Coxsackievirus

infections
Dr.T.V.Rao MD
 Coxsackieviruses
 Coxsackieviruses are part of the
enterovirus family of viruses (which also
includes polioviruses and hepatitis A virus)
that live in the human digestive tract. They
can spread from person to person,
usually on unwashed hands and surfaces
contaminated by feces, where they can
live for several days.
 Coxsackievirus
 Coxsackievirus (sometimes written as two
words, Coxsackie's virus) belongs to a
group of viruses called enteroviruses.
Coxsackievirus infections occur most often
during summer and fall
 Coxsackievirus infections occur most often
in young children,
Coxsackie's belongs to
Enterovirus
 Coxsackie, New York
 The virus family he
discovered was
eventually given the
name Coxsackie, for
the town of
Coxsackie, New York,
a small town on the
Hudson River where
Dalldorf had obtained
the first fecal
specimens
 Groups
 Coxsackievirus are divided into group A and
group B viruses based on early observations of
their Pathogenicty in mice. Group A
Coxsackievirus were noted to cause a flaccid
paralysis, which was caused by generalized
myositis, while group B Coxsackievirus were
noted to cause a spastic paralysis due to focal
muscle injury and degeneration of neuronal
tissue. At least 23 serotypes (1-22, 24) of group
A and 6 serotypes (1-6) of group B are
recognized
Coxsackie's virus Infects Suckling
Mice but not Adult Mice
 Several Serotypes
 At least 23 serotypes
(1-22, 24) of group A
and 6 serotypes (1-6)
of group B are
recognized
 Sources of Coxsackie's viral
infections
 Infection usually is spread
by fecal-oral
contamination, although
occasionally the virus is
spread by droplets
expelled by infected
individuals. Items like
utensils, diaper-changing
tables, and toys that
come in contact with body
fluids that contain the
virus may also transmit
them to other individuals
Coxsackie virus spread through
 They can spread from
person to person,
usually on unwashed
hands and surfaces
contaminated by
feces, where they can
live for several days.
 Diseases Caused by
Coxsackievirus
 Herpangina
 coxsackie A virus
 Hand-foot-and-mouth disease
 Coxsackievirus A16 and enterovirus 71
 Pleurodynia
 coxsackie B virus
 Myocardial and pericardial infections
 coxsackie B virus. (B3)
 Viral meningitis
 Coxsackievirus or echovirus
 Pathophysiology
of Coxsackie's virus
 Coxsackieviruses are transmitted primarily via
the fecal -oral route and respiratory aerosols,
although transmission via fomites is possible.
The viruses initially replicate in the upper
respiratory tract and the distal small bowel. They
have been found in the respiratory tract up to 3
weeks after initial infection and in feces up to 8
weeks after initial infection. The viruses have
been found to replicate in the sub mucosal
lymph tissue and disseminate to the
reticuloendothelial system. Further
dissemination to target organs occurs following
a secondary viremia.
 Symptoms related to the viral
infection
 Upper respiratory tract symptoms, including sore
throat, rhinitis, and dry cough
 Constitutional symptoms, including headaches
(50%), fever, and malaise
 GI symptoms, including nausea, vomiting,
diarrhea (50%); abdominal pain (usually in the
epigastria area) in children
 Testicular pain (ie, orchitis) in 10% of male
Coxsackie virus infection
present with
 Both group A and
group B
Coxsackievirus can
cause nonspecific
febrile illnesses,
rashes, upper
respiratory tract
disease, and aseptic
meningitis
 Coxsackie virus infection
present with
 In general, group A
coxsackieviruses tend
to infect the skin and
mucous membranes,
causing herpangina,
acute hemorrhagic
conjunctivitis (AHC),
and hand-foot-and-
mouth (HFM) disease
 Coxsackie virus - Acute
hemorrhagic conjunctivitis
 Rare complications
include keratitis and
motor paralysis.
 This condition is
highly contagious and
has resulted in
epidemics and
pandemics.
