herpangina

After a short incubation the child develops abrupt high fever, sore throat, odynophagia, and refusal to eat, with small greyish vesicles surrounded by erythema on the posterior oropharynx that ulcerate over a day or two. The distribution is the key diagnostic feature: herpangina affects the posterior structures, whereas primary herpes simplex gingivostomatitis affects the anterior mouth, gingivae, and perioral skin, with markedly inflamed bleeding gums, and hand-foot-and-mouth disease, usually coxsackie A16, adds vesicles on the palms, soles, and buttocks with more anterior oral lesions. Herpangina occurs in summer and early autumn, spreads faecal-orally and by respiratory droplets, and is highly contagious in nurseries. It is self-limited over about a week; treatment is supportive with attention to hydration, since poor oral intake is the main complication, using cold fluids and topical analgesia. Enterovirus 71 can cause similar oral disease with more severe neurological complications including brainstem encephalitis.