Coxsackie virus infections

Coxsackie viruses are a group of RNA viruses with over 20 serotypes; depending on specific viral characteristics, these serotypes are further divided into groups A and B. Infection is associated with a wide range of symptoms, which are dependent on the exact serotype. Hand, foot, and mouth disease (HFMD) and herpangina are commonly caused by group A coxsackie viruses, while pleurodynia and myocarditis are caused by group B coxsackie viruses. Both groups may cause viral meningitis, conjunctivitis, or pneumonia. Diagnostic procedures and treatment should be tailored to the specific disease manifestation.

• Worldwide distribution
• Occur in all age groups
• Highest incidence in infants and young children (< 10 years) ^[1]

Epidemiological data refers to the US, unless otherwise specified.

• Pathogen: coxsackie virus
  • Genus: enterovirus
  • Family: picornaviridae
  • Over 20 serotypes, divided into group A and group B coxsackie viruses
  • Single‑stranded RNA virus
• Route of transmission
  • Airborne droplets
  • Fecal‑oral route

Coxsackie A ^[2]

• Conjunctivitis
• Herpangina
• Hand, foot, and mouth disease
  • Highly contagious
  • Clinical features
    • General symptoms: fever, malaise
    • Anorexia, oral pain
    • Skin/mucosa
      • Maculopapular and partially vesicular rash on the hands and feet (can also involve the buttocks)
      • Oral ulcers
  • Diagnosis: clinical
  • Treatment: symptomatic
  • Prognosis: almost always self‑limiting

Coxsackie B ^[2]

• Myocarditis
• Pericarditis
• Dilated cardiomyopathy
• Pleurodynia ^[3]
  • Characteristics: highly contagious
  • Clinical features
    • Flu‑like symptoms
    • Sudden thoracic and upper abdominal pain caused by irritation of the pleura and muscles
  • Diagnosis
    • Clinical
    • Viral culture or PCR (throat or stool sample), serological testing
    • Creatine kinase may be elevated ^[4]
  • Treatment: symptomatic
  • Prognosis: self‑limiting

Coxsackie A and B

• Viral meningitis, encephalitis
• Pneumonia

Coxsackie B is the most common cause of viral myocarditis.