Abstract

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 flu‑like symptoms. Diagnostic procedures and treatment should be tailored to the specific disease manifestation.

Epidemiology

Worldwide distribution
Occur in all age groups
Highest incidence in infants and young children (< 10 years)

References:^[1]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

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

References:^[1]

Disease manifestations

Coxsackie A
- Herpangina
- Hand, foot, and mouth disease
  - Characteristics: highly contagious
  - Clinical presentation
    - General symptoms: fever, reduced general condition
    - Skin/mucosa
      - Maculopapular and partially vesicular rash on the hands and feet
      - Oral ulcers
  - Diagnosis: clinical
  - Treatment: symptomatic
  - Prognosis: almost always self‑limiting
Coxsackie B
- Myocarditis
- Pleurodynia
  - Clinical presentation
    - Flu‑like symptoms
    - Sudden thoracic and upper abdominal pain caused by irritation of the pleura and muscles
Coxsackie A and B
- Conjunctivitis
- Viral meningitis
- Flu‑like symptoms

Coxsackie B is the most common cause of viral myocarditis!

References:^[2]^[3]^[4]