Coxsackieviruses are a type of enteroviruses and close relatives of echoviruses (ECHO). There can be many manifestations, but the main signs, as a rule, are a sharp deterioration in the general condition, nausea, vomiting, diarrhea, and some others.
Infection with the Coxsackie virus can occur with varying degrees of severity, from mild ailment to life-threatening conditions. Of course, it is always better to prevent a disease than to treat it after it.
Coxsackievirus is a type of enterovirus and a close relative of echoviruses (ECHO). There can be many manifestations, but the main signs, as a rule, are a sharp deterioration in the general condition, nausea, vomiting, diarrhea, and some others.
This virus is considered “children’s”, since children from 3 to 10 years old get sick mainly. However, sometimes the disease occurs in adults, especially if they have a weakened immune system.
Coxsackievirus is a highly contagious RNA virus with excellent survivability and prefers the acidic environment of the stomach. However, it settles not only in the human gastrointestinal tract, practically any tissues and organs can become its target. The nervous system is often affected during infection. But the most likely manifestation of infection is diarrhea, general intoxication, and a characteristic rash. The disease is characterized mainly by a favorable course, however, in some cases, dangerous complications develop.
What are the types of Coxsackie viruses and what they can cause
Coxsackieviruses are divided into two groups:
The researchers observed the effect of this virus on newly born mice.
Coxsackie A virus has caused muscle injury, paralysis and death in rodents.
Coxsackievirus type B — to organ damage, less severe consequences. More than 24 different serotypes of the virus are known to science.
Type A viruses are the source of herpangina: painful blisters in the mouth, throat, arms, legs, or all of these areas. This disease has a very catchy name: “hands, feet, mouth” (eng. HFMD is the common name for this viral infection). Coxsackievirus A16 (CVA16) causes most cases of this rash in the United States. Most often it occurs in children (aged 10 years and younger), but adults can also get sick. Type A virus also causes inflammation of the eyelids and the white area of the eyes (conjunctivitis). Coxsackievirus A6 (CVA6) has been the cause of herpangina in infants.
Type B viruses are causing an epidemic of pleurodynia (fever, mild abdominal pain with headache that lasts two to twelve days and goes away). Epidemic pleurodynia is also called Bornholm’s disease. As many as six serotypes of the Coxsackie B virus are known (1–6). Interestingly, the Coxsackie B4 virus is even considered by some scientists as a possible cause of diabetes.
Both type A and type B viruses can cause meningitis, myocarditis and pericarditis, but to prevent panic, let’s say right away that such things rarely happen. In this respect, Coxsackie virus disease is similar to chickenpox.
How can you get infected with the Coxsackie virus
Any enterovirus infections are considered diseases of dirty hands, and the Coxsackie virus is no exception.
- You can get infected with the Coxsackie virus from a human carrier, both sick and in the absence of signs of the disease.
- The virus is spread by the oral-fecal route — that is, it is brought into the mouth with dirty hands.
- Enteroviruses, including the Coxsackie virus, getting on the oral mucosa, are absorbed into the blood and through the bloodstream are in the intestines, where the virus multiplies and exits with feces.
- The Coxsackie virus can remain viable in the external environment for a long time, infection is possible by airborne droplets, through contaminated products that have not undergone heat treatment, and even water.
The outcome of the infection is determined by the type of virus and the personal characteristics of the patient’s body:
- The person recovers completely (all viral particles are destroyed).
- The process becomes chronic (neurons and internal organs retain the virus indefinitely).
- The patient becomes a virus carrier.
How long are Coxsackie virus patients infectious?
The patient is most contagious during the first week, starting from the onset of the first symptoms. However, viable coxsackieviruses were found in the respiratory tract three weeks after the onset of the disease, and were present in faeces even up to eight weeks, but during this time the viruses became less infectious.
Thus, a person remains contagious with the Coxsackie virus for several weeks after recovery, although not as much as at the beginning of the disease.
Who is at risk of contracting the Coxsackievirus?
It is believed that children under 3 months of age are protected from this enterovirus, and after 10–12 years, almost everyone already has experience of infection behind them, after which stable immunity is developed.
Thus, children older than 3 months and up to 12 years of age are at risk of contracting the Coxsackie virus, but the peak of the disease falls on the period from 3 to 10 years. It is believed that it is impossible to raise a child and never encounter an enterovirus infection.
In addition, the Coxsackie virus is dangerous for weakened adults:
- pregnant women
- elderly people,
- people who have just had another acute illness or who have been debilitated by a chronic illness,
- having problems with the immune system and/or taking immunosuppressive drugs (drugs that suppress the immune system).
