Herpetic sore throat in children and adults - symptoms and treatment

Herpangina is one of the most common viral diseases in children. Almost everyone experiences this disease in childhood, although this diagnosis also occurs in adults. From a scientific point of view, the very name “herpetic sore throat” was incorrectly given to the disease. Previously, the disease was little studied. Scientists, noticing the similarity of rashes during the disease with those of herpes, came to the conclusion that the causative agent of the disease was the herpes virus, and gave the disease a name that has stuck and is found in the medical literature in exactly this form. Although the disease has nothing in common with herpes infection. It has been established that the cause of herpetic sore throat is enteroviruses - Coxsackie viruses of groups A and B and ECHO viruses (echoviruses). In medical reference books you can find different versions of the names of this disease: aphthous tonsillitis, vesicular pharyngitis, herpetic tonsillitis, herpangina, etc.

As already mentioned, children under ten years of age are at risk: infants, preschoolers and children of primary school age. The severity of the disease depends on the age of the child. The disease is most severe in children in the first year of life. Preschoolers are more often infected because at this age they do not pay due attention to hygiene, have contact with animals and are often in children's groups. To become infected, it is enough to eat unwashed fruit. This should also include the immaturity of immunity at an early age. The disease is highly contagious, and often its outbreaks become epidemic. It is noteworthy that this disease does not occur in babies in the first months of life - the antibodies found in mother's milk create some kind of immunity to herpangina.

One can trace the obvious seasonality of herpetic sore throat: the peak occurs in summer and autumn. As a rule, having been ill once, a child becomes immune to re-infection, so this disease is less common among adolescents and adults.

Infection can occur in one of three ways:

• airborne
• contact
• fecal-oral.

With the airborne method, infection occurs by sneezing, coughing, or talking with a carrier of the virus. In case of contact - through discharge from the nasopharynx. With the fecal-oral method - through dirty hands, through unwashed food, toys and pacifiers, which is especially typical for children.

Even a recovering person can still spread the infection around him for about a month, so it is believed that herpes sore throat is highly contagious: a child can easily become infected in kindergarten from a baby who does not even have obvious symptoms of the disease. If one family member gets sick, most likely everyone will suffer from the disease.

How does infection spread throughout the body? First, the virus from the nasopharynx reaches the intestinal lymph nodes through the lymph flow. Already in the intestines, the virus gains strength and enters the blood, and severe inflammation begins in the oropharynx.

Causes of stomatitis

In children, as in adults, stomatitis can be caused by viruses, fungi, bacteria, allergies and injuries. About six months after birth, the child loses the immunity received from the mother, the protective power of the immune system changes, and the child’s body becomes more susceptible to infections. The oral mucosa in children is more delicate and easier to injure; children also more often “bite” their cheeks after dental treatment due to a temporary loss of sensitivity after anesthesia, which causes traumatic stomatitis.

Children are not always motivated to brush their teeth, so poor hygiene can also cause stomatitis.

With the following diseases, stomatitis is observed in children much more often: chronic tonsillitis, diabetes mellitus, heart defects, chronic hepatitis.

Tonsils on guard

The tonsils (or tonsils) are located on both sides of the throat. All bacteria and viruses that enter the body through the mouth are encountered first. Externally, the tonsils have a porous structure; this structure helps them “examine” all the substances that enter the body and decide what to do with them. In the thickness of the palatine tonsils there are special depressions - lacunae, and the convoluted channels in the thickness of the tonsils are called crypts; they are difficult to see in a photo or with the naked eye. There are also target cells that act as “traps” for microorganisms. When it comes into contact with them, the tonsil decides whether to fight them or not, whether they will cause harm to a person or whether they will be harmless.

When a person is healthy and his tonsils are strong, when any infection enters the body, they begin to actively produce white blood cells to fight the infectious pathogen. But when inflammation affects the tonsils themselves, they lose their protective function and themselves become a source of infection. Pathogenic viruses and bacteria settle firmly in the gaps. What function can inflamed tonsils perform? None! As a result, the tonsils fall out of the body's general defense system and there is a high chance of developing chronic tonsillitis in children.

Classification of HRAS (chronic recurrent aphthous stomatitis)

All types of stomatitis occur in children, but the most common are: herpetic, candidal and traumatic stomatitis.

Possible complications.

