Coxsackie virus facts

Coxsackie viruses are RNA viruses that may cause hand, foot, and mouth disease (HFMD). HFMD usua y occurs in chi dren !ut can occur in adu ts" the ma#ority of infections are se f$ imited so no treatment is re%uired. HFMD, caused !y Coxsackie viruses, usua y cause fever, ma aise,rash, and sma ! isters that u cerate. &he most fre%uent ocations for the ! isters'u cers are on the (a ms of the hand, so es of the feet, and in the mouth. HFMD usua y reso ves in a!out )* days +ith no scarrin,, !ut the (erson may shed Coxsackie virus for severa +eeks. A thou,h a! tests for Coxsackie viruses can !e done, the vast ma#ority of infections are dia,nosed !y c inica features (HFMD ! isters'u cers), !ut this may chan,e +ith the onset of ne+ out!reaks and causes of severe HFMD. &here is no s(ecific treatment or vaccine avai a! e for Coxsackie virus infections. -revention is difficu t" avoid direct contact +ith anyone +ith HFMD, and their stoo , sa iva, and ! ister f uid. Hand +ashin, and c eanin, of items hand ed !y HFMD (atients are the !est methods for (revention.

What is Coxsackie virus?

Coxsackie virus is a mem!er of the Picornaviridaefami y of viruses in the ,enus termed enterovirus. Coxsackie viruses are su!ty(e mem!ers ofenterovirus that have a sin, e strand of ri!onuc eic acid (RNA) for its ,enetic materia . &he enteroviruses are a so referred to as (icornaviruses (pico means .sma ,. so, .sma RNA viruses.). Coxsackie virus +as first iso ated from human feces in the to+n of Coxsackie, Ne+ /ork, in )012 !y 3. Da dorf. Coxsackie virus is a so +ritten as coxsackievirus in some (u! ications.

What are the types of Coxsackie viruses, and what can they cause?
Coxsackie viruses are se(ara! e into t+o ,rou(s, A and 4, +hich are !ased on their effects on ne+!orn mice (Coxsackie A resu ts in musc e in#ury,(ara ysis, and death" Coxsackie 4 resu ts in or,an dama,e !ut ess severe outcomes.) &here are over 51 different seroty(es of the virus (havin, distinct (roteins on the vira surface). Coxsackie viruses infect host ce s and cause host ce s to !reak o(en ( yse).

Picture of the Coxsackie virus; SOURCE: CDC

&y(e A viruses cause her(an,ina ((ainfu ! isters in the mouth, throat, hands, feet, or in a these areas). Hand, foot, and mouth disease (HFMD) is the common name of this vira infection. Coxsackie A )6 (C7A)6) causes the ma#ority of HFMD infections in the 8.9. :t usua y occurs in chi dren (a,e )* and under), !ut adu ts can a so deve o( the condition. &his chi dhood disease shou d not !e confused +ith the .foot and mouth disease. usua y found in anima s +ith hooves (for exam( e, catt e, (i,s, and deer). &y(e A a so causes con#unctivitis (inf ammation of the eye ids and +hite area of the eye). &y(e 4 viruses cause e(idemic ( eurodynia (fever, un,, and a!domina (ain +ith headache that asts a!out t+o to )5 days and reso ves).- eurodynia is a so termed 4ornho m disease. &here are six seroty(es of Coxsackie 4 ()$6, +ith 4 1 considered !y some researchers as a (ossi! e cause of dia!etes in a num!er of individua s). 4oth ty(es of viruses (A and 4) can cause menin,itis, myocarditis, and(ericarditis, !ut these occur infre%uent y from Coxsackie infections. 9ome researchers su,,est Coxsackie virus (main y Coxsackie 41) has a ro e in the deve o(ment of acute onset ty(e : (former y kno+n as #uveni e) dia!etes, !ut this re ationshi( is sti under investi,ation. Coxsackie viruses and other enteroviruses may cause the chi dhood disease of hand, foot, and mouth disease. Ho+ever, the ma#ority of chi dren +ith Coxsackie virus infections com( ete y reso ve the sym(toms and infection in a!out )*$)5 days. Recent y (;u y 5*)5), in Asia ((articu ar y Cam!odia), chi dren sus(ected to !e infected +ith enterovirus <) had a 0*= morta ity. &his e(idemic (main y in !a!ies, todd ers, and chi dren under 5 years of a,e) is sti under intense investi,ation and it is ike y researchers +i have a !etter understandin, of this hi,h death rate inked to enterovirus <) soon. :f enterovirus <) is u timate y found res(onsi! e for these deaths, it is ike y the virus has deve o(ed a ne+ etha a!i ity to ra(id y infect and destroy chi dren>s un, tissue. Ho+ever, the research is on,oin, and some investi,ators su,,ests that the chi dren are dyin, from a com!ination of enterovirus <), Streptococcus suis, and den,ue vira coinfections.

