DDx
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
Media Gallery
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Coxsackievirus B4 virions under electron microscopy. Courtesy of Centers for Disease Control and Prevention (CDC).
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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).
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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).
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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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