Herpetic sore throat: what kind of disease. Coxsackie virus - description, incubation period, symptoms and signs of enterovirus infection in children and adults, photos. How can a child become infected with the Coxsackie virus? Herpetic tonsillitis and viral exanthema

Acute, virus-induced damage to the lymphoid tissue of the pharynx, caused by the Coxsackie and ECHO viruses. Herpetic sore throat in children occurs with a rise in temperature, sore throat, lymphadenopathy, hyperemia of the pharynx, vesicular rashes and erosions on the tonsils and the back wall of the pharynx. Herpetic sore throat in children is diagnosed by a pediatric otolaryngologist based on examination of the pharynx, virological and serological examination of nasopharyngeal swabs. Treatment of herpetic sore throat in children includes taking antiviral, antipyretic, desensitizing drugs; local treatment of the oral mucosa, ultraviolet radiation.

General information

Herpangina in children (herpangina, herpetic tonsillitis, vesicular or aphthous pharyngitis) is a serous inflammation of the palatine tonsils caused by Coxsackie enteroviruses or ECHO. Herpetic sore throat in children can be a sporadic disease or an epidemic outbreak. In pediatrics and pediatric otolaryngology, herpetic sore throat is predominantly found in children of preschool and primary school age (3-10 years); Herpangina is most severe in children under 3 years of age. In children in the first months of life, herpetic sore throat occurs less frequently, which is associated with the receipt of appropriate antibodies from the mother along with breast milk (passive immunity).

Herpetic sore throat in a child can occur either in isolated form or in combination with enteroviral serous meningitis, encephalitis, epidemic myalgia, myelitis, also caused by these viruses.

Causes of herpetic sore throat in children

Herpangina in children is one of the viral diseases caused by enteroviruses from the picornavirus family - Coxsackie group A (usually viruses of serovars 2-6, 8 and 10), Coxsackie group B (serotypes 1−5) or ECHO viruses (3, 6, 9 , 25).

The mechanism of transmission of pathogens is airborne (when sneezing, coughing or talking), less often fecal-oral (through food, pacifiers, toys, dirty hands, etc.) or contact (through nasopharyngeal discharge). The main natural reservoir is a virus carrier or a sick person; less often, infection occurs from domestic animals. Convalescents can also serve as sources of infection, since they continue to release the virus for 3-4 weeks. The peak incidence of herpetic sore throat in children occurs in June-September. The disease is highly contagious, so in the summer-autumn period there are often outbreaks of herpetic sore throat in children within families or organized groups (camps, kindergartens, school classes).

Penetrating into the body through the mucous membranes of the nasopharynx, the causative agents of herpetic sore throat in children enter the intestinal lymph nodes, where they actively multiply and then penetrate into the blood, causing the development of viremia. The subsequent spread of viral pathogens is determined by their properties and the state of the child’s body’s defense mechanisms. Together with the bloodstream, viruses spread throughout the body, fixing themselves in certain tissues, causing inflammatory, dystrophic and necrotic processes in them. Enteroviruses Coxsackie and ECHO have high tropism for mucous membranes, muscles (including myocardium), and nervous tissue.

Often, herpetic sore throat in children develops against the background of influenza or adenovirus infection. After suffering from herpangina, children develop stable immunity to this strain of the virus, however, when infected with another type of virus, herpangina may occur again.

Symptoms of herpetic sore throat in children

The latent period of infection ranges from 7 to 14 days. Herpetic sore throat in children begins with a flu-like syndrome: malaise, weakness, loss of appetite. Characterized by high fever (up to 39−40°C), pain in the muscles of the limbs, back, and abdomen; headache, vomiting, diarrhea. Following the general symptoms, sore throat, drooling, pain when swallowing, acute rhinitis, and cough appear.

With herpetic sore throat in children, local changes quickly increase. Already in the first two days, against the background of hyperemic mucosa of the tonsils, palatine arches, uvula, and palate, small papules are found in the oral cavity, which quickly turn into vesicles with a diameter of up to 5 mm, filled with serous contents. After 1-2 days, the blisters open, and in their place whitish-gray ulcers are formed, surrounded by a halo of hyperemia. Sometimes the ulcers unite, turning into superficial drainage defects. The resulting erosions of the mucous membrane are sharply painful, and therefore children refuse to eat and drink. With herpetic sore throat in children, bilateral submandibular, cervical and parotid lymphadenopathy is detected.

Along with the typical forms of herpetic sore throat in children, blurred manifestations can occur, characterized only by catarrhal changes in the oropharynx, without mucosal defects. In children with weakened immune systems, the rash may recur in waves every 2-3 days, which is accompanied by a resumption of fever and symptoms of intoxication. In some cases, with herpetic sore throat, a child experiences the appearance of a papular and vesicular rash on the distal limbs and torso.

In typical cases, fever with herpetic sore throat in children subsides after 3-5 days, and defects in the mucous membrane of the oral cavity and pharynx epithelialize after 6-7 days. With low reactivity of the body or a high degree of viremia, generalization of entroviral infection with the development of meningitis, encephalitis, myocarditis, pyelonephritis, hemorrhagic conjunctivitis is possible.

