II. Epidemiology
- Occurs in summer months (may be epidemic)
- Preschool children and their siblings
III. Pathophysiology
- Caused by Enteroviruses in the Picornaviridae family
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Picornaviridae
- Picornaviridae are a family of non-enveloped (naked) RNA Viruses with an icosahedral capsid
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Picornaviridae are linear, Message Sense RNA Viruses (Positive Stranded, +ssRNA)
- Message sense RNA (+ssRNA) are identical to Messenger RNA (mRNA)
- Like mRNA, +ssRNA may be immediately translated by host ribosomes into Protein
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Enterovirus
- Enteroviruses infect small intestinal epithelial cells (peyer's patches) and lymphoid cells (Tonsils)
- Enteroviruses may also infect other tissue (e.g. Neurons) depending on the specific virus
- Transmission in pharyngeal secretions and via fecal-oral route
V. Signs
- Non-toxic appearance
- Multiple small 1-2 mm Vesicle or ulcers
- Soft Palate, posterior pharynx, Tonsillar Pillars and uvula
- Spares the anterior pharynx
- Contrast Hand Foot and Mouth Disease which spares the posterior pharynx
- No skin lesions
- Unlike Hand Foot and Mouth Disease
VI. Differential Diagnosis
- See Oral Ulcer
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Hand Foot and Mouth Disease
- Vesicles in anterior pharynx, sparing posterior pharynx
- Aphthous Ulcer
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Primary Herpetic Gingivostomatitis
- External Vesicles are only seen with HSV (not with Herpangina or Hand Foot and Mouth Disease)
VII. Course
- Illness of 1 week duration with rare complication