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The Coxsackie virus belongs to the Picornaviridae family. It is one of the most numerous virus families. As the name implies, these are small naked-capsid RNA viruses. There are nine genera within Picornaviridae: Enterovirus, Rhinovirus, Hepatovirus, Cardiovirus and Aphtovirus. Coxsackie virus is a representative of enteroviruses.

Coxsackie virusis an enterovirus from thePicornaviridaefamily. The name of the virus "Coxsackie" comes from Coxsackie Town, New York, where it was first isolated in 1948 during research on the polio virus. Due to biological and antigenic differences, Coxsackie viruses are divided into two groups - A and B. A more detailed division is based on serotyping additional antigenic differences in the numerical system. 23 serotypes of Coxsackie A viruses and 6 serotypes of Coxsackie B viruses have been identified. secreted by droplets and cause respiratory tract infection.

Coxsackie virus: pathogenicity

The virus enters the epithelium in the digestive tract, and then penetrates and replicates in the submucosal lymphatic tissue (tonsils and Peyer's patches). The virus then moves to the surrounding lymph nodes and causes viremia. The virus, through the blood, spreads throughout the body to tissues that have receptors for the virus: the reticuloendothelial system, lymph nodes, spleen and liver. In some patients, the second stage of viral replication occurs - secondary viremia, and thus disease symptoms appear. Most Coxsackie viruses have a hatching period of 2 to 14 days, but usually less than a week. The greatest infectivity occurs in the period just before and immediately after the onset of symptoms, because then the viruses are present in large amounts in the stool and nasopharyngeal secretions.

Coxsackie virus: epidemiology

These viruses are widespread all over the world, but most of all they are found in developing countries, especially densely populated countries, such as India or China.

Babies and young children are a group particularly vulnerable to infection, and at the same time a significant source of family infections.

WIn tropical climates, due to poor sanitation, Coxsackie is spread easily via the faecal-oral route, and infections are observed throughout the year. The situation is different in temperate climates, where seasonal occurrence of infections is observed in summer and autumn.

Worth knowing

Enteroviruses are extremely resistant to unfavorable environmental conditions, they are stable at a pH of 3, they are not afraid of even the conditions in the digestive tract. Therefore, they are transmitted mainly through the fecal-oral route, i.e. through hands or objects contaminated with feces (dirty hands disease). Note that Coxsackie viruses are also resistant to standard disinfectants and can survive in the environment at room temperature for many days. Therefore, poor sanitation and overcrowding contribute to the spread of the virus. Enteroviruses are only human pathogens.

Diseases caused by the Coxsackie virus

Although enterovirus infections begin in the gastrointestinal tract, they rarely cause intestinal disease. Symptomatic infections predominate. If symptoms do occur, they most often take the form of a non-specific febrile illness.

  • PERSONAL FEVERAGE- (called summer flu); is the most common form of virus infectionCoxsackie ; starts suddenly with a high fever, malaise and headaches; some patients also complain of upper respiratory symptoms, nausea and vomiting; symptoms disappear spontaneously within a week; Unlike other viruses attacking the respiratory system, the peak incidence is in summer and early fall, hence the name summer flu

Other disease entities affect a significant minority of patients, and include:

