By: J. Michael Klatte, MD, FAAP
Coxsackieviruses are one of the four kinds of viruses (along with polioviruses, echoviruses, and numbered enteroviruses) that together are known as enteroviruses. These viruses cause a wide variety of illnesses, especially in young children. Infections are most common during summer and early fall.
How do coxsackieviruses spread?
Coxsackieviruses can be spread through respiratory droplets that becomes airborne by sneezing and coughing. Children may also become infected after touching surfaces or objects contaminated with the virus. Other ways the virus spreads is through contact with the stool of a someone with the infection or from a mother to her infant at birth. The usual amount of time from exposure to the start of symptoms for most coxsackieviruses is 3 to 6 days.
Coxsackieviruses can cause children to develop illnesses that include:
Infections of the skin and mouth
Hand, foot and mouth disease (HFMD) is an extremely common infection seen in children, and is usually caused by coxsackievirus types A16 and A6. It most often affects infants and children younger than 5 years. The rash of HFMD is known for being located over the palms of the hands, soles of the feet, and within the mouth. However, rashes may also be found over the face, arms, legs, and within the diaper area. Symptoms of HFMD can also include fever, headaches and poor appetite.
Children with coxsackievirus infections can have herpangina no relation to herpes infections), painful ulcers or sores on the roof of the mouth and tonsils. This infection is typically seen in children between 3 and 10 years of age. Herpangina often develops suddenly, and additional symptoms may include high fevers and headaches. Most cases resolve within 3-6 days.
Infection with coxsackievirus types B3, B5, or B6 can cause repeated sharp spasms in the muscles located between the ribs and over the upper half of the belly. The spasms generally last about 15-30 minutes at a time and are made worse by deep breathing. This infection is usually seen in young adults, and tends to resolve after 1 to 6 days.
Nervous system infections
Certain types of coxsackieviruses can cause meningitis (infection of the protective layers surrounding the brain and spinal cord). Stiff neck, headache, vomiting, and pain related to bright lights (photophobia) are signs of meningitis. Meningitis occurs most frequently in young children, but older children and teenagers can also be affected.
Infections with coxsackievirus types B2 to B5 can cause swelling and inflammation of the heart's muscle and tissue layers, which is known as "myopericarditis." Physically active teenagers are at highest risk for developing myopericarditis. Symptoms can include chest pain, shortness of breath (especially with exercise), and abnormal heart rhythms.
Infections in newborns
Newborns that get enterovirus infections from their mothers at birth may have an overwhelming infection with fever that leads to liver failure, heart failure, meningitis, seizures, bleeding, and sometimes death.
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 has mouth sores that are causing difficulty swallowing, which may lead to dehydration.
How are coxsackievirus infections diagnosed?
Your pediatrician will conduct a physical examination that evaluates signs and symptoms which may indicate a coxsackievirus 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 for sores in the mouth and throat.
In most cases, the diagnosis is based on clinical findings, and no lab work is done. However, to confirm the diagnosis, your doctor can test samples from the throat, nose, stools, or other areas of your child's body. Tests of the blood, skin lesions (if present) and urine may suggest enterovirus infection. If your pediatrician suspects meningitis, they may perform a lumbar puncture (spinal tap) so that the spinal fluid can be examined in the laboratory. If myopericarditis is suspected, a chest x-ray film and electrocardiogram (EKG) will help with the diagnosis.
How are coxsackievirus infections treated?
There is no licensed specific treatment available for coxsackieviruses or any of the other types of enteroviruses. An antiviral drug (pleconaril) has been tested, but is not licensed for general use or available in the United States at this time. 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?
Almost always, children recover from these infections within 7 to 10 days without problems. Complications do occur on occasion, including heart failure related to myopericarditis and even sudden death related to abnormal heart rhythms. Newborns with enterovirus infections during the first 1-2 weeks of life can get severe infections leading to liver failure and massive bleeding, which may be fatal.
How to prevent coxsackievirus infections
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 any type of enterovirus infection, be sure to avoid going to school, swimming pools, and child care settings for the first few days of the illness.
About Dr. Klatte
J. Michael Klatte, MD, FAAP is an assistant professor at the University of Massachusetts Medical School – Baystate and a member of the Division of Infectious Diseases at Baystate Children's Hospital, where he serves as medical director of antimicrobial stewardship. His research and clinical interests include enterovirus infections, Clostridium difficile infections, and antibiotic stewardship. Within the American Academy of Pediatrics, he is a member of the Section on Infectious Diseases Education Subcommittee.