More often, the disease passes without dangerous consequences for the patient. But with weak immunity, especially in young children, severe herpes sore throat can lead to serious complications caused by the spread of the virus to other organs:

• serous meningitis
• heart pain, myocarditis
• pyelonephritis
• encephalitis
• conjunctivitis.

To exclude the development of serous meningitis, you need to consult a neurologist; if you have heart complaints, you need to contact a pediatric cardiologist. If there are changes in the general urine test, you must make an appointment with a pediatric nephrologist.

With proper and effective treatment of herpes sore throat complicated by meningitis, the prognosis is usually favorable. But at the same time, the treatment of the youngest patients requires careful attention. With myocarditis the situation is more severe. Any complications of herpetic sore throat require the intervention of specialists!

Acute herpetic stomatitis

It occurs most often, and mainly affects children from 10 months to 3 years.3 The appearance of rashes is preceded by inflammation of the lymph nodes.

With a mild form

In acute herpetic stomatitis, the temperature rises to 37-37.5°C, the general condition is satisfactory, slight swelling and redness may occur on the gums, then up to six blisters appear, which burst with the formation of painful aphthae surrounded by a red rim.
Afta is a round-shaped erosion. Aphthae may merge together. The rash appears once, and after 1-2 days the erosion gradually heals.

Moderate form

Acute herpetic stomatitis is characterized by deterioration of the child’s well-being, weakness, and headache. The child is capricious, has no appetite, the lymph nodes are enlarged and painful, the temperature rises to 38-39°C, the symptoms resemble ARVI. The oral mucosa is swollen, reddened, rashes appear (bubbles, then erosions) of 10-15 pieces, and often there are rashes on the face. Salivation increases, and gingivitis appears (inflammation of the gums, accompanied by bleeding). The rash may appear several times, i.e. after the old ones heal, new ones appear. Healing of erosions takes up to 4-5 days. Bleeding gums and swollen lymph nodes persist for some time after the erosions have healed.

Severe form

It begins as an acute respiratory viral infection, there is pain in the muscles, joints, tachycardia and bradycardia (increased and slow heartbeat), and nosebleeds may even be observed. In this form, the temperature is high up to 40°C, gingivitis is pronounced, the mucous membrane is bright red, swollen, the child’s lips are dry, the mucous membrane of the eyes is swollen, reddened. The rashes constantly appear again, their number can reach 100. Rashes often appear around the mouth, on the eyelids, on the mucous membranes of the eyes, between the fingers, on the earlobes. Simple gingivitis turns into ulcerative (a more severe form of gum inflammation, with the formation of ulcers), salivation increases, and bad breath appears. Recovery is long and hospitalization is often required.

Prevention of tonsillitis

To reduce the risk of developing the disease, you need to devote time to preventing this disease and strengthening the immune system. It is necessary to accustom children to hardening procedures. Hardening will bring positive results if you do it gradually, and at the same time consistently and regularly.

It is important to eat healthy and varied, eat foods rich in vitamins and avoid seasonings that irritate the throat. You also need to remember the relationship between the ENT organs and the surrounding tissue. Therefore, it is extremely necessary to promptly treat dental diseases and any inflammatory processes in the nasopharynx and larynx.

From an early age, children should be taught sanitary standards: washing hands, washing fruits, covering their mouths when coughing with a handkerchief or napkin. During periods of epidemics, it is advisable to avoid places with large crowds of people.

Following these simple measures will help avoid inflammation and the unpleasant consequences of this disease.

Enteroviral vesicular stomatitis (arm - leg - mouth)

Caused by enteroviruses. It also occurs in adults, but in 95.7% of cases children are affected.6 It is characterized by seasonal occurrence (summer - autumn) and group incidence.4 It is observed mainly in children under 10 years of age. Vesicular stomatitis is contagious, so it is recommended to use separate utensils and hygiene products. Characteristics for this disease: temperature 37.5-38, weakness, headache, muscle pain, rash on the palms, soles, as well as blisters on the hard palate and pharynx, which then turn into erosions that are almost not painful.

How and why does infection occur?

Infection occurs by airborne droplets, from a sick person, by using shared utensils and eating contaminated food, as well as by a number of other factors:

• weakened immunity;
• hypothermia or consumption of cold foods and drinks;
• mouth breathing (for chronic adenoiditis, deviated nasal septum);
• irritation of the nasopharyngeal mucosa with a runny nose;
• recent viral diseases;
• inflammatory diseases of the ENT organs (sinusitis, sinusitis, otitis);
• caries and other oral infections.

