Description, Causes and Risk Factors:
A group of picornaviruses, included in the genus Enterovirus, of icosahedral shape, stable at acid pH, and about 28 nm in diameter, causing myositis, paralysis, and death in young mice, and responsible for a variety of diseases in man, although in-apparent infections are common. They are divided anti-genically into two groups, A and B, each of which includes a number of serological types, e.g., Enterovirus coxsackie A1 to 24 and Enterovirus coxsackie B1 to 6. Type A viruses cause human herpangina and hand-foot-and-mouth disease; type B viruses cause epidemic pleurodynia; both type viruses may cause aseptic meningitis, myocarditis and pericarditis, and acute onset juvenile diabetes.
Infection is common - in temperate climates, most frequent in summer and autumn and, in the tropics, all year round. It tends to affect those under 16 but adults are also affected. The virus is not destroyed by the acid in the stomach, and it can live on surfaces for several hours. Once a person gets the virus, it takes an average of one to two days for symptoms to develop. People are most contagious in the first week of illness, but the virus may still be present up to one week after symptoms resolve. The virus may be present longer in children and those whose immune system is weak.
Coxsackieviruses are very contagious. They can be passed from person-to-person on unwashed hands and surfaces contaminated by feces. They also can be spread through droplets of fluid sprayed into the air when someone sneezes or coughs. When an outbreak affects a community, risk for Coxsackievirus infection is highest among infants and kids younger than 5. The virus spreads easily in group settings like schools, Childcare centers, and summer camps. People who are infected with a Coxsackievirus are most contagious the first week they're sick.
They are very common in pregnancy, especially at times of the year when prevalence is high but the outcome is usually benign if the mother was asymptomatic. As many as 65% of women who give birth to infants with proven Enteroviral infection have symptomatic disease during the perinatal period. Maternal Coxsackievirus B may cause an increase in early spontaneous abortions and rarely, fetal myocarditis. It is also associated with an increased risk of stillbirth. Maternal echoviruses do not affect the fetus but their ability to cause severe maternal illness may result in stillbirth.
Seek medical care if you or your child has a rash, fever, seizure, severe headache, or stiff neck. Chest pain and shortness of breath should also prompt medical attention. Mild symptoms may be handled over the Phone by a doctor's office. More severe symptoms should prompt a trip to the Clinic or emergency room.
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.
There are some more severe syndromes caused by the virus, but these are less common. They include meningitis (an infection of the linings of the spinal cord and brain), encephalitis (inflammation of the brain), pleurodynia (chest pain), and myopericarditis (inflammation of the heart).
Some people with Coxsackievirus have a rash. In many, this is a nonspecific generalized red rash or clusters of fine red spots.
The virus may also cause small, tender blisters and red spots on the palms, soles of the feet, and inside the mouth. In the mouth, sores occur on the tongue, gums, and cheek. This condition is known as hand-foot-mouth disease (HFMD) and is caused by group A Coxsackievirus. HFMD is most common in children under 10 years of age. HFMD usually causes a sore throat, fever, and the characteristic rash. It is mild and resolves on its own.
Coxsackievirus also may cause a syndrome called herpangina in children. Herpangina presents with fever, sore throat, and small, tender blisters inside the mouth.
Usually diagnosis is clinical but some laboratory tests are available. The most specific findings are found in samples from the blood and vesicles. Fecal specimens are less useful.
Cell culture of the virus is possible.
Polymerase chain reaction (PCR) has made Enteroviral subtyping possible but it is difficult and expensive and not routinely performed.
IgM with enzyme-linked immunosorbent assay (ELISA) can aid diagnosis. Blood samples are required in the acute phase because IgM disappears rapidly.
In aseptic meningitis, a doctor may take a sample of the spinal fluid by doing a spinal tap. Most patients with aseptic meningitis will show an increase in the number of white cells in the spinal fluid, a normal sugar level, and normal to slightly elevated protein level in the fluid. These changes in the spinal fluid are much milder than would be seen with bacterial meningitis. A sample of the spinal fluid may be cultured to see if it grows Coxsackievirus, but culture is difficult and expensive and many hospitals do not have the ability to do it. More recently, a rapid test called the polymerase chain reaction (PCR) has been used that detects the genetic material of the virus. The PCR can detect 66%-90% of infections.
Myopericarditis is a serious condition and requires evaluation with an electrocardiogram (EKG) and an ultrasound of the heart (echocardiogram). The electrocardiogram may show rhythm problems caused by the enlargement of the heart and may reveal whether the sac around the heart is inflamed. The echocardiogram shows how large the heart is, how well it pumps blood, and whether there is fluid around the heart. Blood tests are done to tell if other organs are being damaged.
There's no specific treatment for Coxsackievirus infections. Antibiotics aren't effective in treating Coxsackievirus or any other viral infection. Doctors usually recommend rest, fluids, and over-the-counter pain relievers or fever reducers when appropriate.
If your child develops more-serious signs or symptoms of Coxsackievirus infection, such as severe headaches, joint pain or a high fever, he/she should be evaluated by a doctor. Coxsackievirus infection can lead to meningitis, but most cases are uncomplicated and resolve within a week or so. However, in rare cases, a child infected with Coxsackievirus can develop a severe illness that may require hospitalization.
Treatment for myopericarditis is supportive. This includes using medicines to support the blood pressure if the heart is pumping too poorly to do so by itself. In extreme cases, Heart transplant may be needed.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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