Coxsackie Virus

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Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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• Coxsackie viruses are RNA viruses that may cause hand, foot, and mouth disease (HFMD).
• HFMD usually occurs in children but can occur in adults; the majority of infections are self-limited so no treatment is required.
• HFMD, caused by Coxsackie viruses, usually cause fever, malaise, rash, and small blisters that ulcerate. The most frequent locations for the blisters/ulcers are on the palms of the hand, soles of the feet, and in the mouth.
• HFMD usually resolves in about 10 days with no scarring, but the person may shed Coxsackie virus for several weeks.
• Although lab tests for Coxsackie viruses can be done, the vast majority of infections are diagnosed by clinical features (HFMD blisters/ulcers), but this may change with the onset of new outbreaks and causes of severe HFMD.
• There is no specific treatment or vaccine available for Coxsackie virus infections.
• Prevention is difficult; avoid direct contact with anyone with HFMD, and their stool, saliva, and blister fluid. Hand washing and cleaning of items handled by HFMD patients are the best methods for prevention.

Coxsackie virus is a member of the Picornaviridae family of viruses in the genus termed enterovirus. Coxsackie viruses are subtype members of enterovirus that have a single strand of ribonucleic acid (RNA) for its genetic material. The enteroviruses are also referred to as picornaviruses (pico means "small," so, "small RNA viruses"). Coxsackie virus was first isolated from human feces in the town of Coxsackie, New York, in 1948 by G. Dalldorf. Coxsackie virus is also written as coxsackievirus in some publications.

Coxsackie viruses are separable into two groups, A and B, which are based on their effects on newborn mice (Coxsackie A results in muscle injury, paralysis, and death; Coxsackie B results in organ damage but less severe outcomes.) There are over 24 different serotypes of the virus (having distinct proteins on the viral surface). Coxsackie viruses infect host cells and cause host cells to break open (lyse).

Picture of the Coxsackie virus; SOURCE: CDC

Type A viruses cause herpangina (painful blisters in the mouth, throat, hands, feet, or in all these areas). Hand, foot, and mouth disease (HFMD) is the common name of this viral infection. Coxsackie A 16 (CVA16) causes the majority of HFMD infections in the U.S. It usually occurs in children (age 10 and under), but adults can also develop the condition. This childhood disease should not be confused with the "foot and mouth disease" usually found in animals with hooves (for example, cattle, pigs, and deer). Type A also causes conjunctivitis (inflammation of the eyelids and white area of the eye).

Type B viruses cause epidemic pleurodynia (fever, lung, and abdominal pain with headache that lasts about two to 12 days and resolves). Pleurodynia is also termed Bornholm disease. There are six serotypes of Coxsackie B (1-6, with B 4 considered by some researchers as a possible cause of diabetes in a number of individuals).

Both types of viruses (A and B) can cause meningitis, myocarditis, and pericarditis, but these occur infrequently from Coxsackie infections. Some researchers suggest Coxsackie virus (mainly Coxsackie B4) has a role in the development of acute onset type I (formerly known as juvenile) diabetes, but this relationship is still under investigation.

Coxsackie viruses and other enteroviruses may cause the childhood disease of hand, foot, and mouth disease. However, the majority of children with Coxsackie virus infections completely resolve the symptoms and infection in about 10-12 days. Recently (July 2012), in Asia (particularly Cambodia), children suspected to be infected with enterovirus 71 had a 90% mortality. This epidemic (mainly in babies, toddlers, and children under 2 years of age) is still under intense investigation and it is likely researchers will have a better understanding of this high death rate linked to enterovirus 71 soon. If enterovirus 71 is ultimately found responsible for these deaths, it is likely the virus has developed a new lethal ability to rapidly infect and destroy children's lung tissue. However, the research is ongoing and some investigators suggests that the children are dying from a combination of enterovirus 71, Streptococcus suis, and dengue viral coinfections.