Management of herpangina: a viral infection in infants

https://doi.org/10.22146/majkedgiind.79883

Caecilia Dewi Ratna Prathiwi(1), Indra Bramanti(2*)

(1) Study Program of Pedodontic, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta
(2) Department of Pediatric Dentistry, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta
(*) Corresponding Author

Abstract


Herpangina is a self-limiting disease caused by coxsackievirus. The manifestation consists of acute febrile with small ulcerative or vesicular lesions on the tonsillar, soft palate, uvula and buccal mucosa. The disease mostly affects children. The aim of this case report is to discuss the oral symptoms of herpangina based on current literature for dental and health practitioners. In our case, a 15-month-old baby girl presented with high fever reaching 40.2 °C for 2 days with no seizures, cold and cough. Intra oral examination showed several well-defined whitish round lesions on the soft palate and one on the upper left lip. The patient was prescribed 3ml of methisoprinol 250 mg 3 times a day, 4 ml of paracetamol 125 mg every 6 hours, hyaluronic acid spray 3 times a day, and 1ml of vitamin C 40 mg taken once a day. The patient showed no sign of bacterial infection. Lesion disappeared after 7 days of treatment. Upon follow-up visit after 2 weeks, the lesion had completely disappeared. Dentists should be able to recognize and manage herpangina cases in infants.


Keywords


herpangina; infant; oral ulcer; viral infection

Full Text:

PDF


References

1. Puenpa J, Mauleekoonphairoj J, Linsuwanon P, Suwannakarn K, Chieochansin T, Korkong S,
Theamboonlers A, Poovorawan Y. Prevalence and characterization of enterovirus infections
among pediatric patients with hand foot mouth disease, herpangina and influenza like illness
in Thailand, 2012. PLoS One. 2014; 9(6): e98888. doi: 10.1371/journal.pone.0098888

2. Xie MZ, Chen LY, Yang YN, Cui Y, Zhang SH, Zhao TS, Zhang WX, Du J, Cui FQ, Lu QB.
Molecular epidemiology of herpangina children in Tongzhou District, Beijing, China, During
2019-2020. Front Med (Lausanne). 2022; 9: 822796. doi: 10.3389/fmed.2022.822796

3. Oliveira DB, Campos RK, Soares MS, Barros RB, Batista TCA, Ferreira PCP, Bonjardim CA,
Trindade GS, Abrahão JS, Kroon EG. Outbreak of herpangina in the Brazilian Amazon in 2009
caused by Enterovirus B. Arch Virol. 2014; 159(5): 1155–1157.
doi: 10.1007/s00705-013-1858-5

4. Chansaenroj J, Auphimai C, Puenpa J, Mauleekoonphairoj J, Wanlapakorn N, Vuthitanachot V, Vongpunsawad S, Poovorawan Y. High prevalence of coxsackievirus A2 in children with herpangina in Thailand in 2015. Virusdisease. 2017; 28(1): 111–114. doi: 10.1007/s13337-017-0366-8

5. Li W, Gao HH, Zhang Q, Liu YJ, Tao R, Cheng YP, Shu Q, Shang S. Large outbreak of
herpangina in children caused by enterovirus in summer of 2015 in Hangzhou, China. Sci
Rep. 2016; 6: 1–5. doi: 10.1038/srep35388

6. Yao X, Bian LL, Lu WW, Li JX, Mao QY, Wang YP, Gao F, Wu X, Ye Q, Li XL, Zhu
FC, Liang Z. Epidemiological and etiological characteristics of herpangina and hand foot mouth diseases in Jiangsu, China, 2013–2014. Hum Vaccin Immunother. 2017; 13(4): 823–830. doi: 10.1080/21645515.2016.1236879

7. Chang YK, Chen KH, Chen KT. Hand, foot and mouth disease and herpangina caused
by enterovirus a71 infections: A review of enterovirus a71 molecular epidemiology, pathogenesis, and current vaccine development. Rev Inst Med Trop Sao Paulo. 2018; 60: 1–8.
doi: 10.1590/S1678-9946201860070

8. Pons-Salort M, Parker EPK, Grassly NC. The epidemiology of non-polio enteroviruses:
Recent advances and outstanding questions. Curr Opin Infect Dis. 2015; 28(5): 479–487.
doi: 10.1097/QCO.0000000000000187

