Coxsackieviruses are a group of common RNA viruses that belong to the enterovirus genus within the Picornaviridae family. These viruses are widespread and can cause a variety of illnesses, ranging from mild, self-limiting conditions to more severe presentations. They are named after Coxsackie, New York, where they were first identified. They are particularly prevalent among children, especially infants and young children under five years of age.
Characteristics and Diseases of Coxsackievirus A
Coxsackievirus Group A causes illnesses affecting the skin and mucous membranes. Hand-Foot-and-Mouth Disease (HFMD) is a common condition. It presents with fever, unwellness, and distinctive painful red blisters or spots. These lesions commonly appear on the palms of the hands, soles of the feet, and inside the mouth.
Another illness linked to Group A viruses is Herpangina, which affects the throat. This condition features painful, red-ringed blisters and ulcers on the tonsils and soft palate. Herpangina begins with a high fever and sore throat, resolving within three to six days. Acute hemorrhagic conjunctivitis, characterized by eye pain, redness, watery eyes, swelling, and light sensitivity, is also associated with Group A coxsackieviruses.
Characteristics and Diseases of Coxsackievirus B
Coxsackievirus Group B infections involve internal organs, including the heart, pancreas, and central nervous system. These viruses are a cause of pleurodynia, also known as Bornholm disease or epidemic myalgia. This condition is characterized by sudden, sharp, spasmodic pain in the chest and upper abdomen, which can worsen with deep breathing or coughing.
Group B coxsackieviruses are a cause of viral myocarditis, inflammation of the heart muscle, and pericarditis, inflammation of the sac surrounding the heart. Myocarditis can lead to symptoms like chest pain, shortness of breath, and fatigue, and in some cases, heart failure. Group B viruses are also linked to viral meningitis, an inflammation of the membranes surrounding the brain and spinal cord. They can cause hepatitis, particularly in newborns, potentially leading to severe systemic neonatal disease.
Distinguishing Between Coxsackievirus A and B
While both Coxsackievirus A and B can cause fever, rash, and upper respiratory symptoms, their clinical presentations differ in the body systems affected. Group A viruses are more commonly associated with external manifestations, involving the skin and mucous membranes. This includes the characteristic rashes and mouth sores seen in Hand-Foot-and-Mouth Disease and the throat lesions of Herpangina.
In contrast, Group B viruses are implicated in conditions affecting internal organs. They cause inflammation of the heart (myocarditis, pericarditis), pleura, pancreas, and liver. Group B infections can also lead to serious conditions like viral meningitis and, in newborns, severe systemic illness.
Transmission, Diagnosis, and Management
Coxsackieviruses, both Group A and B, are contagious and primarily spread through the fecal-oral route. Transmission can also occur through respiratory droplets released by coughing or sneezing, and by touching contaminated surfaces or objects. The incubation period, from exposure to symptom onset, ranges from three to six days.
Diagnosis of coxsackievirus infections is often made based on clinical signs and symptoms, especially for common presentations like Hand-Foot-and-Mouth Disease. For severe cases, laboratory tests such as reverse transcription polymerase chain reaction (RT-PCR) or viral culture may be used to identify the virus. Management is primarily supportive, focusing on symptom relief, as no specific antiviral treatment is available. This includes rest, adequate hydration, and over-the-counter medications like acetaminophen or ibuprofen for fever and pain. Medical attention should be sought if symptoms are severe, such as high fever in infants, difficulty breathing, chest pain, stiff neck, or unusual sleepiness.