Coxsackie virus infections
Coxsackie virus infections are caused by a group of single-stranded RNA viruses that belong to the Enterovirus genus, classified into groups A and B. These infections are generally mild, though they can occasionally lead to more severe health issues and, in rare cases, death. The most prevalent type in the U.S. is Coxsackie B1, while B4 carries a higher risk for serious complications. Coxsackie viruses are primarily spread through the fecal-oral route and can also be transmitted via contaminated objects, emphasizing the importance of good hygiene practices, especially handwashing.
Infections can occur at any age but are most common in infants, particularly males, during the spring and fall seasons. Symptoms often include fever, rashes, and respiratory issues, with group A viruses causing hand, foot, and mouth disease, and group B viruses potentially affecting the heart and other organs. Diagnosis may involve isolating the virus from swabs, but accuracy can be an issue. While most cases resolve without treatment, supportive care may be necessary for more severe infections. Preventive measures focus on minimizing contact with infected individuals and maintaining hygiene to lower the risk of transmission.
Coxsackie virus infections
- ANATOMY OR SYSTEM AFFECTED: All
- ALSO KNOWN AS: Hand, foot, and mouth disease
Definition
The coxsackie virus is a single-stranded ribonucleic acid (RNA) virus that belongs to the genus Enterovirus. The viruses are categorized as group A or B, with twenty-three and six types in each respective group. They cause common infections that are often mild; infrequently, they can be more severe. Rarely, they lead to death. Type B1 is the most common type in the United States, but type B4 has the highest risk for fatal complications.
Causes
Coxsackie viruses are spread by human contact, mainly through the fecal-oral route. Transmission by objects (fomites) contaminated with nasal and oral excretions is also possible. Improper handwashing often leads to the spreading of the disease. Some coxsackie viruses may be transmitted from a pregnant woman to her fetus during pregnancy.
Risk Factors
Coxsackie virus infections may occur at any age but are most common during the first year of life and are most common among males. Newborns and immunocompromised persons have the greatest risk for more severe disease manifestations. The time of year with the greatest risk for getting the infections is the spring and fall seasons.
Symptoms
Most people with a coxsackie virus infection are asymptomatic or have an isolated fever. Both groups of coxsackie viruses may additionally cause rashes and upper respiratory tract infections. Group A viruses cause hand, foot, and mouth disease, cause mouth blisters and a rash on the hands and feet, and cause eye infections. Group B viruses infect the heart, pancreas, and liver and are more commonly associated with meningitis and inflammation of the muscles. Group B coxsackie virus infection has been found to be associated with insulin-dependent diabetes.
Screening and Diagnosis
It is possible to isolate coxsackie viruses from a rectal or oral swab in cell culture, although false-positive results are possible because the virus can remain in the system for up to two months following infection. Polymerase chain reaction (PCR) is a genetic technique that amplifies the virus for a faster result, but this test too lacks 100 percent accuracy.
Treatment and Therapy
Mildly affected persons do not require treatment as the infection independently resolves. No approved therapies exist for the treatment of coxsackie virus infections. Acetaminophen may be given for fever and nonsteroidal anti-inflammatory drugs for pain in mildly affected persons. If a more severe infection has been diagnosed, medical care is provided based on the specific symptoms. In persons with meningitis or a cardiac infection, experimental treatments have been attempted, but their overall effectiveness has yet to be proven.
Prevention and Outcomes
To reduce the chance of becoming infected with a coxsackie virus, one should avoid contact with infected persons and with contaminated items and should follow proper hygiene, including proper handwashing techniques.
Bibliography
"HFMD: Causes and How It Spreads." Centers for Disease Control and Prevention (CDC), 7 May 2024, www.cdc.gov/hand-foot-mouth/causes/index.html. Accessed 2 Feb. 2025.
Richer, M. J., and M. S. Horwitz. “Coxsackievirus Infection as an Environmental Factor in the Etiology of Type 1 Diabetes.” Autoimmunity Reviews 8 (2009): 611-615.
Rotbart, H. A., et al. “Clinical Significance of Enteroviruses in Serious Summer Febrile Illnesses of Children.” Pediatric Infectious Disease Journal 18 (1999): 869-874.
Tebruegge, M., and N. Curtis. “Enterovirus Infections in Neonates.” Seminars in Fetal and Neonatal Medicine 14 (2009): 222-227.