coxsackievirus an update

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Coxsackievirusesan updateDr.T.V.Rao MD

Dr.T.V.Rao MD 1


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History of Coxsackieviruses The Coxsackieviruses

were discovered in1948-49 by Dr.Gilbert Dalldorf, ascientist working atthe New York State

Department of Health in Albany,New York.

Dr.T.V.Rao MD 2


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Coxsackie, New York The virus family

discovered waseventually given the

name Coxsackie, forthe town of Coxsackie,New York, a smalltown on the Hudson

River where Dalldorf had obtained the firstfaecal specimens

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The Virus belongs to .. Coxsackievirus is a virus that belongs to a

family of nonenvelopedd, linear, positive-

sense ssRNA viruses, Picornaviridae andthe genus Enterovirus, which alsoincludes poliovirus and echovirus.

Enterovirus are among the mostcommon and important humanpathogens, and ordinarily its members

are transmitted by the fecal-oral route.Dr.T.V.Rao MD 4


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Coxsackie's belongs toEnterovirus

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Coxsackievirus spread They can spread

from person to

person , usually onunwashed handsand surfaces

contaminated byfeces, where theycan live for several

days. Dr.T.V.Rao MD 6


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Coxsackievirus Coxsackievirus (sometimes written as

two words, Coxsackie's virus)belongs to a group of viruses calledenterovirus. Coxsackievirusinfections occur most often during

summer and fall Coxsackievirus infections occur most

often in young children,Dr.T.V.Rao MD 7


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The Virus belongs to TwoGroups

Coxsackievirus are divided into group A andgroup B viruses based on early observations of their pathogenicity in mice. Group A

coxsackieviruses were noted to cause a flaccidparalysis (which was caused by generalizedmyositis) while group B coxsackieviruses were

noted to cause a spastic paralysis (due to focalmuscle injury and degeneration of neuronaltissue). At least 23 serotypes (1-22, 24) of groupA and six serotypes (1- 6 of group B arerecognized. Dr.T.V.Rao MD 8


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Coxsackie's virus Infects Suckling Mice but notAdult Mice

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Several Serotypes At least 23

serotypes (1-22, 24) of group A and 6

serotypes (1-6)of group B arerecognized

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Sources of Coxsackie's viralinfections

Infection usually is spreadby fecal-oral contamination,although occasionally thevirus is spread by droplets

expelled by infectedindividuals. Items likeutensils, diaper-changingtables, and toys that comein contact with body fluids

that contain the virus mayalso transmit them to otherindividuals

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Coxsackie virus spread through

They can spreadfrom person to

person, usually onunwashed handsand surfaces

contaminated byfeces, where theycan live for several

days.Dr.T.V.Rao MD 12


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Diseases Caused byCoxsackievirus

Herpangina coxsackie A virus

Hand-foot-and-mouth disease Coxsackievirus A16 and enterovirus 71

Pleurodynia coxsackie B virus

Myocardial and pericardial infections coxsackie B virus. (B3)

Viral meningitis Coxsackievirus or echovirusDr.T.V.Rao MD 13


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Pathophysiologyof Coxsackie's virus

Coxsackieviruses are transmitted primarily via thefecal -oral route and respiratory aerosols, althoughtransmission via fomites is possible. The virusesinitially replicate in the upper respiratory tract andthe distal small bowel. They have been found in therespiratory tract up to 3 weeks after initial infectionand in feces up to 8 weeks after initial infection. Theviruses have been found to replicate in the submucosal lymph tissue and disseminate to theReticuloendothelial system. Further dissemination totarget organs occurs following a secondary Viremia.

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Symptoms related toCoxsackievirus

Upper respiratory tract symptoms, includingsore throat, rhinitis, and dry cough

Constitutional symptoms, including headaches(50%), fever, and malaise

GI symptoms, including nausea, vomiting,diarrhea (50%); abdominal pain (usually in theepigastria area) in children

Testicular pain (i.e., orchids) in 10% of male

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Coxsackie virus infection present with

Both group A andgroup BCoxsackievirus cancause nonspecificfebrile illnesses,rashes, upper

respiratory tractdisease, and asepticmeningitis

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Coxsackie virus infection present with

In general, group Acoxsackievirusestend to infect the

skin and mucousmembranes, causingherpangina, acute

haemorrhagicconjunctivitis (AHC),and hand-foot-and-mouth (HFM)disease

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Coxsackie virus Can causeAcute haemorrhagic conjunctivitis

Rare complicationsinclude keratitis andmotor paralysis.

