The coxsackie virus is a non-polio enterovirus (1, 3). The enteroviruses are small viruses made up of RNA (1). Enteroviruses are linked taxonomically to Rhinovirus, or the common cold, and are considered the second most common virus (1, 4). Rhinovirus is the most common of viral infections (1). The coxsackie virus was first isolated in Coxsackie, New York in 1948, hence the name (8). Non-Polio enteroviruses (NPEV) are found worldwide (8). There are 23 coxsackie A viruses and six coxsackie B viruses (1). Everyone is at risk of contracting the virus and developing symptoms unless they have developed immunity to the specific coxsackie virus (1). Infants, children, and adolescents are most likely to become infected, due to their lack of immunity (1). In tropical parts of the world, people can become infected on a year round basis, otherwise the virus is most prevalent during the summer and fall months (3). Humans are the only known natural hosts (5).
The virus in very contagious and is spread from person to person by unwashed hands or from surfaces that have been contaminated with feces, and respiratory droplets (2,3). Approximately half of all the children who become infected with coxsackie virus will be without symptoms (3). However, some children will experience fevers of 101 degrees Fahrenheit to 104 degrees Fahrenheit, and muscle aches (3). In addition to fever, coxsackie viruses can cause different types of symptoms that affect different parts of the body (3). For instance, hand foot and mouth disease, a type of coxsackie virus syndrome will cause painful blisters on the tongue, gums, and inside the cheeks as well as on the palms of hands and soles of feet (3). Herpangina, another coxsackie virus infection of the throat, causes blisters and ulcers on the soft palate, roof of the mouth, and tonsils (3). Pleurodynia, which is also known as Bronholm disease, is a related coxsackie virus infection that causes painful spasms in the upper abdomen and chest (3). In boys, pain in the testicles can occur approximately two weeks after the chest pain starts (3). "Hemorrhagic conjunctivitis is an infection that affects the whites of the eyes" (3). Eye pain develops followed by swelling, red, watery eyes, light sensitivity and blurry vision (3). Serious and rare conditions that can be caused by coxsackie virus are meningitis, encephalitis, and myocarditis (3).
The coxsackie virus mutates over long periods of time and is known to alter its pattern of behavior as well as its preferred tissue or organ target (7). The coxsackie B viruses are able to change target and raise its destructive capability more rapidly than coxsackie A viruses (7). The virulence factor is ICAM-binding protein (2). It is cytolytic, causing damage to the target cells (i.e. the tongue, hands, feet, heart, lung, etc) (2). Coxsackie virus replication begins in the gastrointestinal tract, or the respiratory tract, and then progresses to the blood stream (5). Then the infection may affect various organs, causing a variety of diseases (5). The virus is able to confuse the body's normal defense system (7). Initially, the body detects the presence of the virus using its antigen recognition system (7). The virus will then mimic the protein structure of the target cells and may even interact and alter the antigenic configuration there (7).
Diagnosis is performed by a physical exam where the physician looks for rashes, and blisters (3). Also stool, fluids from the back of the throat, or specimens collected from the affected part of the body can be tested to determine if the virus is present (3,5). Treatment is given to make the patient comfortable; there is no vaccine or current medication that is available to treat this virus (3). The more severe symptoms related to the coxsackie virus, myocarditis and encephalitis can be fatal and require hospitalization for monitoring (3). The best method to prevent contraction of this virus is thorough hand washing (3, 5).
References:
Center for Disease Control (CDC). Available from: http://www.cdc.gov/ncidod/dvrd/revb/enterovirus/hfhf.htm Accessed February 25, 2003.
Bugs Index Available from: http://www.medinfo.ufl.edu/year2/mmid/bms5300/bugs/coxsaca.html Accessed February 20, 2003.
Gauin MD, Mary. Infections The Coxsackie Virus. Reviewed June 2002. Available from: http://kidshealth.org/parent/infections/bacterial_viral/coxsackie.html Accessed February 22, 2003.
The Merck Manual of diagnosis and therapy. Chapter 265. Available from: http://www.merck.com/pubs/mmanual/section19/chapter265/265b.htm
World Health Organization. Non Polio Enterovirus fact sheet 174. Revised May 2002. Available from: http://www.WHO.int/inf-fs/en/fact174.html Accessed February 23, 2003.
Wong MD, Michael. Find the facts: Coxsackie Virus. September 28, 2000. Available from: http://www.personalmd.com/news/handmouthdisease_09282000.shtml Accessed February 21, 2003.
Chong MD, W.M. Understanding the coxsackie virus. New Strait Times, June 11, 1997. Available from: http://www.vadscorner.com/newsNST.html Accessed February 28, 2003.
Texas Department of Health. Available from: http://www.tdh.state.tx.us/epidemiology/99annual/reports/enterovirus.htm
Casey, Janet and Pichicher, Michael E. Non Polio Enterovirus Infections: A new era. June 2001. Available from: http://www.findarticles.com/cf_dls/m0BGH/6_18/76876547/p1/article.jhtml?term=non+polio+enterovirus Accesses February 28, 2003.