Diagnosis of herpetic sore throat in children

In a typical clinical presentation of herpetic sore throat in children, a pediatrician or pediatric otolaryngologist can make a correct diagnosis even without additional laboratory examination. When examining the pharynx and pharyngoscopy, a typical location for herpetic sore throat is revealed (posterior wall of the pharynx, tonsils, soft palate) and type of rash (papules, vesicles, ulcers). A general blood test reveals slight leukocytosis.

To identify the causative agents of herpetic sore throat in children, virological and serological research methods are used. Washings and swabs from the nasopharynx are examined by PCR; Using ELISA, an increase in the titer of antibodies to enteroviruses by 4 or more times is detected.

Herpetic sore throat in children should be distinguished from other aphthous diseases of the oral cavity (herpetic stomatitis, chemical irritation of the oropharynx, thrush), chickenpox.

Treatment of herpetic sore throat in children

Complex therapy for herpetic sore throat includes isolation of sick children, general and local treatment. The child needs to drink plenty of fluids and take liquid or semi-liquid food to avoid irritation of the oral mucosa.

For herpetic sore throat, children are prescribed hyposensitizing drugs (loratadine, mebhydrolin, hifenadine), antipyretic drugs (ibuprofen, nimesulide), and immunomodulators. In order to prevent the accumulation of a secondary bacterial infection, oral antiseptics, hourly gargling with antiseptics (furacilin, miramistin) and herbal decoctions (calendula, sage, eucalyptus, oak bark) are recommended, followed by treatment of the back wall of the pharynx and tonsils with drugs. For herpetic sore throat in children, aerosols that have an analgesic, antiseptic, and enveloping effect are used topically.

A good therapeutic effect is achieved with endonasal/endopharyngeal instillation of leukocyte interferon and treatment of the oral mucosa with antiviral ointments (acyclovir, etc.). In order to stimulate the epithelization of erosive defects in the mucosa, ultraviolet irradiation of the nasopharynx is recommended.

In case of herpetic sore throat in children, it is strictly unacceptable to carry out inhalations and apply compresses, since heat increases blood circulation and promotes the spread of viruses throughout the body.

Forecast and prevention of herpetic sore throat in children

For children with herpetic sore throat and contact persons, quarantine is established for 14 days. Current and final disinfection is carried out in the epidemiological site. In most cases, herpetic sore throat in children ends in recovery. With the generalization of a viral infection, multiple organ damage is possible. Fatal outcomes are usually observed among children in the first years of life with the development of meningitis.

Specific vaccine prophylaxis is not provided; children who have been in contact with a patient with herpetic sore throat are given specific gamma globulin. Non-specific measures are aimed at timely detection and isolation of sick children, increasing the reactivity of the child’s body.

Among enteroviral diseases, the two most common forms are hand-foot-mouth disease and herpangina.

Atypical manifestations of enterovirus rashes are much less common and can imitate rubella, scarlet fever, Kawasaki disease, sudden exanthema and many other diseases, however, even with an atypical course, upon closer examination the child still has aphthae in the mouth or pharynx, and/or typical dense blisters on flexor surfaces of the palms and feet. It is these typical manifestations that allow a correct diagnosis to be made.

The subject of our consideration will be the typical forms of manifestation of these enteroviral diseases.

HAND-FOOT-MOUTH DISEASE

The name of this disease comes from the English Hand, Foot and Mouth Disease (HFMD).

Hand-foot-mouth disease (HFMD) is caused by the Coxsackievirus, a member of the enterovirus family. HFMD most often affects children under 10 years of age, but people of any age can get the infection.

Symptoms

The disease is manifested by fever (high temperature) and red spots with blisters in the center. Most often, the rash with HFMD is located in the mouth (tongue, gums), arms and legs (hence the name of the disease), but can also affect the buttocks, especially the perianal area, and appear as single elements on any part of the body. Typically, HFMD lasts about 10 days, with incidence typically peaking in late summer and fall.

Contrary to popular belief, your child cannot get HFMD from animals.

Treatment

A child's fever can be relieved with drugs based on ibuprofen or paracetamol, and they can also be taken to relieve pain in the mouth. You just need to consult your doctor about the optimal dose and method of administering the drug.

Never give your child aspirin without a doctor's permission - aspirin provokes the development of an extremely serious disease - Reye's syndrome.

Daily regime

If your child feels tired or sick, you should allow him to rest as much as possible. If the child is energetic and cheerful, then you should not insist on rest; let him play and spend the day as usual.

Nutrition

If a child has painful mouth sores, he or she will likely eat less or stop eating and drinking completely. It is important not only to relieve pain from the rash, but also to offer him pureed, easily digestible foods that do not irritate the oral mucosa. These include yoghurts, puddings, milkshakes, jellies, purees, etc. It's best to eat these foods cool or at room temperature, not hot.

Do not give your child spicy, salty or sour foods. There is no need to feed him citrus juices and carbonated drinks. These fluids can make your child's mouth feel worse. Offer to drink from a cup rather than a bottle—negative sucking pressure also increases pain and promotes mucosal trauma and bleeding. Drinking through a straw is safe - it can be a complete alternative to a bottle, especially for aphthae on the lips and tip of the tongue.

