What are the criteria for diagnosing herpangina?

Diagnostic Criteria for Herpangina

Herpangina is diagnosed based on the presence of characteristic vesicular lesions in the oropharynx that progress to shallow ulcers, typically caused by enterovirus infection, particularly Coxsackievirus. 1

Clinical Presentation

• Fever is a common presenting symptom, with higher body temperature typically observed in herpangina compared to hand, foot, and mouth disease 2
• Characteristic pharyngeal damage with vesicular lesions that progress to shallow ulcers or erosions in the posterior oropharynx 1
• Vesicles contain clear fluid with high concentrations of viral particles 3
• Vesicles eventually burst, forming shallow ulcers that crust and heal without scarring 3
• The disease course generally lasts 4-6 days with good prognosis 1

Diagnostic Approach

• Diagnosis is primarily based on:

  • History of epidemiology (exposure to infected individuals)
  • Typical symptoms (fever, sore throat)
  • Characteristic oropharyngeal lesions
  • Virological confirmation tests 1

• Laboratory confirmation should be sought when clinical presentation is atypical 4

• PCR testing of vesicular fluid is the most definitive diagnostic method 5

Differential Diagnosis

• Herpangina must be differentiated from:
  • Genital herpes (when lesions appear in genital region) 6
  • Hand, foot, and mouth disease (which can have similar oral lesions but also presents with skin manifestations) 2
  • Herpes zoster in the oropharyngeal region 3
  • Other causes of pharyngitis 1

Specimen Collection for Laboratory Confirmation

When laboratory testing is needed:

• Open vesicles with a sterile needle
• Collect vesicular fluid with a swab for:
  • Immunofluorescence staining
  • Viral culture
  • Nucleic acid amplification tests (NAATs) 4

Common Pitfalls in Diagnosis

• Relying solely on clinical diagnosis without laboratory confirmation can lead to both false positive and false negative diagnoses 4
• Misdiagnosing herpangina as herpes simplex virus infection due to similar vesicular appearance 6
• Failing to recognize atypical presentations, especially in immunocompromised patients 6

Treatment Considerations

• Treatment is primarily symptomatic and supportive 1
• May include:
  • Adequate rehydration
  • Diet modifications (avoiding salty, spicy, and irritating foods)
  • Topical treatments for pain relief 5
  • Antiviral medications in some cases 1
  • Restriction of physical activity during acute phase 5

Special Populations

• Herpangina is most commonly encountered in young children, with an average age of onset around 2.5 years 7
• Immunocompromised patients may present with more severe, persistent, and atypical infections 6