Symptoms and signs of Coxsackie virus infection
The incubation period is from 2 to 10 days, most often the disease manifests itself on the 3rd-4th day.
- the temperature rises to 37–39 degrees and above,
- the patient feels weakness and severe malaise,
- may feel pain in the muscles,
- a common symptom is complaints of headache.
These are signs of general intoxication, when viruses massively penetrate into the bloodstream. The very next day, the characteristic signs of the Coxsackie virus appear:
- small bubbles appear on the mucous membrane of the mouth and throat, damage to the tonsils is possible.
- the skin may turn red, especially in the upper body, and sclera.
- very often in children the submandibular and cervical lymph nodes are enlarged and painful.
- the rash appears on the palms and feet, and it resembles chickenpox in terms of speed of spread and appearance — small bubbles filled with liquid. Unlike chicken pox, the rash does not itch or spread throughout the body, although it can appear on the buttocks, inner forearm, and thighs, for example.
- hand-foot-mouth syndrome — a rash appears simultaneously on the oral mucosa, palms and feet.
- the patient feels sick and severe diarrhea begins, up to 5–10 times a day. The stool is watery, free of mucus or blood.
Also, infection with the Coxsackie virus can occur in several more complex and dangerous forms.
1. Enterovirus exanthema.
The main distinguishing feature of this form is a rash on the arms, chest and even the head. Emerging bubbles burst with the formation of crusts. In these places, the skin can peel off and exfoliate. At the same time, the child’s body temperature rises. This manifestation of the disease is often confused with rubella or chicken pox. But it passes, like the flu-like form, rather quickly (from 3 to 5 days) and without consequences. This variety is often called “Boston Fever”, as it was first described after an epidemic in Boston in the middle of the last century.
The incubation period for such an infection is 1–2 weeks. In this case, the virus infects the pharyngeal mucosa. Signs of the disease: high fever, weakness, sore throat. Although this form was called angina, there are no symptoms of the usual form of tonsillitis. The condition is exacerbated by headache. Lymph nodes may enlarge and a runny nose may begin.
Unlike classic tonsillitis, bubbles with liquid appear on the mucous membrane of the tonsils and oral cavity. After a while they burst. On examination, one can observe an accumulation of small erosions covered with a white coating. The disease is even more like stomatitis than a sore throat. All symptoms go away in about a week.
3. Hemorrhagic conjunctivitis
It develops at lightning speed — no more than 2 days pass from the moment of infection to the first signs. This form of infection is characterized by a feeling of sand in the eyes, pain, photophobia, lacrimation, swelling of the eyelids, numerous hemorrhages, and purulent discharge from the eyes. Usually one eye is affected first, then symptoms appear in the other eye. At the same time, the patient feels relatively well. The illness continues for two weeks.
4. Intestinal form of Coxsackie virus
Symptoms typical of intestinal infections: dark-colored diarrhea (up to 8 times a day), vomiting. The condition is exacerbated by abdominal pain, fever. In young children, in addition to intestinal symptoms, a runny nose and sore throat may begin. Usually diarrhea lasts from 1 to 3 days, complete recovery of intestinal functions occurs after 10–14 days.
5. Polio-like form
All manifestations as in poliomyelitis. But unlike him, paralysis develops at lightning speed, not so heavy, the affected muscles recover quickly. With this form, as with others, all the classic symptoms of Coxsackie virus damage can be noted: rash, fever, diarrhea.
Coxsackievirus can attack liver cells. The organ increases in size, there is a feeling of heaviness in the right side.
The disease manifests itself in the form of muscle lesions. When the virus settles in the muscles, myositis develops. Pain is noted in different parts of the body. Very often, painful manifestations are localized in the intercostal muscles. In this case, breathing may be difficult, but the pleura is not damaged, despite the name “pleurodynia”. When walking or performing some other movements, the pain intensifies. Usually they are undulating in nature (repeating after a certain period of time). Therefore, sometimes this form of the disease is called “devil’s fight.” The temperature may persist for several days. Fortunately, this form is quite rare.
8. Violations in the work of the heart
Endocarditis, pericarditis, myocarditis may develop. There is pain in the chest, weakness. The disease develops when infected with type B viruses. A very severe form. Blood pressure may drop, the temperature rises, the child constantly wants to sleep. There are also frequent manifestations of tachycardia, shortness of breath, arrhythmias, edema and liver enlargement. If the central nervous system is affected, then convulsive seizures are observed. A child can die just a few hours after the first signs appear. This form of infection often develops in newborns, but may occur in older children and adults.
