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Coxsackie virus infections

Last updated: August 13, 2021

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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.

Coxsackie A virus infection [2]


Hand, foot, and mouth disease

  • Definition: highly contagious infection that manifests with a characteristic maculopapular/partially vesicular rash on hands and feet
  • Clinical features
  • Diagnosis: based on clinical features
  • Treatment: symptomatic
  • Prognosis: almost always self‑limiting

Other manifestations

Coxsackie B virus infection [2]

Pleurodynia [3]

  • Definition: acute illness characterized by fever and/or other flu-like symptoms and painful spasms of the chest and upper abdomen due to irritation of the pleura and muscles
  • 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

Other manifestations

Coxsackie B is the most common cause of viral myocarditis.

Coxsackie A and B virus infection

  1. Modlin JF. Clinical manifestations and diagnosis of enterovirus and parechovirus infections. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. updated: September 30, 2016. Accessed: March 19, 2017.
  2. Epidemic Pleurodynia (Bornholm Disease; Bornholm's Disease). Updated: January 1, 2016. Accessed: March 19, 2017.
  3. Bornholm disease. Updated: April 30, 2020. Accessed: July 29, 2020.
  4. Carlin B. Corsino, Rimsha Ali, Derek R. Linklater.. Herpangina - StatPearls. StatPearls. 2020 .