Children's institutions

The child can return to the children's group after normalization of body temperature and general condition, but the main indicator will be the disappearance of elements of the rash. Until this moment, going out in public is not advisable, since the child may be contagious to others.

Contact your doctor if:

The blisters filled with pus or became sharply painful. This may be a sign of a secondary infection.
Your child's mouth sores are so painful that he won't open his mouth and completely refuses to eat or drink.

See a doctor immediately or call an ambulance if:

Your child is dehydrated due to complete refusal to eat or drink. You can talk about dehydration if:
- the child has not urinated for more than 8 hours
- the baby can feel a sharply sunken fontanel on the head
- baby crying without tears
- his lips are cracked and dry.
Also, don't waste another minute if your child has a stiff neck (difficulty bringing the chin to the chest), severe headache or back pain, and these symptoms are combined with a fever above 38°C.

GERPANGINA

Herpangina is a viral disease that is caused by the same Coxsackie viruses and is manifested by the formation of painful ulcers (ulcers) in the throat and mouth, as well as severe sore throat and fever.

Herpangina is one of the common childhood infections. It most often occurs in children aged 3 to 10 years, but can affect people in any age group.

Herpangina symptoms:

Usually no additional diagnostic methods are required - the doctor makes a diagnosis based on a physical examination and medical history.

Treatment

Treatment and care are similar to those described for hand-foot-mouth disease. Herpangina usually goes away within a week.

As with hand-foot-mouth disease, and with herpangina, the main complications are considered to be dehydration and aseptic meningitis. Therefore, you should closely monitor your child for signs of dehydration and headache levels, and consult a doctor immediately if complications are suspected.

Fortunately, complications are quite rare and most children recover within 10 days.

During a child’s illness, all family members must maintain careful hygiene: wet cleaning more often than usual, using dishes separately, frequently washing their hands and treating them with antiseptics.

Acute infectious diseases caused by intestinal viruses belong to the group of enteroviral infections. The pathology affects various human organs and is manifested by fever and a wide range of clinical signs.

Enterovirus infection is characterized by outbreaks of mass diseases, especially in children's organized groups and families. The risk group includes people with reduced immunity - children, the elderly, people with chronic pathologies.

Enterovirus infection is characterized by high susceptibility of the population and seasonality - an increase in incidence in the summer-autumn season. A feature of enteroviruses is the ability to cause clinical symptoms of varying intensity: from mild discomfort to the development of paralysis and paresis.

Etiology

The causative agents of enterovirus infection are RNA-containing viruses, ECHO, polioviruses. Microbes have a relatively high resistance to physical factors - cooling and heating, as well as some disinfectants. Prolonged boiling, disinfectants with chlorine, formaldehyde and ultraviolet radiation have a detrimental effect on viruses.

Enteroviruses remain viable in the external environment for quite a long time. High air temperatures and high humidity increase the lifespan of the virus.

Sources of infection are patients and virus carriers.

Infection occurs:

The fecal-oral mechanism, which is realized by water, nutritional and contact-household routes of infection;
An aerogenic mechanism implemented by airborne droplets,
Transplacental mechanism using a vertical route during transmission of the pathogen from a sick mother to the fetus.

Microbes multiply on the mucous membrane of the pharynx and accumulate in nasopharyngeal discharge, feces, and cerebrospinal fluid. During the incubation period, the virus is released into the environment in small quantities. Patients remain dangerous to others for a month, and in some cases longer.

Microbes enter the mucous membrane of the esophagus and upper respiratory tract, multiply and cause local inflammation, which occurs in the form of respiratory disease and intestinal disorders. The period of reproduction and accumulation of viruses coincides with incubation and ranges from one to three days. Pathogenic biological agents enter the cervical and submandibular lymph nodes. At this time, patients develop pharyngitis and diarrhea. With the blood flow, microbes spread throughout the body, affecting internal organs with the development of another pathology and the appearance of corresponding symptoms.

Symptoms

Enterovirus infection often occurs without any characteristic signs and reminds me of a banal one. Viruses, affecting various organs and systems, usually cause herpangina, hemorrhagic inflammation of the conjunctiva, fever, gastroenteritis, and in rare cases, severe diseases: inflammation of the brain, liver, myocardium.

Symptoms of enterovirus infection:

Intoxication syndrome,
Exanthema,
Qatar of the respiratory system,
Abdominal signs.

Persons with strong immunity and a relatively healthy body rarely suffer from severe enteroviral diseases. Their infection is usually asymptomatic. Newborns, small children, elderly people and those weakened by chronic diseases are more susceptible to the development of enteroviral meningoencephalitis, hepatitis, myocarditis, and paralysis. Herpetic tonsillitis, acute respiratory infections and pharyngitis are less severe, but are accompanied by persistent, painful pain.

Herpangina

– one of the most frequently occurring forms of enterovirus infection. Its causative agents are Coxsackie viruses. The disease manifests itself with symptoms of intoxication and catarrhal syndromes.