This condition ishighly contagiousand has resulted inepidemics andpandemics.

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Hand, Foot, and Mouth Disease Type of Coxsackie Virus

syndrome Causes painful red

blisters on: Throat Tongue Gums Cheeks Palms of hands Soles of Feet

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Coxsackievirus syndrome Hand, foot, and mouth

disease , a type of Coxsackievirus

syndrome, causespainful red blisters inthe throat and on thetongue, gums, hard

palate, inside of thecheeks, and the palmsof hands and soles of the feet.

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Herpangina , Herpangina , an

infection of thethroat which causesred-ringed blistersand ulcers on thetonsils and soft

palate, the fleshyback portion of theroof of the mouth.

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Hand, Foot, and Mouth Disease Although HFM is most

often associated withCoxsackievirus A16, theprocess does occur withother enterovirusstrains (enterovirus 71& others). A child will

develop immunity to anindividual strain after anillness but besusceptible to other

unrelated strains,. Dr.T.V.Rao MD 23


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Myocarditis can be a serious disease

Group BCoxsackievirus tendto infect the heart,pleura, pancreas,and liver, causingPleurodynia,

myocarditis,pericarditis, andhepatitis

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Coxsackie B3 - Myocarditis Coxsackie B3 has been

found to be one of the maincauses of certaindebilitating or life-threatening diseases, such

as viral myocarditis. In about 20% of the cases,

there can be progressivedisease or recurrence of symptoms; the heart

damage can be extensive,causing arrhythmias,weakened left ventricularfunctions

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Born Holm disease present with Pain on inspiration is similar

to Pleuritic pain andpulmonary embolism maybe suspected.

The muscles are locallytender.

There will be nohaemoptysis.

There may be a slight

sensation of dyspnoea orpain on breathing

Born Holm word is aplace where the

disease is identified.Dr.T.V.Rao MD 26


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Difficult to Diagnose ? Many infections are caused by Coxsackie

viruses, most of which are never diagnosedprecisely.

Coxsackie type A usually is associated withsurface rashes (exanthemas) while type Btypically causes internal symptoms(Pleurodynia, myocarditis) but both can also

cause paralytic disease or mild respiratorytract infection. The latter can be caused byseveral Coxsackie virus types and byEchoviruses and the symptoms are much like arhinovirus infection Dr.T.V.Rao MD 27


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Emerging Diagnostic Methods All the Conjunctival swabs from Coxsackievirus

A24 variant related outbreak and the 41Coxsackievirus A24 variant strains were testedpositive by the RT-PCR assay within 4 h. Thisnovel single-tube real-time RT-PCR assay issensitive and specific, and consists in a reliable

and faster alternative to the viral culture forrecent and future acute haemorrhagicconjunctivitis outbreaks caused by

Coxsackievirus A24 variant.Dr.T.V.Rao MD 28


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Is Coxsackie Contagious? VERY contagious Passed on by:

Unwashed hands Surfaced

contaminated byfeces

Sneezes or coughs

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To prevent spread into society

Children who feel ill or have afever should be excluded from

group settings until the fever isgone and the child feels well.

Thorough hand washing and carewith diaper changing practices isimportant.

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Treatment and Prevention Treatment usually

consists of simpleanalgesia for sorethroat/aches,adequate fluidintake, and rest

There is no vaccineagainst theCoxsackie's virus

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FDA-approved specific therapy While there is no FDA-

approved specifictherapy forCoxsackievirusinfection, a recentstudy demonstratedthat fluoxetine(marketed as Prozac in

the US) appears toinhibit replication of viral RNA in vitro.

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Newer treatments ? Specific antiviral

therapy such asPleconaril shows

promise in thetreatment of meningitisand other lifethreatening infections

due to enterovirus. However, the safety or

efficacy of this drug tobe considered withmore tails Dr.T.V.Rao MD 33


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Prevention

Coxsackie virus istransmitted bycontamination withfeces, which means you

can catch the virus bytouching your mouth oreating withoutthoroughly washingyour hands. Good handwash reduces thespread of infection insociety

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Programme Created by Dr.T.V.Rao MD

for Medical and Paramedical Students inthe Developing World Email

[email protected]

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coxsackievirus an update

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