A 5-year-old boy is brought to the clinic due to 3 days of fever. For the past 2 days he has also had throat pain and has not eaten well. His father is worried because the boy is due to start the fall school term in 2 weeks. The patient has no chronic medical conditions and is current with his immunizations. He lives with his older brother, parents, and grandmother. Temperature is 38.3 C (101 F), blood pressure is 108/58 mm Hg, pulse is 108/min, and respirations are 18/min. The oropharynx has several scattered, 1-mm vesicles on the anterior palatine pillars. Several gray, shallow ulcers are also seen on the soft palate and uvula, but the tongue, lips, and buccal mucosa are spared. The skin has no rashes. The remainder of the physical examination is normal. Which of the following is the most likely pathogen associated with this patient's condition?

Question

A 5-year-old boy is brought to the clinic due to 3 days of fever.  For the past 2 days he has also had throat pain and has not eaten well.  His father is worried because the boy is due to start the fall school term in 2 weeks.  The patient has no chronic medical conditions and is current with his immunizations.  He lives with his older brother, parents, and grandmother.  Temperature is 38.3 C (101 F), blood pressure is 108/58 mm Hg, pulse is 108/min, and respirations are 18/min.  The oropharynx has several scattered, 1-mm vesicles on the anterior palatine pillars.  Several gray, shallow ulcers are also seen on the soft palate and uvula, but the tongue, lips, and buccal mucosa are spared.  The skin has no rashes.  The remainder of the physical examination is normal.  Which of the following is the most likely pathogen associated with this patient's condition?

Quizplus · Accepted Answer

11ec25c8_d6b8_6c3a_bc81_7b263036a182_MD0003_00 Herpangina and herpetic gingivostomatitis are common vesicular oral infections in children. They present similarly with fever and pharyngitis; however, the primary distinguishing feature is the location of the oral lesions. Herpangina is caused by Coxsackie virus and typically affects young children in the late summer or early fall. Patients have gray vesicles that progress to fibrin-coated ulcers. The oral enanthem is located in the oropharynx on the posterior soft palate, anterior palatine pillars, tonsils, and uvula. Unlike hand-foot-and-mouth disease, another condition caused by Coxsackie virus, herpangina is not associated with a rash. oropharynx hand-foot-and-mouth disease In contrast, herpetic gingivostomatitis is a herpes simplex virus infection characterized by clusters of vesicles that generally localize to the anterior oral cavity (buccal mucosa, tongue, gingiva, hard palate) and lips (Choice D). lips This patient with ulcers in the back of the mouth has herpangina. Treatment is supportive (eg, oral hydration, analgesia) as lesions self-resolve within a week. (Choice A) Adenovirus is a common cause of tonsillitis in children and presents with fever, cough, and sore throat. Tonsillar exudates may be present, but not oropharyngeal vesicles or ulcers. (Choice C) Epstein-Barr virus (EBV) is the primary cause of infectious mononucleosis. It typically presents with fever, pharyngitis, posterior cervical lymphadenopathy, and tonsillar exudates. EBV does not cause oral vesicles or ulcers. (Choice E) Streptococcus pyogenes is the primary cause of streptococcal pharyngitis, which presents with fever, sore throat, tender anterior cervical lymphadenopathy, and tonsillar exudates. The absence of exudates and presence of vesicles in this patient make the diagnosis of Streptococcus less likely. Educational objective: Herpangina is caused by Coxsackie virus infection. It typically presents with fever and oropharyngeal vesicles and ulcers on the posterior soft palate, palatine pillars, tonsils, and uvula. References: Enteroviruses isolated from herpangina and hand-foot-and-mouth disease in Korean children. (http://www.ncbi.nlm.nih.gov/pubmed/22985487) Herpangina. (http://www.ncbi.nlm.nih.gov/pubmed/29939569) Risk factors for hand, foot, and mouth disease and herpangina and the preventative effect of hand-washing. (http://www.ncbi.nlm.nih.gov/pubmed/21422083)

A 5-Year-Old Boy Is Brought to the Clinic Due to 3