Herpetic (herpetic) sore throat

Herpangina begins acutely. The body temperature in patients rises to 40 degrees, nausea, malaise, and headache occur.
Around the second day, signs of catarrhal inflammation of the pharynx appear.
After a couple of days, papules form on the tonsils, arches, tongue and palate, which eventually turn into red blisters. They burst, forming erosions on the mucous membrane, covered with plaque, which resolve without a trace in 5 days.
Regional lymphadenitis is slightly expressed.
Sore throat with herpangina is often absent or appears only during the formation of erosions.

acute respiratory infections

The respiratory form of enterovirus infection manifests itself with symptoms similar to any other etiology. Patients complain of fever, sore throat, hoarseness, dry cough, runny nose and nasal congestion. Usually these signs are combined with symptoms of indigestion.

The temperature remains high for 4-5 days and then gradually decreases. Other signs of the disease remain for another 2-3 weeks.

The catarrhal form is more common than others and occurs as pharyngitis, or a combined pathology. In young children, a symptom occurs that requires special attention. This makes it difficult for the child to breathe, especially at night. Attacks of “false croup” pose a great danger to children's health.

The cold-like form of enterovirus infection usually does not last long and is rarely accompanied by complications.

Enteroviral exanthema

In patients with enterovirus infection, from about 2-3 days of pathology, a rash appears on the skin in the form of pink spots and papules, often with hemorrhages. For two to three days, the rash remains on the body, and then gradually disappears without a trace. Exanthema is often combined with herpangina, stomatitis and meningitis.

Enteroviral exanthema

Rare clinical manifestations of enterovirus infection:

Anicteric hepatitis,
Meningoencephalitis,
Inflammation of the optic nerve
Inflammation of the myocardium and pericardium,
Lymphadenitis,
Nephritis,
Paralysis and paresis.

Complications

Inflammation of the brain and peripheral nerves are the most common and dangerous complications of enterovirus infection.

Patients who consult a doctor late and have a severe form of pathology may develop life-threatening diseases - cerebral edema, respiratory and cardiac arrest.

In young children, ARVI of enteroviral etiology is often complicated by the development of “false croup,” and in adults, by secondary bacterial infection with the development of bronchopneumonia.

Features of pathology in children

Enterovirus infection in children occurs in the form of sporadic diseases, but more often in the form of epidemic outbreaks in organized children's groups. The incidence increases in the warm season. For children of preschool and primary school age, the fecal-oral mechanism of transmission of the pathogen is characteristic.

Enterovirus infection in children usually occurs in the form of sore throat, serous inflammation of the meninges, and paralysis.

The pathology clinic is developing rapidly. The temperature rises sharply, chills, dizziness and headache appear, sleep and appetite are disturbed. Against the background of severe intoxication, characteristic signs begin to appear - catarrhal inflammation of the nasopharynx, myalgia, stool disorder, enteroviral exanthema.

Enteroviral stomatitis

Enteroviral stomatitis develops in children aged 1-2 years after enteroviruses enter the body.

Symptoms of the disease are:

Increased salivation
Low-grade fever,
Arthralgia and myalgia,
Runny nose,
Chills,
Malaise,
Swelling of soft tissues in the mouth.

The child becomes lethargic, restless, and capricious. Typical vesicles with a characteristic red rim appear on the skin and mucous membranes. The rashes hurt and itch. These symptoms intensify with the appearance of new lesions.

The disease develops quickly: blisters appear on the third day of infection, and on the seventh day the patient recovers.

Typically, enteroviral stomatitis is combined with exanthema, gastroenteritis, fever, and sore throat. In more rare cases, stomatitis is asymptomatic.

Due to the abundant symptoms, doctors often misdiagnose patients as ARVI, allergic dermatitis, rotavirus or herpetic infection. Prescribed drugs eliminate the main symptoms of the pathology, but do not cure it completely.

Diagnostics

Diagnosis of enterovirus infection is based on characteristic clinical symptoms, patient examination data, epidemiological history and laboratory test results.

The following clinical signs allow one to suspect enterovirus infection:

Gerpangina,
Enteroviral exanthema,
Enteroviral stomatitis,
meningeal signs,
Nonbacterial sepsis,
respiratory syndrome,
Conjunctivitis,
Gastroenteritis.

Material for research - a swab from the throat, discharge from oral ulcers, feces, cerebrospinal fluid, blood.

Virological research- the main diagnostic method. To detect enteroviruses use:

PCR – polymerase chain reaction. This method is highly specific, highly sensitive and fast. It is designed to identify viruses that are not able to reproduce in cell culture. PCR is used to examine cerebrospinal fluid and respiratory secretions.
Detection of pathogens in cell culture or laboratory animals. This method is longer, but accurately determines the type of microbe.

Serodiagnosis is aimed at determining the antibody titer in paired sera taken from a patient in the first and third weeks of the disease. To do this, a complement binding reaction or a hemagglutination inhibition reaction is performed. A fourfold increase in antibody titer in paired sera is considered diagnostically significant. IgA and IgM are markers of the acute period of the disease, and IgG is a marker of past infection that remains in the blood for a long time. Serological testing is intended to confirm the virological method, since enteroviruses can be detected in the feces of healthy people.

Molecular biological method allows you to determine the serotype of the isolated pathogen.

