Coxsackie Viruses

Signs and Symptoms:
About half of all children with coxsackie virus infection have no symptoms. Most of the remainder develop a sudden fever (101 to 104 degrees F), headache, and muscle aches. Some also develop a mild sore throat, abdominal discomfort, or nausea. A child with a coxsackie virus fever may simply “feel hot” to the touch but have no other symptoms. In most children, the fever lasts about three days, then disappears; in others, the fever is biphasic: it appears for 1 day, then disappears for 2 to 3 days, then returns for 2 to 4 days more.

Besides causing a simple fever, coxsackie viruses also can cause several different patterns of symptoms that affect different body parts. For example, pleurodynia (also called Bornholm disease) is a related coxsackie virus infection that causes painful spasms in the muscles of the chest and upper abdomen. Boys with pleurodynia may also have pain in the testicles beginning about two weeks after the chest pain starts.

Hand, foot, and mouth syndrome, another type of coxsackie virus syndrome, causes ulcers (sores) on the tongue and inside the cheeks, and small blisters (3-7 mm) on the hands and feet. Herpangina, a coxsackie virus infection of the throat, causes red-ringed blisters and ulcers on the tonsils and soft palate, the fleshy back portion of the roof of the mouth.

Coxsackie viruses may rarely cause myocarditis (an infection of the heart muscle), especially in newborns, who can catch the infection from their mothers. Infants with coxsackie myocarditis develop a fever within 2 weeks after birth and have trouble breathing. They feed poorly, move very little, and sometimes develop cyanosis – a bluish color to the skin, lips, and nails caused by too little oxygen in the blood.

Coxsackie viruses are also a common cause of hemorrhagic conjunctivitis, an infection that affects the whites of the eyes. In hemorrhagic conjunctivitis, eye pain usually begins suddenly. The eyes water and become abnormally sensitive to light, and vision becomes blurry. The whites of the eyes become very congested, red, and swollen, with tiny areas of bleeding under the surface. Coxsackie viruses can also cause myositis, a muscle infection; meningitis, an infection of the membranes that cover the brain; and encephalitis, a brain infection.

Description:
The coxsackie viruses are part of the enterovirus family of viruses that live in the human digestive tract. They can spread from person to person, usually on “dirty” (unwashed) hands and surfaces contaminated by tiny amounts of feces, where they can live for several days. They can even survive freezing winter temperatures outdoors. In tropical parts of the world, they actively infect humans year-round, but in cooler climates, their outbreaks most often occur in the summer and fall.

Prevention:
There is no vaccine to prevent coxsackie virus infection. Hand washing is still the best prevention. Remind the members of your family to wash their hands frequently, especially after using the toilet, after changing a diaper, before meals, and before preparing food.

Incubation:
The incubation period for most coxsackie virus infections is about 2 to 10 days, except for pleurodynia (4 days) and hand, foot, and mouth syndrome (4 to 6 days).

Duration:
The duration of a coxsackie virus infection varies, depending on the specific type. For a simple coxsackie fever without other symptoms, a child’s temperature may return to normal within 24 hours, although the average fever lasts 3 to 4 days. In pleurodynia, fever and muscle pain usually last 1 to 2 days, and in herpangina, symptoms generally last 3 to 6 days.

Contagiousness:
Coxsackie viruses can be passed from person to person on unwashed hands and surfaces contaminated by feces (even tiny amounts). When an outbreak of coxsackie virus affects a community, risk for infection is highest among very young children. Older children may be exposed to coxsackie virus infections in summer camps and day-care centers.

Home Treatment:
Most children with a simple coxsackie fever recover completely after a few days at home. If your child has a fever without any other symptoms, she should rest in bed or play quietly indoors. Offer plenty of fluids to prevent dehydration, and give her a nonprescription pain medicine, like acetaminophen, to relieve any minor aches and pains. If the fever lasts for more than 24 hours, or your child has any symptoms of a more serious coxsackie infection, call your doctor.

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