What is Herpetic Angina (Herpetic Tonsillitis)?
Herpetic angina (syn. ulcerous sore throat, aphthous pharyngitis, vesicular pharyngitis) is an acute infection with a sudden rise in body temperature, dysphagia, pharyngitis, sometimes abdominal pain, nausea and vomiting.
A characteristic sign of herpetic sore throat is vesicular prone to ulceration on the back of the pharynx or soft palate.
Causes of Herpetic Angina (Herpetic Tonsillitis)
Herpetic sore throat is described by T. Zagorsky in 1920. The causative agents are Coxsackie Group A viruses, most often caused by serovar 2-6, 8 and 10 viruses. Less commonly, Coxsacke B viruses or ECHO viruses cause herpes sore throat.
Pathogenesis During Herpetic Angina (Herpetic Tonsillitis)
Coxsackie viruses are widespread. Note the characteristic seasonality of morbidity with the rise in the summer-autumn months. The main routes of transmission are fecal-oral and contact (through the discharge of the nasopharynx). The pathogen penetration pathways and spread are identical to those of polioviruses. The main natural reservoir is man, but infection from various animals, such as pigs, is also possible.
Symptoms of Herpetic Angina (Herpetic Tonsillitis)
The incubation period is 7-14 days. The disease begins with a pronounced flu-like syndrome; characterized by decreased appetite, malaise, irritability, fever and weakness. Later, sore throat, salivation (pain, localized in the nasopharynx and pharynx) and acute rhinitis appear. Then on the back of the pharynx, tonsils, soft palate, uvula, anterior part of the oral cavity appear bubbles with serous contents, surrounded by a corona of hyperemia, resembling herpetic lesions. Characterized by bilateral anterior cervical lymphadenopathy. Elements gradually dry up with the formation of crusts, sometimes the bubbles can ulcerate or suppurate (the accession of bacterial infections). In more severe cases, diarrhea, nausea and vomiting are possible.
With the generalization of the process – meningitis, encephalitis and myocarditis.
Diagnosis of Herpetic Angina (Herpetic Tonsillitis)
An accurate diagnosis of herpetic angina is established using virological and serological studies. Pharyngeal washes (in the first 5 days of illness) are used as material for virological studies. For serological studies (neutralization reaction) in order to detect an increase in antibody titer, sera collected in the first days of the disease and after 2-3 weeks are used. The most informative of laboratory diagnostic methods is the immunofluorescence method.
Differential diagnosis is based on the age of the child, the seasonality of the disease, the type and localization of the elements of the lesion in the oral cavity. In case of herpetic tonsillitis, there are no herpetic lesions on the skin of the face, mucosal bleeding and hypersalivation are not characteristic, and gingivitis is absent. Often, the disease is accompanied by a symptom of “abdominal pains” resulting from myalgia of the diaphragm.
Herpetic Angina Research Methods
- Blood test: moderate leukocytosis
- Identification of the pathogen
– Material under study: swabs and swabs from the nasopharynx, intestinal contents that infect cell cultures (for example, HeLa or monkey kidneys) and mouse-suckers (the latter is particularly significant for identifying Coxsackie Group A viruses exhibiting a weak cytopathogenic effect in vitro)- In the presence of a cytopathic effect, the virus is typed by introducing diagnostic fluorescein-labeled immune sera- According to the nature of the pathological changes in mice determine the belonging of the Coxsackie virus to group A or B
– Belonging to the serovars is determined in the reaction of complement fixation (CSC), neutralization reaction and the reaction of indirect hemagglutination (RNA) with type-specific antisera.
Treatment of Herpetic Angina (Herpetic Tonsillitis)
Treatment of herpetic angina symptomatic.
Prescribe hyposensitizing drugs (diazolin, suprastin, fenkarol, claritin, peritol, etc.) in the appropriate age of the child dosages and antipyretics (tylenol, calpol, eferalgan, etc.).
Due to the constant trauma of lesions and the low effectiveness of drugs in the form of ointments, the disease can last 12-14 days.
Local therapy is recommended in the form of irrigation fluids or using aerosol antiseptics, proteolytic enzymes, antiviral drugs, painkillers and keratoplastic agents. For this purpose, irrigation of lesion elements with 0.1% or 0.2% enzyme solutions (trypsin, chymotrypsin, himopsin, etc.) is recommended. Then use aerosols (“Hexoral”, “Tantum Verde”, “Ingalipt”), with antiseptic, analgesic, enveloping action.
Good effect is achieved with frequent use of liquid antiviral agents (leukocyte interferon).
To enhance the processes of epithelialization, the use of ultraviolet irradiation and light helium-neon laser, aerosol preparations “Vinizol”, “Panthenol” and others, as well as tablets for resorption in the oral cavity (sebidine, pharyngosept) with antiseptic and bactericidal action are recommended.
After the general and local treatment is carried out, it is necessary to provide for the organization of a balanced diet and the inclusion of immunomodulators (imudon, immunal, etc.) in therapy.
Prevention. Conduct specific vaccine prophylaxis due to the abundance of pathogenic serotypes of Coxsackie and ECHO viruses. Children who have been in contact with patients are shown gamma globulin at the rate of 0.5 ml / kg body weight.
The prognosis is favorable: the disease ends with full recovery.
Prevention of Herpetic Angina (Herpetic Tonsillitis)
Preventive measures in epidemic foci should be the same as for other respiratory viral infections. Isolation of the first patients, if it is carried out on the first day of the disease, is effective, since it reduces the spread of infection in the children’s team. The contagiousness of patients with enterovirus infection from the 7-8th day of illness is sharply reduced, and the return of the convalescent to its group of children’s institutions does not lead to a recurrence of an epidemic outbreak.