Immunohistochemistry– immunoperoxidase and immunofluorescence methods.

All of these methods are rarely used in mass examination of patients, since they are lengthy, complex and do not have high diagnostic value, which is associated with a large number of asymptomatic carriers of enteroviruses.

Differential diagnosis of enterovirus infection:

Herpetic sore throat is differentiated from fungal infection of the oropharynx and herpes simplex;
Epidemic myalgia - with inflammation of the pancreas, pleura, gall bladder, appendix, lungs;
Enteroviral fever - with acute respiratory viral infections;
Serous meningitis - with inflammation of the meninges of other etiologies;
Enteroviral exanthema - with, allergies;
Enteroviral gastroenteritis - with salmonellosis and shigellosis.

Treatment

Treatment of enterovirus infection includes:

Compliance with the regime
Balanced and rational nutrition,
Taking multivitamins,
Etiotropic and pathogenetic therapy.

Regime and diet

Mild and moderate forms of pathology are treated at home with strict bed rest. Patients with severe forms, prolonged fever and complications are hospitalized.

Patients are prescribed a diet that reduces intoxication, increases immunity, and spares the digestive organs. The patient's diet should contain sufficient amounts of protein, vitamins, and minerals. Drinking plenty of fluids is recommended to detoxify the sick body.

Etiotropic treatment

Specific therapy for enterovirus infection has not been developed.
Antiviral drugs - Remantadine, Kagocel.
Immunostimulants - “Grippferon”, suppositories “Viferon”, “Kipferon”. These drugs have a dual therapeutic effect: they help get rid of viruses and stimulate cellular and humoral immunity.
Immunomodulators – “Amiksin”, “Cycloferon”, “Tsitovir”. They have a pronounced anti-inflammatory effect and stimulate the body’s production of its own interferon, which increases overall resistance and protects against the destructive effects of viruses.

Pathogenetic therapy

Pathogenetic treatment of enterovirus infection is carried out in a hospital setting.

Detoxification measures are indicated for severe pathology.
With the help of diuretics, dehydration is carried out when complications develop - inflammation of the brain and its membranes.
Cardioprotectors are prescribed for viral heart disease.
For treatment, drugs are used that improve blood microcirculation in the vessels of the brain.
Corticosteroids are used to treat pathologies of the nervous system.
Resuscitation measures and intensive care are necessary when emergency conditions develop.

Symptomatic therapy

Pregnant women and children should be under the supervision of a specialist throughout the entire illness. Only a doctor, after making a diagnosis, should prescribe medications and their dosages allowed for a certain period of pregnancy and age group.

Self-medication of enterovirus infection is strictly prohibited. This is due to the nonspecificity of the symptoms of the disease, the possibility of confusing the pathology and being treated incorrectly.

Prevention

Specific prevention for enterovirus infection has not been developed. Main events:

Video: enterovirus infection, “Live Healthy”

Herpetic tonsillitis has a number of synonyms that more accurately and correctly define the pathological inflammatory process: herpes tonsillitis, herpetic tonsillitis, herpangina, enteroviral vesicular pharyngitis, ulcerous tonsillitis.

Herpes sore throat occurs as a result of an enterovirus infection. Sore throat of viral origin - tonsillitis, will be called herpetic, although it has nothing to do with the herpes virus.

It received its name due to the similarity of the rashes with herpetic lesions of the mucous membranes and the general definition of pain symptoms in case of a sore throat.

The course of herpes sore throat always has an acute form, and the development and outcome of the disease will depend on some determining factors: the strength of the immune system, the virulence of the virus and the surrounding epidemiological situation.

Pathogen and etiology of the disease

What is herpes sore throat? This is an acute viral infection that affects the mucous membrane of the mouth, throat, and pharynx, accompanied by anginal pain (as with ordinary bacterial sore throat). The lesions are herpetic in nature not in origin, but in the form of the rash.

The Coxsackie virus has about 30 varieties. Enteroviruses are quite widespread in the external environment and can cause diseases in humans. These include the Coxsackie virus serotype A, B, which is the causative agent of viral sore throat, intestinal, respiratory infections and meningitis.

The virulence (ability to cause disease) of the pathogen is due to its stability in the external environment. It is inactivated only by high temperatures (warming up to 75 - 80°C). It is preserved when frozen, for a long time - in wastewater, contaminated air (in enclosed spaces).

Children from 2 to 10 years of age are susceptible to the disease (up to a year they rarely get sick) and adults aged 30 to 40 years. This age criterion is not a determining factor in the occurrence of infection.

Children get herpes sore throat more often than adults, but the disease is more severe. Adults get sick less often due to the fact that, having been ill in childhood, they acquired specific immunity, but only to the type of one pathogen. When infected with a different serological group, new herpesvirus diseases may arise.

People with reduced resistance get sick more often. Poor nutrition, poor living conditions (unsanitary conditions, violation of microclimate conditions), bad habits, and chronic concomitant diseases contribute to infection.

Herpetic tonsillitis occurs in the form of an outbreak in the summer and autumn months (July - September). Sporadic cases of the disease are observed in winter and spring.

