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What is Coxsackie Virus?
Coxsackievirus is a member of a family of viruses called enteroviruses. Enteroviruses are made up of a single strand of ribonucleic acid (RNA). The enteroviruses are also referred to as picornaviruses (pico means “small,” so, “small RNA viruses”).
Coxsackievirus was first found in the town of Coxsackie, located south of Albany in New York.
Coxsackie Virus Facts
- Coxsackie viruses are RNA viruses that may cause hand, foot, and mouth disease (HFMD).
- HFMD usually occurs in children but can occur in adults.
- The majority of HFMD infections are self-limited, so no treatment is required.
- HFMD, caused by coxsackie viruses, usually causes fever, malaise, rash, and small blisters that ulcerate. The most frequent locations for the blisters/ulcers are on the palms of the hand, soles of the feet, and in the mouth.
- HFMD usually resolves in about 10 days with no scarring, but the person may shed coxsackie virus for several weeks.
- Although lab tests for coxsackie viruses can be done, the vast majority of infections are diagnosed by clinical features (HFMD blisters/ulcers), but this may change with the onset of new outbreaks and causes of severe HFMD.
- There is no specific treatment or vaccine available for coxsackie virus infections.
- Prevention is difficult; avoid direct contact with anyone with HFMD, and their stool, saliva, and blister fluid. Hand washing and cleaning of items handled by HFMD patients are the best additional methods for prevention.
Signs and Symptoms of Coxsackie Virus
Coxsackievirus can produce a wide variety of symptoms. About half of all kids infected with coxsackievirus have no symptoms. Others suddenly develop high fever, headache, and muscle aches, and some also develop a sore throat, abdominal discomfort, or nausea. A child with a coxsackievirus infection may simply feel hot but have no other symptoms. In most kids, the fever lasts about 3 days, then disappears.
Coxsackieviruses can also cause several different symptoms that affect different body parts, including:
- 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, 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.
- Hemorrhagic conjunctivitis, an infection that affects the whites of the eyes. Hemorrhagic conjunctivitis usually begins as eye pain, followed quickly by red, watery eyes with swelling, light sensitivity, and blurred vision.
Occasionally, coxsackieviruses can cause more serious infections that may need to be treated in a hospital, including:
- viral meningitis, an infection of the meninges (the three membranes that envelop the brain and spinal cord)
- encephalitis, a brain infection
- myocarditis, an infection of the heart muscle
Newborns can be infected from their mothers during or shortly after birth and are more at risk for developing serious infection, including myocarditis, hepatitis, and meningoencephalitis (an inflammation of the brain and meninges). In newborns, symptoms can develop within 2 weeks after birth.
Causes of Coxsackie Virus
The virus spreads easily between people, usually through hand-to-hand contact, sneezes or coughs, or exposure to (eww) fecal matter on common surfaces. It tends to spread most easily during the warmest months of the year. Kids under 5 are most susceptible; older children and adults will often show no or few symptoms when exposed. Because there are several different strains, your child might come down with coxsackievirus more than once.
Types of Coxsackie Virus
There are two different types of coxsackie viruses:
- Type A viruses cause herpangina (sores in the throat) and hand, foot, and mouth disease.
- Type B viruses cause epidemic pleurodynia, and inflammation in the chest.
Both types A and B viruses can cause meningitis (inflammation of the spinal cord or brain), myocarditis(inflammation of the heart muscle), and pericarditis (inflammation of the sac surrounding the heart). They also may have a role in the development of acute onset juvenile (type 1) diabetes.
Coxsackie Virus infections Diagnosed
Patients are usually diagnosed by their clinical appearance. Clinically, blisters that are painful usually on the hands, feet, and mouth in a child with fever are considered diagnostic of coxsackie virus infection. However, in rare instances, viral tests can be done to identify the virus, but the tests are expensive, usually need to be sent to a specialized viral diagnostic laboratory that uses RT-PCR, and often take about two weeks to get a result. This testing is almost never done since most infections are self-limited and typically mild, but this situation may change because of an outbreak in Alabama (38 children, 12% hospitalized but no deaths in 2011-2012) and the recent enterovirus 71 epidemic (about 905 of hospitalized children have died) in Cambodia. RT-PCR testing can distinguish between many viral genera, species, and subtypes. Distinguishing coxsackie virus strains from adenoviruses, other enterovirus types, echo virus, viruses causing mononucleosis, and other viral diseases may become necessary in the future.
Prevention of Coxsackie Virus
There is no vaccine to prevent coxsackievirus infection. Hand washing is the best protection. Remind everyone in your family to wash their hands frequently, particularly after using the toilet (especially those in public places), after changing a diaper, before meals, and before preparing food. Shared toys in childcare centers should be routinely cleaned with a disinfectant because the virus can live on these objects for days.
Kids who are sick with a coxsackievirus infection should be kept out of school or childcare for a few days to avoid spreading the infection.
The duration of an infection varies widely. For fever without other symptoms, a child’s temperature may return to normal within 24 hours, although the average fever lasts 3 to 4 days. Hand, foot, and mouth disease usually lasts for 2 or 3 days; viral meningitis can take 3 to 7 days to clear up.
Treatment for Coxsackie Virus
There’s no medication to cure coxsackie, but blisters heal in a week or two on their own. In the mean time, you can help bring down a fever and reduce the pain from blisters with acetaminophen or ibuprofen. If your child has neck pain or a severe headache along with symptoms, or a fever lasting more than a few days, see a doctor immediately to rule out viral meningitis, which can lead to brain damage and death, and should be closely monitored by a physician. Call your doctor if your child has a fever of over 100.4, nausea or vomiting, abdominal discomfort, difficulty breathing, or sores inside the mouth.
Alternative Treatments for Coxsackie Virus
Cold dairy products like milk, ice cream and yogurt can help soothe blisters in the throat (avoid acidic drinks like orange juice, which can irritate them). You can also dip a cotton swab in a mixture of one teaspoon Benadryl (oral diphenhydramine) and one teaspoon liquid antacid (like regular Maalox, not Maalox Total Relief) and gently swab it over your child’s mouth sores a few times a day, which may reduce pain. (Check with your doctor before trying this solution to make sure you aren’t using too much; diphenhydramine can be absorbed through the skin, so there’s a risk of overdose)