ambossIconambossIcon

Coxsackievirus infections

Last updated: April 24, 2025

Summarytoggle arrow icon

Coxsackieviruses are RNA nonpolio enteroviruses that are part of the Picornoviridae family. There are over 20 serotypes divided into groups A and B. Clinical manifestations due to coxsackievirus infection vary based on group and serotype. Group A coxsackieviruses more commonly cause hand, food, and mouth disease (HFMD); herpangina; and conjunctivitis, whereas group B coxsackieviruses more commonly cause pleurodynia, dilated cardiomyopathy, myocarditis, and pericarditis. Both groups can manifest with flu-like illness and cause various conditions, including meningitis, encephalitis, and respiratory illness (e.g., pneumonia). Most patients with coxsackievirus infection are diagnosed clinically; PCR confirms the diagnosis in case of diagnostic uncertainty or severe disease. Treatment is individualized according to symptoms; antiviral agents are not routinely recommended but may be considered by a specialist for severe infection (e.g., encephalitis). Coxsackieviruses are highly infectious and are mainly transmitted through airborne droplets and via fecal-oral spread; prevention includes respiratory hygiene, hand hygiene, and cleaning of contaminated surfaces and objects.

Icon of a lock

Register or log in , in order to read the full article.

Overviewtoggle arrow icon

Epidemiology

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

Etiology

Clinical features

Coxsackievirus infections may be asymptomatic or may manifest as a wide range of diseases. [2]

Group B coxsackieviruses are one of the most common causes of viral myocarditis. [8]

Icon of a lock

Register or log in , in order to read the full article.

Hand, foot, and mouth disease and herpanginatoggle arrow icon

Definition [1]

Hand, foot, and mouth disease (HFMD) and herpangina are highly contagious febrile infections most commonly caused by group A coxsackieviruses.

Etiology [4]

Epidemiology [2][4]

  • Most commonly affects children < 5 years of age
  • Highest incidence in summer and fall in temperate climates

Clinical features [1][4][9]

Onychomadesis may occur 4–6 weeks after resolution of HFMD. [2][11]

Diagnosis [1][2][4]

  • Diagnosis is usually clinical.
  • Perform PCR (e.g., on stool, vesicle fluid, buccal swabs):

Treatment [2][4]

Oral lidocaine is not recommended for odynophagia because of insufficient evidence supporting its use and the risk of poisoning. [1][13]

Differential diagnoses [1]

Complications [1][4]

Complications (more common in enterovirus A71 infection) include:

Icon of a lock

Register or log in , in order to read the full article.

Pleurodyniatoggle arrow icon

Definition

Pleurodynia (Bornholm disease) is an acute viral illness characterized by fever, flu-like symptoms, and painful spasms of the muscles of the chest and/or upper abdomen.

Etiology [5][14]

Epidemiology [14]

  • Typically affects older children, adolescents, and young adults
  • Rare in older adults

Clinical features [5][14]

Spasms are most common in the febrile phase of disease. [14][15]

Diagnosis [5][14]

Treatment [14]

Symptoms are typically self-limited and resolve within days.

Differential diagnoses

Complications [2][14]

Complications are rare and include:

Icon of a lock

Register or log in , in order to read the full article.

Preventiontoggle arrow icon

Exposure control

  • Hospitalized patients
  • Advise all patients to:
    • Use hand hygiene (with soap), especially after changing diapers and before meals
    • Consider respiratory hygiene measures.
    • Avoid close contact with infected individuals.
    • Disinfect contaminated surfaces (e.g., doorknobs, toys, changing areas).
  • Children with mild infections can attend school unless during an outbreak; check the local health department policy.

Fecal shedding can persist for 2–8 weeks after the onset of infection. Respiratory shedding typically lasts up to 3 weeks. [2]

Icon of a lock

Register or log in , in order to read the full article.

Start your trial, and get 5 days of unlimited access to over 1,100 medical articles and 5,000 USMLE and NBME exam-style questions.
disclaimer Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer