Coxsackie virus infections

Last updated: October 27, 2021

Summary

Coxsackie viruses are a group of RNA viruses with over 20 serotypes; depending on specific viral characteristics, these serotypes are further divided into groups A and B. Infection is associated with a wide range of symptoms, which are dependent on the exact serotype. Hand, foot, and mouth disease (HFMD) and herpangina are commonly caused by group A coxsackie viruses, while pleurodynia and myocarditis are caused by group B coxsackie viruses. Both groups may cause viral meningitis, conjunctivitis, or pneumonia. Diagnostic procedures and treatment should be tailored to the specific disease manifestation.

Worldwide distribution
Occur in all age groups
Highest incidence in infants and young children (< 10 years) ^[1]
There is no evidence for complications associated with coxsackie virus infection during pregnancy. ^[2]

Epidemiological data refers to the US, unless otherwise specified.

Pathogen: coxsackie virus
- Genus: enterovirus
- Family: picornaviridae
- Over 20 serotypes, divided into group A and group B coxsackie viruses
- Single‑stranded RNA virus
Route of transmission
- Airborne droplets
- Fecal‑oral route

Definition: seasonal acute infection that manifests with fever, sore throat, and herpes-like lesions on the posterior oropharynx and tonsils
Epidemiology
- Most common in children between the age of 3–10 years
- Occurs predominantly in summer and fall
Clinical features
- High fever, sore throat
- Herpes-like oral lesions
  - Multiple 1-mm vesicles located on the posterior oropharynx and tonsils
  - Pharyngeal and tonsillar redness
  - Later stages: fibrin-covered ulcerations
Diagnosis: based on clinical features
Treatment: supportive care (e.g., ibuprofen for pain relief, parenteral rehydration in dehydration) since the condition is typically self-limiting

Herpangina

Definition: highly contagious infection that manifests with a characteristic maculopapular/partially vesicular rash on hands and feet
Clinical features
- Fever, malaise
- Maculopapular and partially vesicular rash on the hands and feet (can also involve the buttocks)
- Oral ulcers
- Anorexia, oral pain
Diagnosis: based on clinical features
Treatment: symptomatic
Prognosis: almost always self‑limiting

Hand, foot, and mouth disease Skin lesions in hand, foot, and mouth disease

Definition: acute illness characterized by fever and/or other flu-like symptoms and painful spasms of the chest and upper abdomen due to irritation of the pleura and muscles
Clinical features
- Flu‑like symptoms
- Sudden thoracic and upper abdominal pain caused by irritation of the pleura and muscles
Diagnosis
- Clinical
- Viral culture or PCR (throat or stool sample), serological testing
- Creatine kinase may be elevated ^[5]
Treatment: symptomatic
Prognosis: self‑limiting

Coxsackie B is the most common cause of viral myocarditis.

Modlin JF. Clinical manifestations and diagnosis of enterovirus and parechovirus infections. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-enterovirus-and-parechovirus-infections. Last updated: September 30, 2016. Accessed: March 19, 2017.
Epidemic Pleurodynia (Bornholm Disease; Bornholm's Disease). http://www.merckmanuals.com/professional/infectious-diseases/enteroviruses/epidemic-pleurodynia. Updated: January 1, 2016. Accessed: March 19, 2017.
Bornholm disease. https://radiopaedia.org/articles/bornholm-disease-1. Updated: April 30, 2020. Accessed: July 29, 2020.
Carlin B. Corsino, Rimsha Ali, Derek R. Linklater.. Herpangina - StatPearls. StatPearls. 2020.
Pregnancy & Non-Polio Enterovirus Infection. https://www.cdc.gov/non-polio-enterovirus/pregnancy.html. Updated: August 8, 2020. Accessed: October 18, 2021.

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