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Coxsackieviruses and Other Enterovirus Infections

Enteroviruses are a group of organisms that include

  • Polioviruses
  • Coxsackieviruses
  • Echoviruses
  • Enteroviruses

This section describes the many non-polio enteroviruses. There are more than 60 distinct enteroviruses responsible for a wide variety of illnesses. Enterovirus infections are common, especially in young children. They can be spread through saliva that becomes airborne by sneezing and coughing or is present on surfaces or objects that children may touch. These viruses can also be transmitted through contact with the stool of a person with the infection or from mother to infant at the time of birth. Infections are most common during summer and early fall.

One of the most common coxsackie infections is hand-foot-and-mouth disease, most often caused by coxsackievirus A16. It is most often seen in infants and children younger than 10 years. Despite the similarity in names, hand-foot-and-mouth disease is a completely different infection than foot-and-mouth disease, which occurs only in animals and is caused by another type of virus.

The usual incubation period of enteroviral infections is 3 to 6 days from exposure to the initial symptoms.

Although some children with enteroviral infections may have no signs and symptoms, other youngsters can develop a high fever as well as a wide range of other symptoms, including a sore throat, vomiting, diarrhea, abdominal pain, skin eruptions, eye inflammation (conjunctivitis), and sharp pains in the muscles between the ribs. Eye inflammation is sometimes accompanied by bleeding into the outside lining of the eye. Although the eye may look very sick, it does not interfere with vision. These viruses can also produce serious infections such as myocarditis (infection of the heart muscle) or meningitis (infection of the lining of the brain). Signs of myocarditis include chest pain and an irregular heart rate. Stiff neck, headache, and pain related to bright lights (photophobia) are signs of meningitis.

Newborns that get the virus from their mothers at birth may have an overwhelming infection with fever that leads to liver failure, bleeding, and sometimes death.

The signs and symptoms of hand-foot-and-mouth disease include a fever and small but painful sores on the throat, gums, and tongue and inside the cheeks. It also may cause a rash, often with blisters, on the hands, soles of the feet, and diaper area, as well as headaches and a poor appetite.

When to Call Your Pediatrician

Call your pediatrician if your child complains of neck pain, chest pain, difficulty breathing, listlessness, or lethargy. Also consult your pediatrician if your child’s mouth sores are causing difficulty swallowing, which may lead to dehydration.

How Is the Diagnosis Made?

Your pediatrician will conduct a physical examination that evaluates signs and symptoms which may indicate an enteroviral infection. If the doctor suspects that your child has hand-foot-and-mouth disease, your pediatrician will look for the rash associated with this infection as well as sores in the mouth and throat.

To confirm the diagnosis, your doctor can test specimens from the throat or stools, as well as other areas of the body. Also, tests of the blood and urine may indicate the presence of enteroviruses. If meningitis is suspected, the pediatrician will perform a lumbar puncture (spinal tap) so that the spinal fluid can be examined in the laboratory. If myocarditis is suspected, a chest x-ray film will be taken and an electrocardiogram (EKG) will be performed.


There is no licensed specific treatment available for infections caused by enteroviruses. An antiviral drug, pleconaril, has been tested, but is not yet licensed for general use. Your pediatrician may recommend the use of acetaminophen to reduce your child’s fever and ease the discomfort of the mouth sores.

What Is the Prognosis?

In most cases, children recover from these infections within 7 to 10 days without problems. Complications do occur on occasion, including heart failure related to myocarditis and even sudden death related to abnormal heart rhythms. Newborns with enteroviruses can get severe infections leading to liver failure and massive bleeding, which may be fatal.


Children and adults should adopt good hand-washing habits to reduce the chances of spreading these viruses. In particular, parents and other caregivers who change baby diapers should wash their hands frequently. When a child becomes ill with an enteroviral infection, she should be kept out of school, swimming pools, and child care settings for the first few days of her illness.

Last Updated
Immunizations & Infectious Diseases: An Informed Parent's Guide (Copyright © 2006 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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