Coxsackievirus Infections

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