It is transmitted by airborne droplets (sneezing, coughing), orally - fecally and by contact. The virus enters the human body through the mucous membranes, where it settles, invades cells and actively multiplies.

Pathogenesis of herpes tonsillitis

Replication of the enterovirus occurs in the epithelial cells of the intestinal mucosa and oral cavity (lymphoid formations). The pathogen circulates in the bloodstream (viremia) and spreads throughout the body, causing intoxication and the appearance of characteristic symptoms.

The affected cells die, creating necrotic lesions. Exudate accumulates in areas of necrosis, which leads to the appearance of a papular rash. Rashes rarely merge into larger lesions, usually when the disease is complicated by a bacterial infection. The development of the disease is characterized by an increase in intoxication, the occurrence of local pain syndrome and a deterioration in the general condition of the patient.

The course of the disease is significantly influenced by:

degree of virulence of the pathogen;
body resistance;
route of transmission of the virus (method of infection);
exogenous factors (nutrition, microclimate, lifestyle);
age (children get sick more seriously).

Clinical picture of herpetic tonsillitis

The incubation period of the disease for herpetic viral sore throat is 2 - 4 days. With strained immunity, it can be 10 days. Herpes sore throat develops suddenly and acutely in adults, as in children. Over the course of one to two hours, there is a sharp increase in body temperature with the development of febrile and pyretic fever.

General symptoms of the disease:

malaise (headache, body weakness, dizziness);
loss of appetite;
sleep disturbance;
abdominal pain, nausea;
myalgia.

One to two days after the development of primary symptoms, the appearance of specific clinical signs is noted.

Herpetic tonsillitis manifests itself:

acute stabbing pain in the throat, which gradually increases;
hyperemia and swelling of the mucous membrane of the oral cavity and pharynx;
dysphagia (impaired swallowing - pain);
the appearance of a papular-vesicular rash on the mucous membranes of the mouth and pharynx;
dyspepsia and vomiting.

Throughout the entire period of the disease, viral herpes tonsillitis is accompanied by hypersalivation (increased salivation). The decompensatory function of the salivary glands in this case plays the role of a protective mechanism. Frequent and increased salivation helps to wash the affected tissues and accelerates their regeneration.

Important! It is necessary to increase fluid intake during illness (especially during febrile syndrome) to prevent dehydration and reduce intoxication.

A secondary symptom of the disease is the development of lymphadenitis (inflammation of the lymph nodes). Lymphoid formations (cervical, submandibular, parotid lymph nodes) respond to the spread and reproduction of the virus by increasing. They are observed to be sore and dense, which, if the course is favorable, disappears as they recover.

Experts consider a characteristic symptom of the disease to be the phenomenon of hyperthermia, which occurs in two stages: the first increase in body temperature is observed on the first day of illness, followed by a slight decrease, and the second one on the 3rd day of illness, which is critical or peak.

Stages of development of herpangina:

The first two days are characterized by general symptoms of a viral infection (hyperthermia, sore throat, general malaise, runny nose, nasal congestion).
On the 2-3rd day after the onset of symptoms, bright red bubbles appear on the oral mucosa, soft palate, tonsils, and back wall of the pharynx. A day later they become transparent white with serous exudate, bordered by a red corolla (size 1 - 2 mm), similar to a herpetic rash. The temperature is slightly lowered, but remains stable. Myalgia, stabbing pain in the throat, and diarrhea develop.
The third day of illness is accompanied by pyretic fever (39 - 41°C). The condition worsens, painful symptoms increase.
On the 4th day, after a few hours (from 2 - 3 hours to a day), the papules pass into the stage of vesicles, which open (the temperature decreases slightly). Very painful ulcers appear. The more complex the disease, the greater their number. On average, the number is 5 - 12 vesicles, with complications - up to 20. Sometimes the vesicles merge, forming large foci.
On the 5th - 6th day of the process, the ulcers dry out with the formation of crusts, the condition of the patient improves significantly, and the signs of intoxication of the body weaken. If bacterial microflora is involved in the process, the vesicles become ulcerated and erosions occur.
With a favorable course, on the 7th-8th day of the disease, the signs of pharyngitis (inflammation of the pharyngeal mucosa) decrease, the crusts are washed off, the mucous membrane regenerates and no traces of the previous lesion are observed.

After 10 days from the onset of the disease, the pain in the lymph nodes disappears. Their inflammation disappears by the second week (14 - 16 days of illness).

Diagnosis and prognosis of herpes tonsillitis

Viral herpes tonsillitis is fairly easy to diagnose. When making a diagnosis, the following are taken into account: the epidemiological situation at the time of the onset of the viral infection, the etiology of the disease, and clinical symptoms.

A characteristic symptom complex allows one to accurately determine the diagnosis. The need for additional laboratory tests arises with an atypical form of herpes tonsillitis. Blood samples, smears of mucous secretions of the nasopharynx, oral cavity, and intestinal contents are examined.

In this case, virological and serological research methods are used. The presence of specific antibodies, cultural and biochemical properties of the pathogen are determined. Differential diagnosis is aimed at excluding diseases in which a similar clinical picture is observed. Based on the nature of the rash, catarrhal, purulent tonsillitis, diphtheria, scarlet fever, and aphthous stomatitis are excluded.