 Hand, Foot, and Mouth Disease

 Type of Coxsackie
Virus syndrome
 Causes painful red
blisters on:
 Throat
 Tongue
 Gums
 Cheeks
 Palms of hands
 Soles of Feet
 Coxsackievirus syndrome
 Hand, foot, and mouth
disease, a type of
Coxsackievirus
syndrome, causes painful
red blisters in the throat
and on the tongue, gums,
hard palate, inside of the
cheeks, and the palms of
hands and soles of the
feet.
Herpangina,
 Herpangina, an
infection of the throat
which causes red-
ringed blisters and
ulcers on the tonsils
and soft palate, the
fleshy back portion of
the roof of the mouth.
 Hand, Foot, and Mouth Disease
 Hand, foot and mouth disease usually
affects infants and children, and is quite
common. It is highly contagious and is
spread through direct contact with the
mucus or faeces of an infected person. It
typically occurs in small epidemics in
nursery schools or kindergartens, usually
during the summer and autumn months.
Myocarditis can be a serious
disease
 Group B
Coxsackievirus tend
to infect the heart,
pleura, pancreas, and
liver, causing
pleurodynia,
myocarditis,
pericarditis, and
hepatitis
 Coxsackie B3 - Myocarditis
 Coxsackie B3 has been
found to be one of the
main causes of certain
debilitating or life-
threatening diseases,
such as viral myocarditis.
 In about 20% of the
cases, there can be
progressive disease or
recurrence of symptoms;
the heart damage can be
extensive, causing
arrhythmias, weakened
left ventricular functions
Born Holm disease present with…
 Pain on inspiration is similar to
pleuritic pain and pulmonary
embolism may be suspected.
 The muscles are locally
tender.
 There will be no haemoptysis.
 There may be a slight
sensation of dyspnoea or pain
on breathing
 Born Holm word is a
pace where the disease
is identified.
 Difficult to Diagnose ?
 Many infections are caused by Coxsackie
viruses, most of which are never diagnosed
precisely.
 Coxsackie type A usually is associated with
surface rashes (exanthemas) while type B
typically causes internal symptoms (pleurodynia,
myocarditis) but both can also cause paralytic
disease or mild respiratory tract infection. The
latter can be caused by several Coxsackie virus
types and by Echoviruses and the symptoms are
much like a rhinovirus infection
 Emerging Diagnostic Methods
 All the conjunctival swabs from Coxsackievirus
A24 variant related outbreak and the 41
Coxsackievirus A24 variant strains were tested
positive by the RT-PCR assay within 4 h. This
novel single-tube real-time RT-PCR assay is
sensitive and specific, and consists in a reliable
and faster alternative to the viral culture for
recent and future acute hemorrhagic
conjunctivitis outbreaks caused by
Coxsackievirus A24 variant.
 Is Coxsackie Contagious?
 VERY contagious
 Passed on by:
 Unwashed hands
 Surfaced contaminated by feces
 Sneezes or coughs
 To prevent spread into society
 Children who feel ill or have a fever should
be excluded from group settings until the
fever is gone and the child feels well.
Thorough hand washing and care with
diaper changing practices is important as
we
Treatment and Prevention
 Treatment usually
consists of simple
analgesia for sore
throat/aches,
adequate fluid intake,
and rest
There is no vaccine
against the
Coxsackie's virus
 Newer treatments ?
 Specific antiviral therapy
such as Pleconaril shows
promise in the treatment
of meningitis and other
life threatening infections
due to enteroviruses.
 However, the safety or
efficacy of this drug to be
considered with more
tails
 Prevention
 Coxsackie virus is
transmitted by
contamination with feces,
which means you can
catch the virus by
touching your mouth or
eating without thoroughly
washing your hands.
Good hand wash
reduces the spread of
infection in society
Created for Dr.T.V.Rao MD’s ‘e’
learning Programme
Email
doctortvrao@gmail.com