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 virus infection ^[2]

Herpangina

• Definition: seasonal acute infection that manifests with fever, sore throat, and herpes-like lesions on the posterior oropharynx and tonsils
• Epidemiology
  • Most common in children between the age of 3–10 years
  • Occurs predominantly in summer and fall
• Clinical features
  • High fever, sore throat
  • Herpes-like oral lesions
    • Multiple 1-mm vesicles located on the posterior oropharynx and tonsils
    • Pharyngeal and tonsillar redness
    • Later stages: fibrin-covered ulcerations
• Diagnosis: based on clinical features
• Treatment: supportive care (e.g., ibuprofen for pain relief, parenteral rehydration in dehydration) since the condition is typically self-limiting

Hand, foot, and mouth disease

• Definition: highly contagious infection that manifests with a characteristic maculopapular/partially vesicular rash on hands and feet
• Clinical features
  • Fever, malaise
  • Maculopapular and partially vesicular rash on the hands and feet (can also involve the buttocks)
  • Oral ulcers
  • Anorexia, oral pain
• Diagnosis: based on clinical features
• Treatment: symptomatic
• Prognosis: almost always self‑limiting

Other manifestations

• Conjunctivitis

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

• Myocarditis
• Pericarditis
• Dilated cardiomyopathy

Coxsackie B is the most common cause of viral myocarditis.

Coxsackie A and B virus infection

• Viral meningitis
• Encephalitis
• Pneumonia

1. Modlin JF. Clinical manifestations and diagnosis of enterovirus and parechovirus infections. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-enterovirus-and-parechovirus-infections.Last updated: September 30, 2016. Accessed: March 19, 2017.
2. Epidemic Pleurodynia (Bornholm Disease; Bornholm's Disease). http://www.merckmanuals.com/professional/infectious-diseases/enteroviruses/epidemic-pleurodynia. Updated: January 1, 2016. Accessed: March 19, 2017.
3. Bornholm disease. https://radiopaedia.org/articles/bornholm-disease-1. Updated: April 30, 2020. Accessed: July 29, 2020.
4. Carlin B. Corsino, Rimsha Ali, Derek R. Linklater.. Herpangina - StatPearls. StatPearls. 2020 .