Is herpangina the same as herpetic gingivostomatitis?

Herpangina vs. Herpetic Gingivostomatitis: Different Clinical Entities

No, herpangina and herpetic gingivostomatitis are not the same condition - they are distinct clinical entities caused by different viruses and have different clinical presentations.

Etiology and Causative Agents

• Herpetic Gingivostomatitis:

  • Caused by Herpes Simplex Virus (HSV), primarily HSV-1 and occasionally HSV-2 1, 2, 3
  • Represents the most common clinical manifestation of primary HSV infection in childhood 4
  • HSV-1 typically causes orolabial disease, while HSV-2 is more commonly associated with genital disease, though HSV-2 can occasionally cause oral lesions 2, 3

• Herpangina:

  • Caused by non-herpes enteroviruses (primarily Coxsackie A virus)
  • Not caused by herpes simplex virus
  • Often mentioned alongside hand-foot-and-mouth disease as a distinct enteroviral infection 5

Clinical Presentation and Distribution of Lesions

• Herpetic Gingivostomatitis:

  • Characterized by fever, irritability, tender submandibular lymphadenopathy 1
  • Presents with superficial, painful ulcers in the gingival and oral mucosa and perioral area 1
  • Lesions can involve the entire oral cavity including gingiva, buccal mucosa, tongue, and lips 4
  • Mean duration of oral lesions is approximately 12 days 4
  • Fever typically lasts about 4-5 days 4
  • Eating/drinking difficulties persist for 7-9 days 4

• Herpangina:

  • Characterized by small vesicles/ulcers primarily on the posterior pharynx, soft palate, and tonsillar pillars
  • Lesions are typically more localized to the posterior oropharynx
  • Generally spares the gingiva and anterior mouth, unlike herpetic gingivostomatitis

Disease Course and Complications

• Herpetic Gingivostomatitis:

  • Viral shedding persists for approximately 7 days (range 2-12 days) 4
  • Main complications include dehydration requiring hospitalization and secondary bacterial infections 4
  • In immunocompromised patients (e.g., HIV-infected), can lead to severe ulcerative disease and frequent recurrences 1
  • Can be relatively severe in young children 4

• Herpangina:

  • Generally self-limiting with shorter duration than herpetic gingivostomatitis
  • Can also cause significant pain leading to poor oral intake and dehydration 5

Diagnosis

• Herpetic Gingivostomatitis:

  • Clinical diagnosis based on characteristic appearance of vesicles and ulcers 1
  • Laboratory confirmation through viral culture, PCR for HSV DNA, or direct immunofluorescence 1, 2
  • Tzanck preparation may show multinucleated giant cells but doesn't differentiate HSV types 1

• Herpangina:

  • Clinical diagnosis based on characteristic lesion distribution
  • Viral culture or PCR can identify the causative enterovirus

Treatment Approach

• Herpetic Gingivostomatitis:

  • Acyclovir is the drug of choice for treatment 1, 6, 7
  • Treatment should be started within the first 3 days of disease onset 7
  • Recommended dose is 15 mg/kg, 5 times daily for 5-7 days 7
  • Early acyclovir treatment significantly shortens the duration of clinical manifestations and viral shedding 7

• Both Conditions:

  • Supportive care is crucial, focusing on pain management and hydration 5
  • Intranasal fentanyl has been shown to be effective for pain relief to improve oral intake in children with painful mouth lesions 5

Key Distinguishing Features

The primary differences between these conditions are:

• Causative agent: HSV for gingivostomatitis vs. enteroviruses for herpangina
• Distribution of lesions: Widespread oral involvement in gingivostomatitis vs. posterior oropharyngeal focus in herpangina
• Gingival involvement: Present in gingivostomatitis, typically absent in herpangina

Understanding these distinctions is crucial for accurate diagnosis and appropriate management of these painful oral conditions in pediatric patients.