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Coxsackie virus infections

Last updated: September 8, 2020

Summary

Coxsackie viruses are a group of RNA viruses with over 20 serotypes; depending on specific viral characteristics, these serotypes are further divided into groups A and B. Infection is associated with a wide range of symptoms, which are dependent on the exact serotype. Hand, foot, and mouth disease (HFMD) and herpangina are commonly caused by group A coxsackie viruses, while pleurodynia and myocarditis are caused by group B coxsackie viruses. Both groups may cause viral meningitis, conjunctivitis, or pneumonia. Diagnostic procedures and treatment should be tailored to the specific disease manifestation.

Epidemiology

  • Worldwide distribution
  • Occur in all age groups
  • Highest incidence in infants and young children (< 10 years) [1]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

Disease manifestations

Coxsackie A [2]

Coxsackie B [2]

  • Myocarditis
  • Pericarditis
  • Dilated cardiomyopathy
  • Pleurodynia [3]
    • Characteristics: highly contagious
    • Clinical features
      • Flu‑like symptoms
      • Sudden thoracic and upper abdominal pain caused by irritation of the pleura and muscles
    • Diagnosis
      • Clinical
      • Viral culture or PCR (throat or stool sample), serological testing
      • Creatine kinase may be elevated [4]
    • Treatment: symptomatic
    • Prognosis: self‑limiting

Coxsackie A and B

Coxsackie B is the most common cause of viral myocarditis.

References

  1. Modlin JF. Clinical manifestations and diagnosis of enterovirus and parechovirus infections. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-enterovirus-and-parechovirus-infections.Last updated: September 30, 2016. Accessed: March 19, 2017.
  2. Epidemic Pleurodynia (Bornholm Disease; Bornholm's Disease). http://www.merckmanuals.com/professional/infectious-diseases/enteroviruses/epidemic-pleurodynia. Updated: January 1, 2016. Accessed: March 19, 2017.
  3. Bornholm disease. https://radiopaedia.org/articles/bornholm-disease-1. Updated: April 30, 2020. Accessed: July 29, 2020.
  4. Carlin B. Corsino, Rimsha Ali, Derek R. Linklater.. Herpangina - StatPearls. StatPearls. 2020 .