  • HERPANGINA- although the name would suggest it, this condition has nothing to do with virus infectionherpes ; it is caused by several types of virusesCoxsackieA; the symptoms include: fever, pharyngitis, pain upon swallowing, loss of appetite and vomiting; vesicles or ulcerations on the soft palate and uvula are characteristic of the physical examination; in some cases, changes may also occur on the hard palate; these changes may persist for weeks, and over time, the eruptions turn into erosions; the infectious material is skin eruption or faeces; symptomatic treatment is sufficient, as the disease is self-limiting
  • HAND, FOOT AND Mouth SYNDROME- (hand, foot and mouth disease - HFMD);the etiological factor is the virusCoxsackieA16; it is a rash disease typical of childhood; may be asymptomatic or with fever and painful blisters appearing as named on the palms, soles of the feet and in the mouth; skin changes usually disappear within a week
  • PLEURODYNIA- (Bornholm's disease, called "devil's ticks") - the perpetrator is the virusCoxsackieB; patients mainly complain of fever, severe pleural pain on one side of the chest, often also abdominal pain and vomiting; chest pain is more typical for adults, and abdominal pain for children; The patients compare pain with a knife stabbing, attacks of pain usually last 15-30 minutes, coexist with sweating and rapid breathing; by the similarity of the symptoms, the disease can be confused with a myocardial infarction; the treatment uses non-steroidal anti-inflammatory drugs and local warm compresses; symptoms usually disappear after 2-4 days, however, there are relapses, and in a few cases complications in the form of: meningitis, orchitis, less often pericarditis and myocarditis.
  • MYOCARDIC AND PERICON INFLAMMATION- enteroviruses, including the virusCoxsackieB is responsible for about a third of all cases of myocarditis; the vast majority of these cases occur in newborns, adolescents and young adults; the disease more often affects the male sex; there is fever and sudden and unexplained circulatory failure, cyanosis, tachycardia, cardiomegaly, and hepatomegaly; also the EKG examination shows abnormalities; older children and young adults usually recover completely; possible complications include: dilated cardiomyopathy or chronic constrictive pericarditis; in newborns, the disease is more severe and has a high mortality, and postmortem examinations reveal the involvement of all internal organs: the brain, liver and pancreas.
  • VIRUS (ASEPTIC) CERRIBO-MENTINAL DIAMONDitis- typical symptoms of meningitis: fever, headache, meningeal symptoms, eg neck stiffness, petechiae; seasonal epidemics are observed locally in spring and autumn; unless encephalitis has occurred, most cases heal without permanent neurological sequelae, although the cerebrospinal fluid abnormalities may persist for several weeks;
  • Fever, rash, and cold symptomshives, may resemble erythema multiforme or erythema sudden; it is important to consider meningococcal sepsis, which is much more severe in differentiation.
  • ACUTE HEMORRHAGIC CONJUNCTION- highly contagious eye disease caused by Coxsackie A24 virus; patients complain of sudden, severe eye pain, visual disturbances: blurred vision, photophobia and watery discharge from the eye; subject the eye is swollen and bloodshot; the hatching period is 24 hours and symptoms disappear within 1-2 weeks; epidemics and hospital infections were observed.
  • GENERATED NEWBORN DISEASE- some strains of Coxsackie B viruses have the ability to cross the placenta; infection is the most severe in newborns in the first week of life, but severe infections can occur in infants up to 3 months of age; the course resembles bacterial sepsis, there is fever, irritability and drowsiness; laboratory tests show: high leukocytosis with a shift to the left, thrombocytopenia, increased activity of liver enzymes and increased pleocytosis in the cerebrospinal fluid.
  • POLIO-REMINDER SYNDROME- infestations caused by enteroviruses other than polio are very rare; those caused by the Coxackie virus tend to be milder than polio; it is most often associated with the Coxsackie A7 and A9 viruses.

Coxsackie virus: laboratory diagnosis

Some disease entities have such a characteristic clinical course that no additional tests are needed to establish the diagnosis. Symptoms and clinical history allow to diagnose herpangina or diseases of the hand, foot and mouth, especially when we are dealing with numerous diseases. Additional examinations are required in patients with severe symptoms requiring hospitalization. If we suspect meningitis or encephalitis, we perform a lumbar puncture. Fecal culture, nasopharyngeal swab or pharyngeal swab are also collected. It should be remembered that a positive stool culture or pharyngeal swab result does not always mean that the disease is related to Coxsackie virus infection, as some asymptomatic carriers shed viruses for many weeks. However, the results of cultures from sterile sites, i.e. cerebrospinal fluid, blood, fluid from body cavities or tissues, are certain.

The plating result is obtained within one week of the inoculation on the cell culture. Note that the result may be a false negative. The Coxsackie A virus in particular is difficult to breed.

Much faster than breeding, and the reaction methods are very sensitive and specificpolymerase chain (PCR). Cerebrospinal fluid, blood, urine, throat swabs and tissue samples can be examined this way.

The huge number of enterovirus serotypes and the lack of a common antigen limits serological diagnostics. This is of little clinical significance but is important from an epidemiological point of view.

Coxsackie virus: treatment

We do not have any causal treatment for Coxsackie virus infections, therefore only symptomatic treatment is used: painkillers and antipyretics. In severe cases, such as meningitis, brain inflammation, and myocarditis, as well as in neonates and infants, hospital treatment is necessary. In these patients, the administration of intravenous immunoglobulin preparations may have a beneficial effect.

Coxsackie virus: prognosis

Fortunately, most diseases caused by Coxsackie viruses resolve on their own without permanent complications. After falling ill, immunity develops, but only to a specific serotype of the virus. However, due to the multiplicity of serotypes, multiple diseases are possible with the same symptoms but each time caused by a different virus subtype. Complications can occur especially in newborns and infants, especially in cases of encephalomyocarditis. Patients with inherited IgG deficiency, i.e. agammaglobulinemia, belong to the high-risk group.

Coxsackie virus: prevention

There are no immunizations against Coxsackie viruses. It's hard to avoid infection, but we can increase your chances by following the rules of hygiene: washing your hands and avoiding bathing in small natural waters. In the prevention of nosocomial infections, it is important that hospital staff thoroughly wash their hands and use protective clothing and gloves.

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