Coxsackievirus Infections

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

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

Clinical diagnosis

No reliable laboratory abnormality

Neutralizing antibodies appear during convalescence

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