What are Coxsackie virus infection signs and symptoms?

&he most fre%uent si,ns and sym(toms of Coxsackie vira infections start +ith fever, sore throat, ma aise (fee in, tired), and a (oor a((etite. &his incu!ation (eriod asts a!out one to t+o days. 9ore areas in the mouth deve o( in a!out a day or t+o after the initia fever and deve o( into sma ! isters that often u cerate. Many infected (eo( e (usua y chi dren )* years of a,e and youn,er) ,o on to deve o( a rash that itches on the (a ms of the hands and the so es of the feet. ?ther areas such as the !uttocks and ,enita s may !e invo ved. &hese sym(toms usua y ast a!out seven to )* days and the (erson recovers com( ete y. &he individua s are most conta,ious for a!out a +eek after sym(toms !e,in, !ut !ecause the virus can !e shed !y the infected individua sometimes for +eeks after the sym(toms have ,one a+ay, the (erson may !e mi d y conta,ious for severa +eeks. &he ast t+o references sho+ (ictures of the ! isters.

Picture of characteristic mouth sores of hand foot and mouth disease

Picture of characteristic rash and blisters of hand foot and mouth disease :nfre%uent y, the infection may resu t in tem(orary fin,ernai or toenai oss (termed onychomadesis). Rare y, the disease may (ro,ress to cause vira menin,itis (headache, stiff neck), myocarditis (heart musc e infection), (ericarditis (inf ammation'f uid co ection of the tissue surroundin, the heart), or ence(ha itis (!rain s+e in,).

How do people get infected with Coxsackie virus?

:nfection usua y is s(read !y feca $ora contamination, a thou,h occasiona y the virus is s(read !y dro( ets ex(e ed !y infected individua s. :tems ike utensi s, dia(er$chan,in, ta! es, and toys that come in contact +ith !ody f uids that contain the virus may a so transmit them to other individua s. A thou,h (eo( e of any a,e, inc udin, adu ts, can ,et

infected, the ma#ority of (atients identified +ith Coxsackie infection are chi dren. -re,nant +omen can (ass Coxsackie virus to their ne+!orns, +hich may cause serious (ro! ems for the ne+!orn, so (re,nant +omen need to notify their o!stetrician if they exhi!it sym(toms of the infection, es(ecia y if they are near their de ivery date.

What are the risk factors for Coxsackie virus infection?

Risk factors for Coxsackie virus infection inc ude (hysica contact +ith any (atient +ith individua s +ith HFMD sym(toms. :nfectious virus can !e found in feces, sa iva, f uid in ! isters, and nasa secretions. @ven (atients +ho have recovered and have no sym(toms may sti shed infectious virus for +eeks. A fetus or ne+!orn is at risk if their mother !ecomes infected near the de ivery date.

How are Coxsackie virus infections diagnosed?