Secondary tonsillitis in children can occur against the background of scarlet fever, diphtheria, mononucleosis, as well as blood diseases.

In any case, a sore throat develops rapidly, in a matter of hours, and is especially acute in children, accompanied by the main symptoms—a sore throat when swallowing and an increase in body temperature.

Acute pseudomembranous candidal stomatitis (thrush)

Acute pseudomembranous candidal stomatitis (thrush) occurs:

• Light shape
• Medium-heavy forms
• Severe form

The main symptom of the disease is a white or yellow coating.

With a mild form

The plaque is located in islands, most often on the tongue and cheeks. Children are restless, sleep poorly, and suck the breast sluggishly. Older children may complain of a burning sensation. The plaque is easily removed; underneath there is a bright red mucous membrane. The disease lasts no longer than 7 days.5

Moderate form

The plaque is located on the cheeks, tongue, hard palate, and mucous membranes of the lips. Under the plaque, erosions form, which sometimes bleed. The plaque is more difficult to remove. Lymph nodes are sometimes enlarged and painful. The duration of the disease is 10-15 days, there are relapses.

Moderate form

The plaque is dirty gray, almost cannot be removed, and is located on the tongue, cheeks, soft palate, tonsils, pharynx, and mucous membranes of the lips. Cheilitis appears in the corners of the mouth - inflammation of the lips. The oral mucosa is dry and inflamed. The child’s health is impaired, the child refuses to eat, and the temperature rises. Lesions in the genital area, neck folds, and between the fingers are also common. The disease is long-term, with frequent relapses.

Fungal diseases of the throat

Pharyngomycosis is an inflammation of the pharynx caused by the yeast-like fungi Candida albicans. Against the background of reduced immunity, red dotted rashes appear on the back of the throat, palate, and tonsils. The tongue is covered with white plaques consisting of a cheesy layer. Symptoms of fungal pharyngitis:

• itching and burning at the site of the rash;
• sore throat;
• dry mouth;
• hyperemia and swelling of the mucous membranes.

In infants, fungal inflammation begins in the oral cavity. In everyday life, the disease is called thrush because of the white coating on the tongue and the inner surface of the cheeks. With erased symptoms, the disease sometimes goes unnoticed.

If left untreated, inflammation spreads to the airways. In this case, pharyngomycosis develops. Therefore, red spots in the mouth cannot be ignored.

Bacterial stomatitis in children

Necrotizing ulcerative stomatitis is more common in weakened children and is caused by fusobacteria and spirochetes. May be a sign of periodontal disease (progressive destruction of periodontal tissue). It is characterized by the appearance of painful ulcers, weakness, gingivitis (inflammation of the gums), enlarged and painful lymph nodes, difficulty eating, speaking, and bad breath.

Often, erosions in traumatic stomatitis can become infected through dirty hands, toys and other objects, then bacterial stomatitis develops, so it is important to pay attention to antiseptic treatment.

Chronic tonsillitis in a child: treatment methods

This disease is diagnosed in children if inflammation of the tonsils occurs more than twice a year. In case of chronic disease, the tonsils themselves become a source of infection. The immune system weakens, and the child is often exposed to illness.

Chronic tonsillitis should be treated by an experienced otolaryngologist. Some ENT doctors recommend removing the tonsils immediately. But you need to remember, by removing the tonsils, you lose the body’s natural defenses against bacteria and viruses forever!

At the ENT Clinic of Doctor Zaitsev, we treat chronic tonsillitis, and we resort to removal of the tonsils only in the most extreme cases, when conservative treatment methods have been completely exhausted.

The procedures for ultrasonic medicinal irrigation of the tonsils using the “Tonsillor” apparatus (it can be seen in the photo) have a good therapeutic effect. Our clinic also has a unique vacuum attachment for this device, which has no analogues in other medical institutions. This attachment is painless, safe and can be used to treat children starting from school age.

Traumatic stomatitis in children

A specific form of traumatic stomatitis in children is Bednar's aphthae . This is a traumatic erosion of the oral mucosa. In children, unlike adults, the mucosal epithelium consists not of four layers, but of two, so it is easily injured. The cause may be early teething, a rough nipple from the mother, or a long nipple on the bottle. Erosion is most often located in the middle of the palate or opposite the cutting edge of the teeth. The child begins to refuse food, cries, and sleeps poorly.

Traumatic stomatitis also occurs in children when wearing braces. Erosions have uneven edges, are painful, and are usually located on the mucous membrane of the cheeks and lips, less often on the tongue.

