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Herpangina Differential Diagnoses

  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
 
Updated: Sep 02, 2015
 
 

Diagnostic Considerations

Table 1. Clinical Manifestations of Herpangina, Herpes Simplex Virus (HSV), and Hand-Foot-and-Mouth Disease (Open Table in a new window)

Clinical ManifestationsHerpanginaHSVHand-Foot-and-Mouth Disease
 



Causative organism



 



Enteroviruses



 



HSV-1 and HSV-2



 



Enteroviruses



 



Oral vesicular/ulcerative lesions



 



+



 



+



 



+1



 



Anterior pharynx



 



-



 



+



 



+



 



Posterior pharynx



 



+



 



+/-



 



-



 



Gingivostomatitis



 



-



 



+/-



 



-



1 Lesions may also occur on the buccal



mucosa



Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Sandra G Gompf, MD, FACP, FIDSA Associate Professor of Infectious Diseases and International Medicine, University of South Florida College of Medicine; Chief, Infectious Diseases Section, Director, Occupational Health and Infection Control Programs, James A Haley Veterans Hospital

Sandra G Gompf, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Burke A Cunha, MD Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Beata Catherine Casanas, DO Associate Professor, Department of Internal Medicine, Division of Infectious Diseases and International Medicine, University of South Florida College of Medicine

Beata Catherine Casanas, DO is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Osteopathic Association, Florida Medical Association, Infectious Diseases Society of America

Disclosure: Received honoraria from ViiV for speaking and teaching; Received honoraria from Pfizer for speaking and teaching.

Moise Carrington, MD Physician, Internal Medicine, Infectious Diseases Specialty

Moise Carrington, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Director, Public Health, Dayton and Montgomery County, Ohio

Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of Ohio, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References
  1. Mandell GL, et al. Enteroviruses. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. 2010. Vol 1: 817-818.

  2. Cherry JD, et al. Herpangina. Textbook of Pediatric Infectious Diseases. 6th ed. 2009. Vol 1: Chap 11.

  3. Chen KT, Chang HL, Wang ST, Cheng YT, Yang JY. Epidemiologic features of hand-foot-mouth disease and herpangina caused by enterovirus 71 in Taiwan, 1998-2005. Pediatrics. 2007 Aug. 120(2):e244-52. [Medline].

  4. Tsai JD, Kuo HT, Chen SM, Lue KH, Sheu JN. Neurological Images and the Predictors for Neurological Sequelae of Epidemic Herpangina/Hand-Foot-Mouth Disease with Encephalomyelitis. Neuropediatrics. 2013 Nov 20. [Medline].

  5. Choi CS, Choi YJ, Choi UY, et al. Clinical manifestations of CNS infections caused by enterovirus type 71. Korean J Pediatr. 2011 Jan. 54(1):11-6. [Medline]. [Full Text].

  6. Lee TC, Guo HR, Su HJ, Yang YC, Chang HL, Chen KT. Diseases caused by enterovirus 71 infection. Pediatr Infect Dis J. 2009 Oct. 28(10):904-10. [Medline].

  7. Chen YH, Lin HC, Lin HC. Increased risk of adverse pregnancy outcomes among women affected by herpangina. Am J Obstet Gynecol. 2010 Jul. 203(1):49.e1-7. [Medline].

  8. Sano T, Saito T, Kondo M, Watanabe S, Onoue Y, Konnai M, et al. Enterovirus detection status of patients with herpangina and hand, foot and mouth disease in epidemic season 2007, Kanagawa Prefecture, Japan. Jpn J Infect Dis. 2008 Mar. 61(2):162-3. [Medline].

  9. Chen YH, Lin HC, Lin HC. Increased risk of adverse pregnancy outcomes among women affected by herpangina. Am J Obstet Gynecol. 2010 Jul. 203(1):49.e1-7. [Medline].

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  14. Chen HL, Huang JY, Chu TW, Tsai TC, Hung CM, Lin CC, et al. Expression of VP1 protein in the milk of transgenic mice: a potential oral vaccine protects against enterovirus 71 infection. Vaccine. 2008 Jun 2. 26(23):2882-9. [Medline].

  15. Chang LY, King CC, Hsu KH, et al. Risk factors of enterovirus 71 infection and associated hand, foot, and mouth disease/herpangina in children during an epidemic in Taiwan. Pediatrics. 2002 Jun. 109(6):e88. [Medline].

  16. Chawareewong S, Kiangsiri S, Lokaphadhana K, et al. Neonatal herpangina caused by Coxsackie A-5 virus. J Pediatr. 1978 Sep. 93(3):492-4. [Medline].

  17. Cherry JD. Enteroviruses: Coxsackieviruses, Echoviruses, and Polioviruses. Textbook of Pediatric Infectious Diseases. 1998. Vol. 2: 1787-1839.

  18. Chole RA, Domb GH. Differential diagnosis of superficial ulcerations of the oral mucosa. Otolaryngol Head Neck Surg. 1979 Nov-Dec. 87(6):734-40. [Medline].

  19. Christie AB. Enteroviral infections (Coxsackieviruses and echoviruses). Infectious Diseases: Epidemiology and Clinical Practice. 1987. 753-81.

  20. Delaney JE, Keels, MA. Soft tissue lesions of the oral cavity in children. UpToDate. Available at www.uptodate.com. Accessed: November 10, 2009.

  21. Foo DG, Alonso S, Phoon MC, Ramachandran NP, Chow VT, Poh CL. Identification of neutralizing linear epitopes from the VP1 capsid protein of Enterovirus 71 using synthetic peptides. Virus Res. 2007 Apr. 125(1):61-8. [Medline].

  22. Haskell R. Oral vesiculo-bullous lesions. J Laryngol Otol. 1976 Jan. 90(1):101-4. [Medline].

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  24. Kung CM, King CC, Lee CN, et al. Differences in replication capacity between enterovirus 71 isolates obtained from patients with encephalitis and those obtained from patients with herpangina in Taiwan. J Med Virol. 2007 Jan. 79(1):60-8. [Medline].

  25. Lin TY, Chang LY, Hsia SH, et al. The 1998 enterovirus 71 outbreak in Taiwan: pathogenesis and management. Clin Infect Dis. 2002 May 1. 34 Suppl 2:S52-7. [Medline].

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  28. Miyazawa I, Azegami Y, Kasuo S, Yoshida T, Kobayashi M, Shiraishi T. Prevalence of enterovirus from patients with herpangina and hand, foot and mouth disease in Nagano Prefecture, Japan, 2007. Jpn J Infect Dis. 2008 May. 61(3):247-8. [Medline].

  29. Modlin JF. Clinical manifestation and diagnosis of enterovirus infections. UpToDate. Available at www.uptodate.com. Accessed: November 10, 2009.

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Coxsackievirus B4 virions under electron microscopy. (This image is in the public domain and thus free of any copyright restrictions. Content provider: Centers for Disease Control and Prevention)
Table 1. Clinical Manifestations of Herpangina, Herpes Simplex Virus (HSV), and Hand-Foot-and-Mouth Disease
Clinical ManifestationsHerpanginaHSVHand-Foot-and-Mouth Disease
 



Causative organism



 



Enteroviruses



 



HSV-1 and HSV-2



 



Enteroviruses



 



Oral vesicular/ulcerative lesions



 



+



 



+



 



+1



 



Anterior pharynx



 



-



 



+



 



+



 



Posterior pharynx



 



+



 



+/-



 



-



 



Gingivostomatitis



 



-



 



+/-



 



-



1 Lesions may also occur on the buccal



mucosa



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