What Is Coxsackievirus A6 and Its Symptoms?

Coxsackievirus A6 is a virus belonging to the enterovirus family, named after Coxsackie, New York, where they were first identified in 1948. Enteroviruses live in the human digestive tract and are a common cause of various illnesses, especially in infants and young children. Coxsackieviruses are categorized into groups A and B, with Coxsackievirus A6 (CVA6) being one of over 24 serotypes in group A.

Atypical Hand, Foot, and Mouth Disease

Coxsackievirus A6 is a primary cause of Hand, Foot, and Mouth Disease (HFMD), but it often results in a more severe and “atypical” presentation. The initial symptoms include a high fever, sore throat, poor appetite, and a general feeling of being unwell, which begins about one to two days after exposure. Following the fever, painful sores can develop in the mouth, followed by a skin rash. This set of symptoms lasts between seven and ten days before resolving.

The rash associated with the A6 variant is more widespread and varied than in typical HFMD. While classic HFMD rashes are concentrated on the palms, soles, and mouth, the CVA6 rash can appear on the arms, legs, buttocks, face, and torso. The lesions themselves can be more diverse, presenting as flat spots, raised bumps, and fluid-filled blisters, known as vesicles. In some cases with CVA6, these vesicles can be larger.

A distinct feature of some CVA6 infections is a delayed side effect known as onychomadesis. This condition involves the painless shedding of fingernails or toenails. It occurs several weeks after the initial illness has completely resolved. This nail shedding is a temporary phenomenon frequently reported following atypical HFMD caused by Coxsackievirus A6.

How Coxsackievirus A6 Spreads

The virus is highly contagious and spreads from person to person through several routes. One primary mode of transmission is through direct contact with fluid from the blisters or saliva of an infected individual. This makes close personal contact a significant risk factor for contracting the illness.

Another major pathway for the virus to spread is through respiratory droplets. When an infected person coughs or sneezes, they release tiny droplets containing the virus into the air, which can then be inhaled by others.

The fecal-oral route is also a common transmission method. The virus is shed in the feces of an infected person for up to eight weeks and can survive on objects for days. Poor hand hygiene after using the toilet or changing a diaper can transfer the virus to surfaces or other people, facilitating spread in settings like schools and daycares.

Managing the Infection and Preventing Spread

There is no specific antiviral medication for a Coxsackievirus A6 infection, so management focuses on relieving symptoms. Over-the-counter medications like acetaminophen or ibuprofen can be used to manage fever and pain from the mouth sores or skin rash. It is important to stay well-hydrated, but acidic drinks should be avoided as they can irritate mouth sores; cold liquids or milk products may be more soothing.

Rest is recommended to help the body recover. Most infections clear up within a week to ten days without medical intervention. However, if a high fever persists for more than 24 hours or if symptoms are severe, consulting a healthcare provider is recommended.

Preventing the spread of Coxsackievirus A6 involves diligent hygiene practices.

• Practice frequent and thorough handwashing with soap and water, especially after using the toilet, changing diapers, and before preparing or eating food.
• Disinfect frequently touched surfaces and shared items, like toys and doorknobs, to reduce transmission.
• Limit contact with others during an active infection, which often means keeping children home from school or daycare until their fever is gone.
• Avoid sharing personal items like cups, utensils, and towels to help contain the spread of the virus within a household.