Coxsackie viruses belong to the group of human enteroviruses that mainly cause flu-like colds, viral meningitis, and painful
Inflammation of the mouth and throat. Due to their cardiotropic effect, myocarditis or pericarditis are frequent concomitants of this infection. The virus reservoir is humans, and transmission occurs fecal-orally or via droplet or smear infection.
What is coxsackie virus?
Coxsackie viruses are spherical non-enveloped RNA viruses that belong to the enterovirus group in the family Picornaviridae and are divided into two strains (A and B). Like all human enteroviruses, they are relatively environmentally resistant, making their spread comparatively easy. Coxsackie viruses are found throughout the world and are transmitted directly from person to person by fecal-oral and droplet or smear infection. Indirect transmission is possible through contaminated objects or contaminated food. It is named for Coxsackie, near New York, where pathologist and virologist Gilbert Dalldorf first described these viruses in 1948.
Occurrence, distribution, and characteristics
Diseased individuals and fomites excrete Coxsackie viruses in the stool, and excretion may continue for several weeks. Infection occurs directly from person to person or indirectly via contaminated objects on which the viruses can survive for an extended period. Infection is also possible via contaminated water as well as contaminated food. For people with a healthy immune system, however, these viruses pose little danger, because over time a strong adaptation to the human reservoir host has occurred, resulting in a certain immunity. The incubation period is seven to 14 days, but a latency period of two to 35 days is also possible. Healthy people who come into contact with infected persons can become infected two to three days before the disease noticeably breaks out. There is also a risk of infection during the entire period of clinical symptoms. Coxsackie viruses are widespread throughout the world, but are more common in countries with low socioeconomic living conditions than in highly developed industrialized countries. The main reasons are contaminated water and poor hygiene. In latitudes with temperate climates, Coxsackie infections occur mainly in summer and autumn. The most effective prevention options are regular hand washing and efficient hygiene measures.
Diseases and medical conditions
Like all human enteroviruses, coxsackie viruses predominantly cause infections with no clear association to specific diseases, because the viruses are capable of causing a wide variety of symptoms that may indicate both coxsackie A and coxsackie B infections, as the symptoms are largely identical in both types of infections. However, in sixty percent of people, Coxsackie infection is asymptomatic because no symptoms occur and the viruses are excreted unnoticed in the stool. Herpangina, an inflammation of the oral mucosa, is accompanied by high fever and flu-like general symptoms. Diseases of the respiratory tract are manifested by cough, sore throat and irritating cough. The affected regions in the throat are reddened and have bright vesicles. When they burst, small round ulcers with a red yard form and heal within three to four days. The so-called hand-foot-mouth disease is noticeable by red-fringed blisters on the feet and hands. Pseudoparalysis, rhinitis and painful stomatitis in the area of the tongue, palate and gums also indicate a type A infection. Like echoviruses, coxsackie viruses exert cardiotropic effects that can cause pericarditis and myocarditis. Another associated condition is myalgia epidemica, which causes pain in the chest, pleura, and upper abdomen. It is also known as Bornholm disease. The onset of the disease is sudden and manifests with fever, chills, vomiting, nausea and diarrhea. Respiratory distress, tendency to collapse, and headache may occur. Less common conditions include pancreatitis, testicular inflammation, and conjunctivitis. Both virus types can cause diabetes mellitus type 1.In newborns, severe systemic diseases such as palpitations, cyanosis, respiratory distress, pericarditis and myocarditis are possible. The pathogen is detected by examination of stool, pharyngeal lavage, conjunctival swab and cerebrospinal fluid. A differential diagnosis must be made with regard to several diseases that are associated with symptoms similar to those of Coxsackie virus infection. These include arbovirus infections, meningitis following infection with other enteroviruses, inflammation of the oral mucosa, glandular fever, appendicitis, and pancreatitis. Other diseases with similar symptoms are rheumatism, gallbladder inflammation, echovirus diseases, lumbago, tuberculous meningitis, pneumonia, and various heart diseases. In the case of painful symptoms lasting longer than two days, a doctor should be consulted in order to prevent the viral infection from spreading and to rule out similar diseases. Treatment is with analgesics and antipyretics. If the course of the disease is difficult, the doctor prescribes gamma-globin preparations. These are immunoglobulins (antibodies) that act primarily against bacteria and viruses. Preferably, these antibodies are produced from convalescent sera. These blood sera are obtained from people who have just survived an infectious disease and whose blood has the necessary antibodies for successful treatment. Through this treatment, passive immunization of the patient is achieved. Supportive adjunctive therapy can be performed with the homeopathic remedies Mercurius corrsivus, Acidum muriaticum as well as Rhus toxicodendron. These associated single remedies address skin rash and painful vesicles and redness in the throat and pharynx.
