Introduction:
Heart infections such as coxsackie myocarditis are an inflammation of the heart. In this condition, the heart muscles become weak. Coxsackievirus (CVB) infection is a substantial cause of myocarditis and also for dilated cardiomyopathy (DCM). Heart disease can be caused by direct cytopathic effects (structural changes in the host cells are known as a cytopathic effect) of the virus, a pathologic immune response to the stubborn virus, or autoimmunity activated by the viral infection. The virus interacts with its host at numerous stages during the development of the disease.
How Are Coxsackievirus and Heart Infections Related?
Viral infections are the causative factor in many diseases, including inflammation of the heart muscle, called myocarditis. Coxsackievirus is a virus that causes inflammation of the heart. If left untreated, myocarditis can progress into dilated cardiomyopathy, which impairs the heart permanently and alters a person's lifespan. Acute myocarditis cases have been portrayed in many scientific publications, and viruses, such as coxsackievirus B3, parvovirus B19, or, more recently, SARS-CoV-2, were the route of cardiac inflammation. Collected evidence indicates that certain viruses may stay in cardiac tissue after the initial infection and reactivate under favorable conditions.
What Is Coxsackievirus?
Coxsackievirus is a component of a family of viruses named enteroviruses. Enteroviruses are made up of a single strand of ribonucleic acid (RNA). The enteroviruses are also known as picornaviruses (pico means "small," so "small RNA viruses''). They are present worldwide and dispersed by the fecal-oral route. About 80 percent of infections do not induce symptoms or present with a fever only. Infants or young kids are especially sensitive to symptomatic coxsackie infection. Coxsackievirus obtained its name because it was found first in the town of Coxsackie, located in New York, United States Of America (USA). Enterovirus C contains poliovirus 1 to 3, whereas Enterovirus A, B, and C comprise the numbered coxsackieviruses. Coxsackieviruses have many characteristics similar to poliovirus. With the control of poliovirus infections in considerably most of the world, more attention has been concentrated on comprehending the non-polio enteroviruses like coxsackieviruses. Group A coxsackieviruses were noted to cause flaccid paralysis caused by generalized myositis.
In contrast, group B coxsackieviruses were observed to cause spastic paralysis because of the degeneration of neuronal tissue and focal muscle injury. At least twenty-three serotypes (1 to 22, 24) of group A and six serotypes (1 to 6) of group B are recognized as CV-B1, CV-B2, CV-B3, CV-B4, CV-B5, and CV-B6. Group B coxsackieviruses belonging to the picornavirus family provoke heart, pancreas, pleura, and liver infections, causing myocarditis, pleurodynia, pericarditis, and hepatitis. It also generates systemic neonatal disease.
What Is Coxsackievirus Myocarditis?
Coxsackie myocarditis is an inflammation and weakness of the muscle of the heart induced by a viral infection by an enterovirus named Coxsackie. This enterovirus reaches the heart and is the stepping stone of the infection. Myocarditis can harm the heart muscle forcing it to evolve into a thick and swollen mass. The heart muscle can be directly and immediately harmed or damaged by the virus or the bacteria that infect it. The body's immune response can also harm the heart muscle (called myocardium) in the process of battling the infection. This can lead to symptoms of failure of the heart.
What Is the Pathophysiology of Coxsackieviruses?
Coxsackieviruses are primarily transmitted via the respiratory aerosols and fecal-oral route, although transmission via fomites is also possible. Viral replication originally occurs in the upper respiratory tract, specifically in the tonsils and the distal small bowel. Viremia with systemic dissemination then occurs and involves the reticuloendothelial system, which leads to further replication in other anatomic locations and organs and, finally, to the development of symptoms. Central nervous system (CNS) and cardiovascular system (CVS) invasion is suggested to occur from viral migration through peripheral and central nerves into the central nervous system and cardiovascular system. Coxsackieviruses have been recognized in the respiratory tract up to two and a half weeks after initial infection and in feces up to eight weeks after initial infection. Humoral, innate, and cell-mediated immunity all play a part in the body's response to enteroviral infection. Nevertheless, the infection is often eliminated before antibody production occurs.
What Is the Epidemiology of Coxsackieviruses?
Coxsackie group B affects both genders equally and can occur worldwide. Infection generally occurs during the summer months. In a broad sense, population tendencies are studied according to presenting disease syndromes rather than distinct serotypes. Coxsackievirus B1 was known as the predominant serotype for two to three years. Infections due to coxsackievirus B4 were associated with higher mortality than other serotypes. The patient's age appears to play a role in the evolution of the different types of embodiments of the infection. Children and adults tend to have a milder course of the disease with less likelihood of severe complications than neonates. Myopericarditis generates inflammation of the subepicardial myocardium and pericardium. Patients show symptoms like chest pain, shortness of breath, and an irregular heartbeat. The ailment can last for a few hours up to a few months. Rigor varies from asymptomatic to sudden heart failure due to dilated cardiomyopathy and sometimes cardiac arrest.
What Are the Prognosis and Complications of Coxsackieviruses?
Infections from coxsackieviruses are generally self-limited. Most syndromes result in complete recovery, with a few exceptions. While aseptic meningitis due to Enterovirus has an excellent prognosis, some patients may experience malaise and fatigue for a few weeks. Infants and children who suffer from aseptic meningitis may have mild intellectual complications. Myocardial syndromes can sometimes lead to poor outcomes. Complications arise from infections that target the central nervous system, leading to aseptic meningitis and encephalitis, as well as cardiac involvement, leading to viral myopericarditis and fulminant heart failure.
Conclusion:
Since no cure or vaccine protects against Coxsackie B virus infection, healthcare professionals should stress promoting infection control strategies like preserving effective hands and also environmental hygiene. Pregnant women can develop perinatal difficulties like a severe neonatal disease if exposed to persons with enterovirus infection, so they should avoid contact with anyone with a suspected infection.
