrophic and necrotic processes in them. Enteroviruses Coxsackie and ECHO have high tropism for mucous membranes, muscles (including myocardium), and nervous tissue.

Often, herpetic sore throat in children develops against the background of influenza or adenovirus infection. After suffering from herpangina, children develop stable immunity to this strain of the virus, however, when infected with another type of virus, herpangina may occur again.

Symptoms of herpetic sore throat in children

The latent period of infection ranges from 7 to 14 days. Herpetic sore throat 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, and abdomen; headache, vomiting, diarrhea. Following the general symptoms, sore throat, drooling, pain when swallowing, acute rhinitis, and cough appear.

With herpetic sore throat in children, local changes quickly increase. Already in the first two days, against the background of hyperemic mucosa of the tonsils, palatine arches, uvula, palate, small papules are found in the oral cavity, which quickly turn into vesicles with a diameter of up to 5 mm, filled with serous contents. After 1-2 days, the blisters open, and in their place whitish-gray ulcers are formed, surrounded by a halo of hyperemia. Sometimes the ulcers unite, turning into superficial drainage defects. The resulting erosions of the mucous membrane are sharply painful, and therefore children refuse to eat and drink. With herpetic sore throat in children, bilateral submandibular, cervical and parotid lymphadenopathy is detected.

Along with the typical forms of herpetic sore throat in children, blurred manifestations can occur, characterized only by catarrhal changes in the oropharynx, without mucosal defects. In children with weakened immune systems, the rash may recur in waves every 2-3 days, which is accompanied by a resumption of fever and symptoms of intoxication. In some cases, with herpetic sore throat, a child experiences the appearance of a papular and vesicular rash on the distal limbs and torso.

In typical cases, fever with herpetic sore throat in children subsides after 3-5 days, and defects in the mucous membrane of the oral cavity and pharynx epithelialize after 6-7 days. With low reactivity of the body or a high degree of viremia, generalization of entroviral infection with the development of meningitis, encephalitis, myocarditis, pyelonephritis, hemorrhagic conjunctivitis is possible.

Diagnosis of herpetic sore throat in children

In a typical clinical picture of herpetic sore throat in children, a pediatrician or pediatric otolaryngologist can make a correct diagnosis even without additional laboratory testing. When examining the pharynx and pharyngoscopy, a typical location for herpetic sore throat is revealed (posterior wall of the pharynx, tonsils, soft palate) and type of rash (papules, vesicles, ulcers). A general blood test reveals slight leukocytosis.

To identify the causative agents of herpetic sore throat in children, virological and serological research methods are used. Washings and swabs from the nasopharynx are examined by PCR; Using ELISA, an increase in the titer of antibodies to enteroviruses by 4 or more times is detected.

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

Treatment of herpetic sore throat in children

Complex therapy for herpetic sore throat includes isolation of sick children, general and local treatment. The child needs to drink plenty of fluids and take liquid or semi-liquid food to avoid irritation of the oral mucosa.

For herpetic sore throat, children are prescribed hyposensitizing drugs (loratadine, mebhydrolin, hifenadine), antipyretic drugs (ibuprofen, nimesulide), and immunomodulators. In order to prevent the accumulation of a secondary bacterial infection, oral antiseptics, hourly gargling with antiseptics (furacilin, miramistin) and herbal decoctions (calendula, sage, eucalyptus, oak bark) are recommended, followed by treatment of the back wall of the pharynx and tonsils with drugs. For herpetic sore throat in children, aerosols that have an analgesic, antiseptic, and enveloping effect are used topically.

A good therapeutic effect is achieved with endonasal/endopharyngeal instillation of leukocyte interferon and treatment of the oral mucosa with antiviral ointments (acyclovir, etc.). In order to stimulate the epithelization of erosive defects in the mucosa, ultraviolet irradiation of the nasopharynx is recommended.

In case of herpetic sore throat in children, it is strictly unacceptable to carry out inhalations and apply compresses, since heat increases blood circulation and promotes the spread of viruses throughout the body.

Forecast and prevention of herpetic sore throat in children

For children with herpetic sore throat and contact persons, quarantine is established for 14 days. Current and final disinfection is carried out in the epidemiological site. In most cases, herpetic sore throat in children ends in recovery. With the generalization of a viral infection, multiple organ damage is possible. Fatal outcomes are usually observed among children in the first years of life with the development of meningitis.

Specific vaccine prophylaxis is not provided; children who have been in contact with a patient with herpetic sore throat are given specific gamma globulin. Nonspecific measures are aimed at timely identification and isolation of sick children, increasing the reactivity of the child’s body.

consultation with a psychiatrist doctor