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Key Features

  • Named after a town in northern New York State, the coxsackievirus causes several clinical syndromes

  • More than 50 serotypes and 2 major subgroups: A and B

  • Enterovirus occurs most often during the summer months

Clinical Findings

  • Herpangina (subtype A; B3)

    • Sudden-onset fevers

    • Headaches

    • Myalgias

    • Petechiae or papules on the soft palate that ulcerate in about 3 days and then heal

  • Epidemic pleurodynia (Bornholm disease, subtype B)

    • Pleuritic chest pain

    • Systemic symptoms, including headache, malaise, pharyngitis

  • Aseptic meningitis (subtypes A and B)

    • Fever

    • Headache

    • Stiff neck

    • CSF lymphocytosis

    • Encephalitis and transverse myelitis may occur

  • Acute pericarditis (subtype B)

    • Positional, pleuritic chest pain

    • Fevers

    • Myalgias

    • Clinical and echocardiographic signs of pericarditis

  • Hand-foot-and-mouth disease (subtypes A and B)

    • Stomatitis

    • Vesicular rash on hands and feet

    • Nail dystrophies and onychomadesis (nail shedding)

  • Hepatitis, renal disease, and myocarditis are also caused by coxsackievirus infections

Diagnosis

  • Clinical diagnosis

  • No reliable laboratory abnormality

  • Neutralizing antibodies appear during convalescence

Treatment

  • Supportive measures

  • For patients with enteroviral meningitis, pleconaril has shown potential clinical benefit although the compassionate use of this drug has stopped

  • In severe cases, immunoglobulin treatment is anecdotally successful

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