- Coxsackieviruses are RNA viruses that may cause hand, foot, and mouth disease (HFMD), as well as disease of muscles, lungs, and heart.
- HFMD usually occurs in children but can occur in adults.
- The majority of HFMD infections are self-limited, so no treatment is required.
- HFMD, caused by coxsackieviruses, usually causes fever, malaise, skin rash, sore throat, 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 coxsackievirus for several weeks.
- Although lab tests for coxsackieviruses 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 coxsackievirus 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 additional methods for prevention
Coxsackievirus is a member of the Picornaviridae family of viruses in the genus termed Enterovirus. Coxsackieviruses 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”). Coxsackievirus was first isolated from human feces in the town of Coxsackie, N.Y., in 1948 by G. Dalldorf. Coxsackievirus is also written as coxsackievirus in some publications.
What are the types of coxsackieviruses, and what can they cause?
Coxsackieviruses are separable into two groups, A (CVA) and B (CVB), which are based on their effects on newborn mice (coxsackievirus A results in muscle injury, paralysis, and death; coxsackievirus 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). Coxsackieviruses infect host cells and cause host cells to break open (lyse).
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. Coxsackievirus A16 (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 viruses also cause inflammation of the eyelids and white area of the eye (conjunctivitis). Coxsackievirus A6 (CVA6) has caused herpangina (mouth blisters) in infants.
Type B viruses cause epidemic pleurodynia (fever, lung, and abdominal pain with a headache that lasts about two to 12 days and resolves). Epidemic pleurodynia is also termed Bornholm disease. There are six serotypes of coxsackievirus 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 coxsackievirus infections.
Enterovirus 71, like coxsackievirus, also causes HFMD. In Asia in July 2012, particularly Cambodia, children infected with enterovirus 71 (EV-71) had a high mortality rate due to encephalitis and acute polio-like paralysis. This epidemic (mainly in babies, toddlers, and children under 2 years of age).
Is the coxsackievirus contagious?
Yes, coxsackieviruses are the contagious person to person. These viruses are transmitted mainly by the fecal-oral route and by respiratory aerosols. Droplets containing viruses that land on objects like toys or utensils may occasionally transmit the viruses indirectly to uninfected individuals.
How long are coxsackieviruses contagious?
Coxsackieviruses are most contagious during the first week of symptoms. However, viable virus microbes have been found in respiratory tracts for up to three weeks and then in feces up to eight weeks after initial infection, but during this time, the viruses are less contagious.
What is the incubation period for coxsackievirus infections?
The incubation period for coxsackievirus infections is relatively short; it lasts about one to two days with a range of about one to five days.
What are coxsackievirus infection symptoms and signs?
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The most frequent signs and symptoms of coxsackievirus infections are initially fever, a poor appetite, and respiratory illness, including sore throat, cough, and malaise (feeling tired). This incubation period lasts about one to two days. Sore areas in the mouth develop in about a day or two after the initial fever and develop into small blisters that often ulcerate. Many infected people (usually children 10 years of age and younger) go on to develop a rash that itches on the palms of the hands and the soles of the feet. Other areas such as the buttocks and genitals may be involved. Some patients develop conjunctivitis. These symptoms usually last about seven to 10 days, and the person usually recovers completely. The individuals are most contagious for about a week after symptoms begin, but because the virus can be shed by the infected individual sometimes for weeks after the symptoms have gone away, the person may be mildly contagious for several weeks.