Viral tonsillitis (herpes) in most cases has a favorable prognosis. With a strained immune system, recovery occurs in 10 to 14 days. A severe course of the disease and an unfavorable prognosis are rarely observed - with a significant decrease in immunity or illness in children before the first year of life.

Features of treatment

Specific therapy methods have not been developed. Herpetic infection (tonsillitis) as a treatment involves the use of symptomatic remedies, alleviating the general condition of the patient and reducing intoxication of the body.

Drug treatment includes the use of:

antipyretics;
antiallergic (if necessary);
vitamin and mineral preparations;
immunomodulators.

Important! When diagnosing herpes sore throat (tonsillitis), the use of antibacterial agents in the first days of the disease is not advisable. Antibiotics and antiherpetic drugs have no effect on the virus.

The use of antibacterial agents may be necessary to prevent complications when the pathological process worsens and the development of concomitant bacterial infection. An important point in the fight against a viral infection is to ensure that the patient remains in bed and drinks plenty of fluids.

Local treatment for sore throat:

Frequently rinse the mouth with decoctions of medicinal plants - chamomile, sage, calendula (oak bark).
For severe pain, use a 2% lidocaine solution (rinse) or Orasept spray as a local anesthetic.
Treat the affected areas with antiseptic solutions (aqueous solution of gentian violet, Chlorophyllipt, Ingalipt, Tantum Verde). The drugs do not act on the virus, but their use prevents the development of a bacterial infection. Treatment should be avoided if the throat is very sore.

Important! With this pathology, inhalations and warming of a sore throat cannot be performed. This will lead to generalization (spread) of the inflammatory process.

If the course of the disease is favorable, sufficient treatment will be to consume plenty of fluids to avoid dehydration and reduce intoxication and adherence to bed rest in combination with good nutrition.

Food should be nutritious and easy to digest. It is recommended to prepare first courses, purees, and fine-grained porridges. Eat food often, in small portions. After each dose, rinse your mouth and throat with the above products.

If severe symptoms of intoxication develop - nausea, vomiting, convulsions (especially in children), treatment of the patient at home is not allowed. Such clinical signs may indicate the development of complications (meningitis, encephalitis) and require emergency hospitalization.

Prevention of herpes tonsillitis

Prevention of herpes virus infections, including herpes tonsillitis, comes down to increasing and strengthening the body’s immune status, observing personal hygiene rules and reducing the possibility of infection.

Basic preventive measures:

Compliance with hygiene rules - mandatory hand washing before eating and after visiting public places (shops, institutions, vehicles).
If possible, avoid crowded places to prevent infection.
Increasing and strengthening the body’s nonspecific resistance (good nutrition, decent conditions and lifestyle).

Strengthening the body, frequent walks in the fresh air and an active lifestyle helps improve immunity.

The formation of active immunity for herpes sore throat (tonsillitis) is carried out on the 10th - 14th day of the disease.

The specificity of immunity lies in the body's immunity to a specific serotype of enterovirus, which excludes re-infection.

Herpetic sore throat is a disease that affects almost every child under the age of 10 at least once, although pediatricians do not make the diagnosis of “herpetic tonsillitis” very often.

Usually this disease is confused with bacterial streptococcal sore throat, and they are prescribed, which in this case are powerless and completely useless.

Enterovirus thrives in the warm water of swimming pools, in fresh water bodies, as well as in shallow seas with low salinity: it can easily be classified as a “resort” disease.

Children living in rural areas, near pig farms, are at risk, since the enterovirus affects pigs, and its favorite method of entry into the body is fecal-oral.

This disease is seasonal. The virus is heat-loving, outbreaks usually occur in July-September.

The virus’ activity is also characterized by waves – there are years when the incidence increases, then several years of relative calm.

Symptoms of herpes tonsillitis and its distinctive features

Since parents are responsible for the health of their children, you should know the symptoms of herpes sore throat and be able to distinguish it from sore throat of a bacterial nature.

This is important, since treatment of the second type of sore throat must certainly be accompanied by the use of an antibiotic, but in the case of enterovirus infection, the antibiotic will only weaken the body’s immune system.

Increased body temperature, sometimes up to 41 0. Typically, the disease starts with an increase in temperature. The onset of the disease is similar to influenza. In individual cases there may be no fever.
. This type, like any sore throat, is characterized by a sore throat and inflammation of the mucous membranes. These symptoms occur on average on the second day after the first episode of fever.

The above symptoms are inherent in any type of sore throat.

, some of which later transform into ulcers similar to stomatitis. The bubbles are filled with a colorless liquid and resemble. Hence the etymology of the name of the disease. The bubbles gradually grow to 8-10 mm. If with bacterial tonsillitis the throat lesion is localized on the tonsils, then herpes viral tonsillitis gives a rash throughout the entire oral cavity. Lesions can occur in the back wall of the pharynx, tonsils, and uvula. In this case, there can be a lot of ulcers, but sometimes there are only 2-3. They disappear on the fifth to seventh day after occurrence.
Disorders of the gastrointestinal tract. Since the causative agent of the disease is enterovirus, it is not surprising that nausea, diarrhea and vomiting with herpes sore throat occur in every third infected person.
Rash on arms and legs. Another specific symptom is called “Arm – Leg – Mouth”. A red rash covers the arms (starting from the hands) and face, localized around the mouth. This sign is sometimes very pronounced, may not be observed in all specified places, is barely noticeable, or is absent altogether.

