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 Manifestations

Herpangina

HSV

Hand-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

Workup

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Media Gallery

Coxsackievirus B4 virions under electron microscopy. Courtesy of Centers for Disease Control and Prevention (CDC).
Typical ulcerative enanthem of herpangina on the soft palate and posterior oropharynx. The lesions are usually exquisitely painful and make swallowing difficult. Ensuring adequate hydration in children is thus important. Courtesy of Wikimedia Commons/shawn c (https://commons.wikimedia.org/wiki/File:HFMD_soft_palete_oropharynx.jpg).
Typical flat vesicular exanthem of hand, foot, and mouth disease on a child's feet. The lesions may be slightly tender, and the rash often desquamates as it resolves. Courtesy of Wikimedia Commons/Ngufra (https://commons.wikimedia.org/wiki/File:Hand_foot_and_mouth_disease_on_child_feet.jpg).
Typical flat vesicular lesions of hand, foot, and mouth disease that may be associated with herpangina. The lesions may or may not be tender, and often resolve with desquamation. Courtesy of Wikimedia Commons/KlatschmohnAcker (https://commons.wikimedia.org/wiki/File:Hand_Foot_Mouth_Disease_Adult_36Years.jpg).

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Author

Sandra G Gompf, MD, FACP, FIDSA Professor of Infectious Disease and International Medicine, University of South Florida Morsani 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)

Beata Catherine Casanas, DO, FACP, FIDSA Associate Professor, Director of Infectious Disease Fellowship Program, Department of Internal Medicine, Division of Infectious Diseases and International Medicine, University of South Florida Morsani College of Medicine; Executive Medical Director, Hillsborough County Health Department

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

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Pfizer; AbbVie; Insmed; ViiV/GSK.

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; Fellow of the Royal College of Physicians, London

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

Disclosure: Nothing to disclose.

Additional Contributors

Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Consultant, Public Health, Dayton and Montgomery County (Ohio) Tuberculosis Clinic

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

Disclosure: Received research grant from: Regeneron.

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.