Introduction
Coxsackievirus is an RNA (ribonucleic acid) virus belonging to the enteroviruses family. It is known to cause infections mostly in children; however, adults can also be susceptible to the infection. The virus enters the body through the fecal-oral route or respiratory aerosol, followed by which the virus replicates and spreads to multiple organs. It causes diseases like hand, foot, and mouth disease, herpangina, and many diseases of the heart, lungs, and muscles.
What Is Coxsackievirus?
Coxsackievirus is a member of the enterovirus family known to cause infections. The infections may vary from mild to severe and are life-threatening. Although children are more susceptible to the infection, it could affect adults too. It is spread through person-to-person contact, fecal-oral route, or respiratory aerosols.
The virus gets its name from Coxsackie, a small town in New York, where it was first isolated from human feces.
What Are the Types of Coxsackievirus and What Do They Cause?
Coxsackieviruses can be divided into majorly two types: type A and type B. Type A coxsackievirus causes hand, foot, and mouth disease and herpangina, which is common in children but could affect adults too. Hand, foot, and mouth disease develop as painful blisters and rashes on the palm of the hands, the bottom of the feet, and in the mouth. Herpangina presents as a sore throat with blisters in the tonsils and soft palate.
Type B coxsackievirus affects the heart, pleura, pancreas, and liver and causes gastrointestinal distress and heart problems. In addition, subtypes of both type A and B can cause other severe complications like meningitis, myocarditis, etc.
How Are Coxsackieviruses Spread?
Coxsackieviruses are transmitted from person to person through the fecal-oral route or respiratory aerosols. In addition, the surface of items like utensils, rails, and toys that come in contact with the body fluids of an infected person may also transmit them to other individuals. For instance, if an infected person rubs his nose and then touches any surface, the virus is transmitted from the person to the surface. This is then spread to another person when they touch that surface and then touch their nose or mouth.
In children, the virus is also shed through stool. This can get transmitted when a hand that is contaminated with fecal matter touches the face. It is common in daycare centers or nurseries, with diaper-changing tables.
Pregnant women can also pass the infection to the baby, which may cause serious complications for the newborn. Hence, pregnant women need to consult their doctor in case of any symptoms of coxsackievirus infection.
How Long Is Coxsackievirus Contagious?
The virus replicates once it enters the body and spreads to other systemic organ systems. The virus is usually most contagious during the initial week of symptoms. After the initial infection, the virus was found in the respiratory tract for up to three weeks and the fecal matter for up to eight weeks, but it is less infectious. And the infection is removed from the body before the production of antibodies.
How Long Can Coxsackievirus Live on Surfaces?
Coxsackieviruses can spread from person to person, through contaminated surfaces or unwashed hands. The viruses were found to stay live on the uncleaned surface for several days to two weeks in high and low temperatures and humidity.
What Are the Signs and Symptoms of Coxsackievirus Infection?
The signs and symptoms of coxsackievirus infection appear within one to two days of infection.
The most common symptoms include:
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Fever.
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Malaise.
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Loss of appetite.
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Sore throat.
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Cough.
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Headache.
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Nausea and vomiting.
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Abdominal pain in children.
Other syndromes that can be associated with coxsackievirus include:
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Respiratory Distress- Both types of coxsackievirus: type A and type B, cause a febrile respiratory tract infection with a sore throat, cough, and a runny nose.
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Aseptic Meningitis- Meningitis refers to the inflammation of the lining of the brain and spinal cord. It is accompanied by headache, fever, and neck stiffness. Febrile seizures may occur in children; however, it is rare in adults.
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Hand, Foot, and Mouth Disease- Type A virus causes hand, foot, and mouth disease. It is characterized by the presence of small red blisters on the palm, sole of the feet, and inside mouth. It can also cause fever and blister rashes on the body. Although the blister fluid is considered a source of transmission of the virus, the disease is most often transmitted through respiratory droplets and fecal exposure. This is most common in children below the age of ten years.
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Herpangina- Type A also causes herpangina in children and is characterized by small tender blisters in the mouth, fever, and sore throat. It is commonly seen in children between three to ten years of age.
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Acute Hemorrhagic Conjunctivitis- It is characterized by the sudden onset of conjunctivitis on both eyes, watery eyes, swollen eyelids, and red hemorrhages in the white of the eyes.
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Weakness- Rarely some patients may present with weakness or even partial paralysis of one arm or leg.
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Pleurodynia- It is an uncommon cause of type B coxsackievirus and is characterized by a sudden sharp pain in the chest or abdomen, along with fever, malaise, and headache.
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Myopericarditis- It is a rare but very serious complication of coxsackievirus. It is an infection of the heart and the lining of the heart and, in severe cases, may lead to heart failure, heart attack, or death. Symptoms include shortness of breath, swelling in the leg, chest pain, and fatigue.
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Severe Infections in Newborns- The infection may be transmitted from a pregnant lady to the infant through the secretions of the mother. In infants, it may cause serious problems like unresponsiveness, myopericarditis, liver failure, and pneumonia. Diarrhea that accompanies may cause severe dehydration, which may be life-threatening and cause death.
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Effects on Impaired Immunity- In people with impaired immunity or on immunosuppressive medication, Coxsackievirus can have a prolonged effect.
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Orchitis- The virus may infect the testicles of young children, causing inflammation.
How Is Coxsackievirus Infection Diagnosed?
The infection is diagnosed based on its clinical appearance and the signs and symptoms of the patient. For example, in children, blisters on the palm, sole, or mouth are considered a characteristic of coxsackievirus infection. To confirm the causative organism, the doctor may advise a viral test with RT-PCR (real-time reverse transcription-polymerase chain reaction)
What Are the Treatment Options for Coxsackievirus Infections?
Fortunately, the disease is self-limiting and requires no treatment. The symptoms usually subside in two to ten days without any treatment. However, symptomatic treatment with over-the-counter medications like Acetaminophen or Tylenol can help reduce fever and pain. The patient may also be advised to have a lot of fluids to avoid dehydration. In case of a severe complication, like myopericarditis or meningitis, hospitalization with proper care is advised.
How Can We Prevent Coxsackievirus Infection?
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Wash the hands frequently with soap and water or a sanitizer.
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Washing hands after a diaper change.
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Proper disposal of diapers and fecal matter.
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Regularly clean items like pacifiers and toys that are in reach for children.
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Disinfection of all contaminated surfaces.
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Pregnant women should avoid close contact with children or adults who may be infected and have blisters.
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If infected, isolate until the symptoms resolve completely to prevent spreading the infection.
Conclusion
Coxsackie is a virus that causes infections like hand, foot, and mouth disease, herpangina, conjunctivitis, etc., majorly in children, although adults can also be infected. The symptoms of the disease include red, painful blisters on the palm, sole, and inside the mouth, sore throat, fever, malaise, cough, etc. Prevention of the disease is difficult, especially in children. However, washing your hands regularly and disinfecting surfaces and children’s toys can help prevent infection to a greater extent. Fortunately, the symptoms resolve within two to ten days of the infection and do not require any treatment - it is a self-limiting disease.
