What Causes Herpangina?
Herpangina is caused by enteroviruses, most commonly Coxsackievirus A serotypes, with Coxsackievirus A2, A4, A6, and A10 being the predominant causative agents. 1, 2
Primary Causative Agents
The specific viral pathogens responsible for herpangina include:
- Coxsackievirus A group - the most frequent cause, with Coxsackievirus A2 identified as a major subtype in recent outbreaks 3, 2
- Enterovirus-A serotypes including Coxsackievirus A4, A6, and A10 3, 2
- Coxsackievirus B group (B2, B4) - less common but documented causes 3
- Echoviruses (including Echovirus 30) - occasional causative agents 3, 2
Transmission and Epidemiology
Herpangina spreads through two primary routes:
- Fecal-oral transmission - the primary mode of spread 3
- Respiratory droplet dissemination - secondary transmission route 3, 4
The infection predominantly affects young children and is highly prevalent during summer and fall months, with enteroviruses circulating widely among pediatric populations during these seasons 3, 5.
Clinical Context
It is critical to distinguish herpangina from herpes simplex virus (HSV) infection, as they are caused by entirely different viral families. 1 Despite the similar-sounding name, herpangina has no relationship to herpesvirus infections. The CDC specifically recommends considering HSV in the differential diagnosis to avoid this common pitfall, but emphasizes that systemic antivirals effective against HSV (acyclovir, valacyclovir, famciclovir) are NOT effective against the enteroviruses causing herpangina 1.
The human alimentary tract serves as the natural habitat for these enteroviruses, which can cause both symptomatic and asymptomatic infections 5. While herpangina is the characteristic clinical syndrome associated with Coxsackie A viruses, these same viral agents can produce a spectrum of other manifestations including non-specific febrile illness, aseptic meningitis, and respiratory infections 5.