Accompanied by whims and bad mood: the patient is usually depressed, because the throat is very sore and swallowing is difficult.

Although the symptoms of herpes sore throat are characteristic, it is a rather unpopular diagnosis among modern pediatricians.

It is often confused with a sore throat caused by staphylococcus, and is referred to as an allergy to an antipyretic.

Treatment of herpetic sore throat and patient regimen

Treatment of herpes sore throat is carried out on an outpatient basis, hospitalization is required in extreme cases. A sick child needs rest.

This is a highly contagious disease, so contact with children and family members should be minimized. The room in which the infected person is located must be regularly ventilated.

Wet cleaning and a humidifier are also necessary. Dishes and towels must be separate. If there are other children in the house, toys should be separated.

After a sick child has used toys, they must be washed with water and detergent or treated with chlorhexidine.

The doctor decides how to treat herpes sore throat in children and adults. This is usually symptomatic treatment.

At high temperatures, an antipyretic is prescribed. Parents should remember that an increase in body temperature is a protective reaction of the immune system. If your baby is sick, there is no need to try to bring the temperature down to 36.6. Children under 3 years old should be given an antipyretic if the temperature is above 38 o, children over 3 years old - starting from 38.5 o on the thermometer. Otherwise, you are simply interfering with the child’s own immunity.
For sore throat, a gentle gargle is prescribed. For kids who cannot gargle on their own, you can inject a chamomile decoction into the cheek with a syringe without a needle.
Sprays are prescribed to irrigate the throat, often with an anesthetic. The spray must be age appropriate. The drug Tantum Verde for herpes sore throat is usually prescribed to the youngest patients. To properly apply the medicine, place the nozzle of the spray behind the baby’s cheek or irrigate. If the child is still sucking the pacifier, you can treat it with medication. After applying the spray, you do not need to eat or drink for 30 minutes, otherwise its use will be pointless: saliva will wash the drug from the mucous membranes.
For diarrhea and vomiting, an intestinal antiseptic, a rehydration drug (for example, rehydron), and drugs that restore bifid flora are given.
To reduce swelling, antihistamines are prescribed.
Often prescribed. The issue of the effectiveness of antiviral drugs is still being discussed by pharmacists. Therefore, everyone makes their own decision about the advisability of purchasing and receiving them.
An antibiotic for this disease can be prescribed if the doctor has identified bacterial complications of the disease.
To restore immunity and strength, multivitamins and vitamin C are prescribed.

Herpes sore throat is a reason to refuse inhalations and warming up. Do not wrap your baby's neck with a scarf. This will only give the virus new strength.

Important: Remember that this is a heat-loving disease. The child should not be hot!

Drinking regime

High fever, diarrhea and vomiting, difficulty swallowing lead to dehydration becoming a companion to herpes sore throat. If the number of urinations has decreased, dehydration has begun.

To cleanse the body of toxins and restore metabolism, it is very important to give the patient something to drink. Faith in strength sometimes makes mothers forget about this simple but very important action.

Hot and warm drinks can cause pain. There is no need to try to give your baby hot milk when he refuses it, even if both grandmothers insist otherwise!

The drink should be at room temperature. It doesn’t matter whether it’s water, compote, juice or even lemonade. The main thing is to convince the child to drink fluids. If there is severe loss of moisture, electrolyte solutions are needed.

Frequent drinking in small sips washes away plaque in the throat, so it is advisable to offer your baby at least a teaspoon of liquid every 10-15 minutes.

Nutrition

The child may refuse to eat in the first days of the disease. You should not force food into it. This is a normal reaction of the body to intoxication, as well as discomfort in the throat. 70% of our immunity is in the intestines.

An empty intestine during a viral infection helps the immune system cope with the disease faster, so do not feed the baby if he does not want to: children are very intuitive, and you need to listen to their wishes.

When the baby gets better, he will make up for lost time.

Offer the patient soft foods that will not injure the throat (mashed potatoes, cereals, soups, bananas). Food should not be hot. There are no contraindications for cold food.

A good option for any sore throat is everyone’s favorite burnt sugar candy.

It contains the glucose necessary for quickly restoring wasted energy, sucking leads to additional formation of saliva, which is a natural antiseptic, burnt sugar softens the throat, and the lollipop itself lifts the mood.

Complications after herpes sore throat

Herpes sore throat rarely causes serious complications. Possible consequences include inflammation of the heart muscle (myocarditis), brain tissue (encephalitis), meninges (meningitis), and conjunctivitis.

The greatest number of complications of this disease occurs in boys and girls from one to three years old.

Herpangina is a widespread disease, quite aggressive in its manifestations, but generally harmless. The main tasks of parents with this disease are: to prevent dehydration at high temperatures and gastrointestinal disorders (vomiting and diarrhea), to reduce the baby’s body temperature, and to try to reduce discomfort due to a sore throat.