• Clinical science

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 flu‑like symptoms. 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)


Epidemiological data refers to the US, unless otherwise specified.


  • Pathogen: Coxsackie virus
  • Route of transmission
    • Airborne droplets
    • Fecal‑oral route


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
      • Characteristics: highly contagious
      • Clinical presentation
        • Flu‑like symptoms
        • Sudden thoracic and upper abdominal pain caused by irritation of the pleura and muscles
      • Prognosis: self‑limiting
      • Diagnosis:
        • Clinical
        • Viral culture or PCR (throat or stool sample), serological testing
      • Treatment: symptomatic
  • Coxsackie A and B

Coxsackie B is the most common cause of viral myocarditis!