Herpangina

Herpangina is a type of disease caused by a group of Coxsackie viruses, close in its physico-chemical properties to the causative agent of poliomyelitis.

[1], [2],

Epidemiology

The source of the causative agent of infection is only a sick person or a virus carrier. The transmission of infection is carried out by airborne and fecal-oral routes. The contagiousness of patients from the 7th-8th day of illness is sharply reduced. The disease of the herpaginum is widespread everywhere, there are sporadic cases, as well as outbreaks and epidemics. Mostly children and young people are ill. Immunity after a long-term illness is persistent, prolonged, however, in rare cases, repeated infection with Coxsackie virus of group A of another genotype is possible.

[3], [4], [5], [6]

Causes of the herpangins

In 1948, American virologists G.Doldorf and G.Sickles described the properties of a new virus isolated from the intestinal contents of sick children with symptoms of CNS damage. The virus was named "Coxsackie", under the name of Mr. Coxsackie (USA), in which there was a hospital with the children examined. Later, on the basis of virological studies, G. Doldorf divided all the types of the Coxsackie virus into two groups - A and B. The first included 19 serotypes, of which serpentines 2, 4, 5, 6, 8, and 10 cause herpangina. Currently, Consider that Coxsackie viruses, which are representatives of the family of picornaviruses of the genus of enteroviruses, are divided into group A (24 serotype) and group B (6 serotypes).

The pathological anatomy of such forms of the disease as myalgia of the epidemic, herpangina and serous meningitis, has not been studied in man, since these forms of the disease in all cases result in recovery. A severe clinical picture and high mortality (70% in the XX century) are observed only with myocarditis of newborns caused by the Coxsackie virus.

[7], [8]

Symptoms of the herpangins

Symptoms of herpangina and diseases caused by the Coxsackie virus are extremely diverse, while the methods of diagnosis, treatment, prognosis and prevention have much in common. The herpangina begins suddenly with a rise in body temperature to 39-40 ° C, which lasts 2-3 days, and then decreases critically. At a number of patients on a background of a fever there are vomiting, sometimes cramping pains in a stomach. The most characteristic changes develop in the structures of throat. On the 1-2th day of illness on the hyperemic mucous membrane of the palatine arch, tongue, tonsils, soft and hard palate, the tongue appear small papules 1-2 mm in diameter, which quickly turn into vesicles. After 2-3 days, the bubbles burst, and on their bottom erosions are formed, covered with a greyish-white coating; around them there is a narrow border of hyperemia. The appearance of vesicles and erosions is accompanied by a moderate pain when swallowing, but in some cases these pains are painful and accompanied by excessive salivation. Regional lymph nodes increase. By the 4-7th day of the disease in most patients, the changes in the pharynx disappear.

Often the herpagine is accompanied by vesicular stomatitis with skin manifestations, characterized by a combination of vesicular stomatitis with skin lesions. In the oral cavity, the vesicles and ulceration are localized in the tongue, gums, soft palate, and mucous membranes of the cheeks. Skin manifestations are characterized by the appearance of blisters on the feet and hands. In a number of cases, the rash is accompanied by a rise in body temperature. The disease is easy and ends on the 6-7th day. Erosions in the mouth after the disappearance do not leave any traces.

[9], [10], [11]

Diagnostics of the herpangins

Diagnosis is difficult due to the fact that many viral diseases of the pharynx have similar symptoms at the initial stages, and only when the disease develops do they acquire their characteristics, which are also not always easily distinguishable. The final diagnosis is possible only when the virus is isolated from feces and swabs from the patient's throat and blood is titered for antibodies to the virus, and the immunofluorescence method is used to determine the presence of specific antigens of the viruses in the test materials, as well as serological tests (neutralization reaction, complement fixation reaction, hemagglutination inhibition reaction). A certain role in the diagnosis is played by epidemiological data.

[12], [13], [14], [15]

Treatment of the herpangins

Treatment of herpagina practically does not differ from the treatment of other ne complicated viral angina and pharyngitis and is mostly symptomatic (rinses, painkillers, vitamins, etc.). Patients with severe intoxication, Coxsackie meningitis or myocarditis are subject to hospitalization, other patients are isolated at home.

Assign a sparing regimen, easily digestible food rich in vitamins, plentiful drink, with strong head and muscle pains - analgesics, with hyperthermia - antipyretic. Assign vitamins B, in high doses of vitamin C, as well as antihistamines (diphenhydramine, pifolen, suprastin, calcium preparations). At the expressed intoxication - detoxication therapy (intravenously water-salt solutions and glucose).

Prevention

Prevention Gerpangina includes conventional collective and individual measures that exclude infection in food, contact of healthy persons with patients, identification of virus carriers.

[16], [17],

Forecast

Forecast except for complications of encephalitis and myocarditis of newborns is favorable.

[18]