How to cure tonsillitis in a child

Treatment methods for sore throat depend on the nature of the pathogen: for bacterial sore throat, the doctor will prescribe effective antibiotics (the drugs Augmentin, Amoxiclav, Erythromycin are more often prescribed), for sore throats of a viral and fungal nature - anti-inflammatory and antifungal drugs, respectively. The name of the drug, its dosage and the duration of its use can only be determined by an ENT doctor. Excessive parental independence can interfere with the effective treatment of acute or chronic tonsillitis.

If a child's temperature rises above 38°C, an antipyretic based on ibuprofen or paracetamol should be given. Due to blood thinning and the risk of bleeding, aspirin is strictly contraindicated in children.

It is necessary to adhere to strict bed rest and a gentle diet. Eating and drinking should not cause additional strain on the throat. It’s better to make do with warm soups, broths and purees for the first time. Oral antiseptic sprays, special lozenges and tablets (for example, Faringosept) are perfect for relieving a sore throat.

Drug-induced stomatitis

Occurs when there is an allergy to a drug. Often, allergies can occur to antibacterial, antimicrobial drugs, vaccines, iodine. The mucous membrane is red, swollen, the lips and tongue also often swell, blisters appear, which burst, leaving erosion. The gums are inflamed and bleed when touched. General manifestations are possible, such as urticaria, nausea, vomiting. In severe cases, anaphylactic shock occurs (an emergency condition manifested by decreased blood pressure, shortness of breath, fainting, suffocation), Quincke's edema (an atypical reaction of the body, manifested by rapid and severe swelling)

Both conditions are extremely dangerous and require immediate action and calling an ambulance!

Allergic rash

Often in children, allergic reactions of the body lead to the appearance of a red rash in the throat. Various substances can be provocateurs:

• pet fur and feathers;
• house dust;
• chocolate;
• toothpaste;
• pollen of plants and trees;
• volatile chemicals.

Allergies are sometimes similar to respiratory infections. Accompanied by sore throat, discomfort in the throat, and coughing. But there are several signs that make it possible to distinguish it from acute respiratory infections - the absence of high fever, body aches, and swollen lymph nodes.

Important! An allergic rash in the throat is accompanied by swelling of the tissues of the nasopharynx, so it can take a dangerous form.

Blockage of the airways with Quincke's edema begins with difficulty breathing, palpitations, enlarged tongue, swelling of the lips and ears. In this condition, the child needs emergency help.

Prevention of stomatitis in children

In children's groups, infections spread especially quickly. Therefore, if a child is infected with the herpes virus, he needs to stay at home until he recovers. Children who have been in contact with sick people should use antiviral ointments for 5 days.

If a pregnant woman has herpes or candidiasis, she should treat it before giving birth. If you have the herpes virus during the period of illness, you should use separate utensils, do not kiss children, and wear a mask.

Kindergartens and other preschool institutions must be cleaned and objects, including toys, must be treated with disinfectants.

To avoid allergic reactions, you should seek help from an allergist to identify existing allergies.

It is worth preventing a decrease in immunity; hardening works especially well in childhood. It is worth limiting your intake of fast carbohydrates, because... they create a favorable environment for the development of candidiasis. An important point is the proper nutrition of the child; regular intake of vitamins, especially vitamin C, is essential.

Tantum® Propolis

For children over 14 years of age , you can use Tantum® Propolis lozenges; they contain a lot of vitamin C, which will strengthen the immune system, and propolis has an anti-inflammatory effect, preventing the occurrence of infections.7
Find out more

Prevention of Bednar's aft is preparing the breasts for feeding, using special creams to soften the skin, prevent cracks, and it is also worth choosing the right bottle. In case of injury due to braces, you need to use orthodontic wax; here it is important to prevent the wounds from becoming infected, so it is better to treat them with antiseptic solutions and sprays.

Tantum® Verde spray will relieve pain at the site of injury and its antiseptic effect will prevent infection.8,9

Treatment of herpetic sore throat

Patients with complications require hospitalization in an infectious diseases hospital and treatment under the supervision of specialized specialists - a neurologist and a cardiologist. If the doctor has recommended treatment at home, it is necessary to closely monitor the patient's condition2.

The sick person should be isolated and stay in a clean, well-ventilated area so as not to infect other family members. Quarantine must be observed until symptoms subside1.

