Salyna Riggs
WCH
Disease
Coxsackieviruses
Causative Agents
Coxsackieviruses come from the Picornaviridae family and the Enterovirus genus. They are non-enveloped, single-stranded RNA viruses with an icosohedral (def) capsid. Their average size is 30 nanometers (def) in diameter. Coxsackieviruses are broken down into groups A and B. Group A has at least 23 known serotypes (A1-22, 24) and Group B has 6 serotypes (B1-6).
Epidemiology
In the U.S., 10 million symptomatic enterovirus infections occur annually. One-quarter of these infections are attributed to Coxsackieviruses. Asymptomatic infections or febrile illness (def) account for ninety percent of coxsackievirus infections, and are the most common cause of febrile illness in neonates.
Infections are most common in children under 10 years of age, although anyone can be infected. In the U.S., coxsackievirus infections are more prevalent during summer and fall months. Internationally, infections are not seasonally isolated and occur year-round. Some coxsackievirus infections are known to occur in epidemics (def) throughout various parts of the world.
Emerging studies report that coxsackievirus serotypes B2, B3, and B4 may be associated with insulin-dependent diabetes mellitus (IDDM). Studies show that newborns whose mothers were exposed to coxsackievirus during pregnancy are at increased risk for developing childhood onset diabetes. This correlation continues to be studied.
Transmission
Coxsackieviruses are highly pathogenic, occurring second to the “common cold” viruses. The virus is transmitted from person to person, and found in the feces and respiratory tract of infected persons. The main routes of transmission are the fecal-oral route, respiratory aerosols (def), and contact with contaminated surfaces. Group A serotypes tend to infect the skin and mucous membranes, while Group B tends to infect specific organs and muscles.
Signs and Symptoms
In symptomatic infections, some known illnesses such as exanthems (def), meningitis (def), and conjunctivitis (def) have been linked with numerous serotypes of the virus. More rare and severe infections are usually associated with Group B Coxsackie. Below are infections commonly caused by coxsackievirus and the serotypes they are associated with:
Hand, Foot, and Mouth Disease (HFMD): Serotype A16
Usual associated symptoms include fever, sore throat and mouth, poor appetite, and malaise (def) at the onset of the infection. Following signs include painful ulcerated blisters on the tongue, gums, and cheeks. Non-itchy fluid filled blisters appear on the palms of the hands, soles of the feet, genitals, and/or buttocks.Herpangina: Serotypes A1-10, A12, A16, A22, and B1-5
Usual associated symptoms include fever; malaise; painful swallowing; and sore throat. Oropharyngeal (def) and occasionally oral lesions that may turn into papules and ulcerate may occur. Development of pharyngitis (def) and lymphadenopathy (def) is also likely.Aseptic Meningitis: Serotypes A9 and B5
Usual associated symptoms vary by age of the patient. Infants normally exhibit signs of irritability; insufficient eating; and lethargy. Older children and adults commonly display rash; light sensitivity; headache; stiff neck; nausea; vomiting; and malaise. Fever is typical despite the patient’s age.Acute Hemorrhagic Conjunctivitis (AHC): Serotype A24
Usual associated symptoms include subconjunctival hemorrhage (def); painful eyes; swollen eyelids; and increased tear production. In rare instances, keratitis (def) or motor paralysis may occur.
Epidemic Pleurodynia aka “Bornholm Disease”: Serotypes B1-B5
Usual associated symptoms include sharp spasmodic thoracic pain; constant muscle tenderness in the associated area in between attacks; tachycardia (def); pharyngitis; fever; headache; malaise; diarrhea; vomiting; and nausea.
Prevention and Treatment
While there is no treatment available for the virus itself, symptomatic treatment is available and varies upon the acquired infection. On the other hand, most coxsackieviruses are asymptomatic.
There is no vaccine available for non-polio enteroviruses, including coxsackieviruses. Frequent and proper hand washing techniques are the best prevention for the spread of the virus. Cleaning contaminated surfaces with soap and water, and disinfecting with a bleach and water solution may reduce the risk of infection. Close contact with infected individuals should also be avoided.
Bibliography
Dahlquist, G., Frisk, G., & Ivarsson. (1995, November). Indications that maternal coxsackie B virus infection during pregnancy is a risk factor for childhood-onset IDDM . Diabetologia , 1371-1373.
Gompf, S. G., Casanas, B., Carrington, M., & Cunha, B. (2010, January 5). Herpangina. Retrieved April 16, 2010, from emedicine.com: http://emedicine.medscape.com/article/218502-overview
National Center for Immunization and Respiratory Diseases, Division of Viral Diseases (2010, February 1). Hand, Foot, & Mouth Disease (HFMD). Retrieved April 10, 2010, from cdc.gov: http://www.cdc.gov/ncidod/dvrd/revb/enterovirus/hfhf.htm
Petrache, I., & Sigua, N. (2009, April 17). Pleurodynia. Retrieved April 15, 2010, from emedicine.com: http://emedicine.medscape.com/article/300049-overview
Plechaty, G. (2009, January 7). Conjunctivitis, Acute Hemorrhagic. Retrieved April 15, 2010, from emedicine.com: http://emedicine.medscape.com/article/1203216-overview
Rajnik, M., & Doan, N. (2009, December 21). Coxsackieviruses. Retrieved April 10, 2010, from emedicine.com: http://emedicine.medscape.com/article/215241-overview
Vokshoor, A., & Wan, C. (2009, October 28). Viral Meningitis. Retrieved April 15, 2010, from emedicine.com: http://emedicine.medscape.com/article/1168529-overview