9. Xie MZ, Chen LY, Yang YN, Cui Y, Zhang SH, Zhao TS, Zhang WX, Du J, Cui FQ, Lu QB.
Molecular epidemiology of herpangina children in Tongzhou District, Beijing, China, During
2019-2020. Front Med (Lausanne). 2022; 9: 1–10. doi: 10.3389/fmed.2022.822796

10. Zhao TS, Du J, Li HJ, Cui Y, Liu Y, Yang Y, Cui F, Lu QB. Molecular epidemiology and
clinical characteristics of herpangina children in Beijing, China: a surveillance study. PeerJ.
2020; 8: 1–15. doi: 10.7717/peerj.9991

11. Chang LY, Lin TY, Hsu KH, Huang YC, Lin KL, Hsueh C, Shih SR, Ning HC, Hwang MS, Wang HS, Lee CY. Clinical features and risk factors of pulmonary oedema after enterovirus-71-related hand, foot, and mouth disease. Lancet. 1999; 354(9191): 1682–1686. doi: 10.1016/S0140-6736(99)04434-7

12. Romero JR. Hand, foot, and mouth disease and herpangina. UpToDate. 2022.

13. Minhas S, Sajjad A, Kashif M, Taj F, Waddani H al, Khurshid Z. Oral ulcers presentation in
systemic diseases: an update. Open Access Maced J Med Sci. 2019; 7(19): 3341–3347.
doi: 10.3889/oamjms.2019.689

14. Park K, Lee B, Baek K, Cheon D, Yeo S, Park J, Soh J, Cheon H, Yoon K, Choi Y. Enteroviruses isolated from herpangina and hand-foot-andmouth disease in Korean children. Virol J. 2012; 9: 1–6. doi: 10.1186/1743-422X-9-205

15. Thakkar P, Banks JM, Rahat R, Brandini DA, Naqvi AR. Viruses of the oral cavity:
prevalence, pathobiology and association with oral diseases. Rev Med Virol. 2022; 32(4):
e2311. doi: 10.1002/rmv.2311

16. Koh WM, Bogich T, Siegel K, Jin J, Chong EY, Tan CY, Chen MI, Horby P, Cook AR. The
epidemiology of hand, foot and mouth disease in Asia: a systematic review and analysis.
Pediatr Infect Dis J. 2016; 35(10): e285-300. doi: 10.1097/INF.0000000000001242

17. Yu H, Li XW, Liu QB, Deng HL, Liu G, Jiang RM, Deng JK, Ye YZ, Hao JH, Chen YH, Nong
GM, Shen ZB, Liu CS, Zou YX, Wu JZ, Wu XD, Chen BQ, Luo RP, Lin AW, Chen Y, Liu
XD. Diagnosis and treatment of herpangina: Chinese expert consensus. World J Pediatr.
2020; 16(2): 129–134. doi: 10.1007/s12519-019-00277-9

18. Puenpa J, Wanlapakorn N, Vongpunsawad S, Poovorawan Y. The history of enterovirus A71
outbreaks and molecular epidemiology in the Asia-Pacific region. J Biomed Sci. 2019; 26(1):
1-11. doi: 10.1186/s12929-019-0573-2

19. Yao X, Bian L, Lu W, Li J, Mao Q, Wang Y, Gao F, Wu X, Ye Q, Xu M, Li Z, Zhu F, Liang Z. Enterovirus spectrum from the active surveillance of hand foot and mouth disease patients under the clinical trial of inactivated Enterovirus A71 vaccine in Jiangsu, China, 2012-2013. 2015; 87(12): 2009-2017. doi: 10.1002/jmv.24275

20. Wang J, Hu Y, Zheng M. Enterovirus A71 antivirals: past, present, and future. Acta
Pharm Sin B. 2022; 12(4): 1542-1566. doi: 10.1016/j.apsb.2021.08.017.

21. Kail R. Children and Their Development (Mydevelopmentlab Series). 2011.

22. Wardianti Y, Mayasari D. Pengaruh fase oral terhadap perkembangan anak. Jurnal Bimbingan Konseling Indonesia. 2016; 1(2): 36-37.

23. Apriasari ML. Methisoprinol as an immunomodulator for treating infectious mononucleosis. Dental Journal. 2016; 49(1): 1-4. doi: 10.20473/j.djmkg.v49.i1.p1-4



DOI: https://doi.org/10.22146/majkedgiind.79883

Article Metrics

Abstract views : 3230 | views : 3656

Refbacks

  • There are currently no refbacks.




Copyright (c) 2023 Majalah Kedokteran Gigi Indonesia

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.


 

 View My Stats


real
time web analytics