-atients are usua y dia,nosed !y their c inica a((earance. C inica y, ! isters that are (ainfu usua y on the hands, feet, and mouth in a chi d +ith fever are considered dia,nostic of Coxsackie virus infection. Ho+ever, in rare instances, vira tests can !e done to identify the virus, !ut the tests are ex(ensive, usua y need to !e sent to a s(ecia iAed vira dia,nostic a!oratory that uses R&$-CR and often take a!out t+o +eeks to ,et a resu t. &his testin, is a most never done since most infections are se f$ imited and ty(ica y mi d, !ut this situation may chan,e !ecause of an out!reak in A a!ama (B2 chi dren, )5= hos(ita iAed !ut no deaths in 5*))$5*)5) and the recent enterovirus <) e(idemic (a!out 0*C of hos(ita iAed chi dren have died) in Cam!odia. R&$-CR testin, can distin,uish !et+een many vira ,enera, s(ecies, and su!ty(es. Distin,uishin, Coxsackie virus strains from adenoviruses, other enterovirus ty(es, echo virus, and others may !ecome necessary in the future.

Is there any treatment for Coxsackie virus infection?

&here is no s(ecific treatment for this ty(ica y se f$ imited disease (the sym(toms reso ve +ithout s(ecific antivira treatment in a!out t+o to )* days). Ho+ever, sym(tomatic treatment (acetamino(hen D&y eno E) that reduces fever and discomfort is current y recommended. Mouth+ashes and s(rays may essen the ora discomfort. F uids are a so su,,ested to (revent dehydration, ho+ever, acidic #uices may irritate the mouth u cers. Co d mi k may sooth the ora discomfort. 9ome (hysicians use to(ica di(henhydramine (4enadry )$containin, ,e or i%uids to treat the hand and foot discomfort. &he re ative y rare com( ications of Coxsackie virus infections (for exam( e, heart or !rain infection) re%uire s(ecia individua iAed treatments ((ossi! y human immune , o!u in or s(ecific antivira s a thou,h such treatments are rare and not yet (roved to !e safe and effective +ith serious HFMD infections) usua y administered !y an infectious disease consu tant.

Can Coxsackie virus infections be prevented?

-revention of Coxsackie virus infections is difficu t !ut (ossi! e. Fith chi dren, kee(in, strict hy,ienic (recautions is a most im(ossi! e, !ut ,ood (ractices such as hand +ashin, after dia(er chan,in, or touchin, infected skin may reduce vira transmission to other fami y mem!ers. Attem(ts to re,u ar y c ean items that chi dren contact, es(ecia y toys, (acifiers, and any items they may ( ace in their mouths, may a so reduce vira transmission. Hand +ashin,, in ,enera , is the !est (revention techni%ue. Current y, there is no vaccine avai a! e. -re,nant +omen shou d avoid contact +ith chi dren (or adu ts) +ith HFMD !ecause some studies su,,est that Coxsackie virus may cause deve o(menta and other defects in the fetus. A thou,h infection and reso ution of the disease usua y renders the (erson immune to reinfection +ith the vira ty(e that initiated the disease, the (erson is not immune to other Coxsackie vira ty(es. For exam( e, a (erson may !ecome immune to Coxsackie vira ty(e 41 !ut sti +ou d !e susce(ti! e to a of the other Coxsackie vira ty(es (for exam( e,

C7A)6). :n addition, other viruses such as enterovirus <) and enteric cyto(athic human or(han (@CH?) viruses can (roduce HFMD sym(toms. Conse%uent y, it is (ossi! e for some (eo( e to have mu ti( e infections +ith HFMD sym(toms, even thou,h re(eated infections occur infre%uent y.
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What is the prognosis of Coxsackie virus infections?

8nti recent y, the ,enera (ro,nosis for most (atients +as exce ent, +ith chi dren makin, a com( ete recovery +ithout needin, any su((ortive care (hos(ita iAation). Ho+ever, this may !e chan,in, as evidenced !y the out!reak in A a!ama in 5*))$5*)5 that re%uired )5= (ercent of chi dren hos(ita iAed for su((ortive care. ?n y rare y do (atients suffer (oor outcomes +ith com( ications of menin,itis, (ericarditis, or ence(ha itis.