Coxsackievirus

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-andmouth (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 redringed 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 lifethreatening 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 [email protected]