For herpangina you should 1,3,4:

• Wash your hands as often as possible, including after feeding and changing a sick child’s diaper.
• Disinfect surfaces and objects with which the patient has been in contact.
• Drink enough fluids to avoid dehydration. At the same time, pay attention to the temperature of the drink: hot, warm drinks irritate the mucous membranes and cause additional discomfort. You can drink cool drinks.
• Consume food in liquid or mushy form. Spicy, salty, sour foods, including fresh fruits even in the form of puree, are not suitable for a patient with herpetic sore throat.
• Rinse your mouth with a saline solution after every meal to maintain oral hygiene and prevent bacterial infections from erosions.
• Use a soft toothbrush to reduce trauma to the mucous membrane.

Currently, there is no proven antiviral drug to treat herpangina by acting on its causative agent. Sometimes a doctor may prescribe medications that support local immunity of the pharyngeal mucosa1. Antibiotics are not prescribed for herpangina6.

The goal of treatment for herpangina is to relieve the symptoms of the disease4.

If the body temperature is above 38.5°C, physical methods such as cold compresses and ice packs may be used. Your doctor may also recommend anti-inflammatory and antipyretic medications1. Local treatment includes agents with anti-inflammatory, analgesic, enveloping and antiseptic effects1.

For the symptomatic treatment of herpetic sore throat, the doctor may prescribe the drugs HEXORAL®7,8,9,10,11. It is convenient to use HEXORAL® spray to irrigate the pharyngeal mucosa. The active substance of the spray is hexethidine. It acts against the main bacteria found in the oral cavity and pharyngeal mucosa8. The drug is also active against some viruses and fungi of the genus Candida8. Thanks to the local anesthetic effect of hexethidine, HEXORAL ® spray helps reduce pain8. HEXORAL®7 solution is suitable for rinsing. The use of HEXORAL ® spray and solution is allowed in children over 3 years of age7,8.

If herpangina causes severe pain and discomfort, adolescents over 12 years of age and adults can benefit from HEXORAL ® TABS EXTRA lozenges, which contain the anesthetic lidocaine10. For children over 4 years of age, HEXORAL ® TABS lozenges may be suitable. The anesthetic benzocaine in their composition helps reduce pain in the throat and mouth9.

All medications for herpetic sore throat should be used only after consultation with a doctor. In case of severe erosions, HEXORAL ® solution and spray are contraindicated7,8, and lozenges can only be prescribed by a specialist after examining the pharynx9,10.

Up to contents

The information in this article is for reference only and does not replace professional advice from a doctor. To make a diagnosis and prescribe treatment, consult a qualified specialist.

Diagnosis of pharyngitis

Acute pharyngitis can be determined by patient complaints and examination of the oropharynx (pharyngoscopy).

Objective symptoms of pharyngitis, which are assessed by a doctor when examining the throat:

• swelling and hyperemia (redness) of the pharyngeal mucosa
• purulent or mucopurulent plaque on the walls of the pharyngeal mucosa
• the presence of inflammation in the arches, tonsils, orifices of the auditory tubes
• the presence of bright red tubercles on the back surface of the pharynx and on the side - hypertrophied (enlarged) lymphoid follicles
• thinning of the mucosa with areas of exfoliating epithelium, crusts and viscous mucus (atrophic pharyngitis)

Based on this, the doctor can make not only a diagnosis of pharyngitis, but also suggest its cause (viral inflammation, fungal infection, etc.).

Despite the fact that 70% of acute pharyngitis is a viral disease, sometimes it is necessary to exclude a bacterial cause. This is very important for further treatment tactics and prevention of complications. To do this, you should conduct a rapid test to exclude the streptococcal nature of pharyngitis.

In some cases, with fever, long-term complaints, or a temperature exceeding 3 days, it is also necessary to take a general blood test to understand the cause of acute pharyngitis.

Causes of pharyngitis and tonsillitis

Etiology (origin, cause) of pharyngitis. In 70-90% of cases, pharyngitis is caused by viruses. Pharyngitis can also be caused by bacteria, fungi, allergies, injuries, and exposure to irritating factors.

The most common viruses are rhinoviruses, adenoviruses, influenza, parainfluenza, enteroviruses, Coxsackie A, coronaviruses, a group of herpes viruses (Epstein-Barr virus, cytomegalovirus, HSV).12

There are pharyngitis, which are classified as a separate diagnosis depending on the pathogen, for example streptococcal pharyngitis ICD J02.0