9. Serous meningitis
In another way, this type of meningitis is called viral, as it occurs as a result of a viral infection. It can be caused by various viruses, including the Coxsackie virus. With the development of the disease, the meninges are affected. Meningitis is characterized by:
- Acute onset;
- muscle pain and cramps;
- General malaise;
- Lack of appetite;
- abdominal pain and diarrhea;
- sore throat, cough, runny nose;
The clinical picture becomes less pronounced after 3–5 days. Timely identified and properly treated serous meningitis resolves without complications.
It is believed that infection with the Coxsackievirus and echovirus is not dangerous for a child or adult, and in the vast majority of cases passes without consequences with proper care.
However, the manifestations of enteroviruses are so diverse that the likelihood of complications always exists.
Much depends on the type of Coxsackie virus (groups A and B), concentration and luck. The danger of dehydration always exists when the patient has a fever and diarrhea. The younger the child, the more dangerous and more likely dehydration is for him. In any case, the doctor should make a diagnosis, as well as prescribe the appropriate treatment. Fortunately, in the vast majority of cases, the disease resolves without consequences and without hospitalization.
Important: Viral infections are not treated with antibiotics! Moreover, they can significantly worsen the condition of the patient, especially the child. The doctor may prescribe antibiotics if a bacterial infection has joined the viral infection.
Basically, infection with the Coxsackie virus passes without complications. But in some cases, the disease has consequences. The heaviest of them:
- Heart failure;
- Diabetes is insulin dependent.
Treatment of Coxsackie virus
If the disease proceeds without complications, then it is treated in the same way as conventional ARVI. Basically, it is enough to be treated at home.
At the same time, symptomatic treatment is still needed. Means to reduce fever, relieve itching — antihistamines, sore throat — sprays, lozenges, etc. It is recommended to prevent dehydration by drinking liquids, however, juices, fruit drinks, and acidic foods can irritate mouth ulcers. Cool milk will come to the rescue, which will help soothe this pain and soothe the throat. It is useful to drink cool chamomile tea, as well as brew chamomile in milk.
In some cases, the Coxsackie virus is confused in clinical manifestations with herpes or bacterial tonsillitis and, accordingly, the antiherpetic acyclovir and antibiotics are prescribed. You need to know that acyclovir does not help with Coxsackie enterovirus at all, but it can damage the body, because. is hepatotoxic.
rash when infected with the Coxsackie virus An urgent call to a doctor is necessary if:
1. Paleness of the skin;
2. The appearance of blue on the body, near the ears, between the fingers;
3. The appearance of signs of dehydration: lethargy, dry lips, decreased urination, increased drowsiness, delirium, dizziness;
4. Sharp headache;
5. Refusal of food;
6. Long fever.
With severe infection, urgent hospitalization is necessary. Relatively rare complications of coxsackievirus infections (for example, heart or head infections) require special individual treatment, which is prescribed by an infectious disease specialist and often in a hospital setting.
What specialists treat the Coxsackie virus
When symptoms of infection appear, they turn to a pediatrician, internist and / or infectious disease specialist, if the attending physician considers it necessary.
Usually Coxsackie infection is diagnosed by their clinical manifestation — by symptoms. Painful blisters—usually on the arms, legs, and in the mouth (near the mouth) combined with fever—are considered grounds for a diagnosis of coxsackievirus infection. Tests for the Coxsackie virus are expensive, the results come in approximately 10 days, during which time the patient has time to recover and begin normal activities.
How to prevent infection: prevention of the Coxsackie virus
To date, a vaccine against the Coxsackie virus, however, as well as from other enteroviruses, has not been received. The only prevention is personal hygiene. But since the main route of transmission of the virus is still airborne, then this method is not a panacea.
In general, if there are already a lot of sick people in a settlement, doctors recommend staying less in crowded places, washing your hands regularly, drinking enough fluids, getting enough sleep and eating well — these are all possible ways to prevent the Coxsackie virus.
Pregnant women need to be especially vigilant and avoid contact with children (or adults) with Coxsackie infection. Some studies show that the virus can adversely affect the baby.
A recovered person is immune to a particular type of Coxsackie virus, but this does not protect him from infection by other types. For example, a person may become immune to coxsackievirus type B4, but still be susceptible to all other types of coxsackieviruses (eg CVA16). In addition, there are other viruses, such as enterovirus 71 and human enteric viruses (ECHO), that can still cause hand-foot-mouth symptoms. Some people may therefore have multiple infections with rash symptoms in these areas. At the same time, recurring infections are known to occur rarely.
Dr. Komarovsky about the Coxsackie virus
based on materials moirebenok.ua