Coxsackievirus

Shandong university school of medicine

Class 2 Grade 2002 clinical medicine for seven years

Kayla Nicole Clingerman of Woollum, KY was tragically taken from us at the age of 6 from Viral Meningitis.

October 13, 1997 - October 11, 2004

This is a picture of Seven month old Olivia Grace Hamilton at Cayuga Lake in 2004. Viral Meningitis. tragically took her life.

Late summer or early fall…It’s not yet cold or flu season, but your child is sick. Consider coxsackievirus.

It’s often the culprit when parents leave a doctor’s appointment without knowing what disease their child has.

Introduction

History

1947 Coxsackievirus was first identified 1957 associated with "hand, foot and mout

h" disease and first documented 1988 epidemics occurred 1994 the largest epidemic in Britain

Most of the 952 cases were children

aged one to four

Definition

Coxsackieviruses, a family of enteroviruses. These viruses share in common that they infect the human intestines (and stool), but they can cause symptoms throughout the body.

spherical,20-30nm.

Icosahedral

symmetry,

non-enveloped.

Capsid:VP1-VP4

+ssRNA.

Capsid:VP1-VP4

VP1 is associated with absorption of virus

VP4 locates in the capsid

Once VP1 bound to receptor on the target cell,then VP4 is released,+ssRNA enter the cell.

+ssRNA:infectious.

Pathogenic mechanism

CV are characterized by their ability to cause CPE in tissue culture and by their capacity to initiate acute disease by inducing apoptosis within targeted organs in vivo. So,these viruses are considered highly cytolytic.

CV can establish persistence in susceptible cells, indicating that a regulatory mechanism may exist to shut off viral protein synthesis and replication under certain situations. The persistence of coxsackieviral RNA is of particular medical interest due to its association with chronic human diseases.

To cell

Basically, the virus confuses the body's defence system. First, the body detects the presence of an enemy using its

antigen recognition system. The virus, meanwhile, may mimic the protein structure of the heart muscle, and sometimes, may even interact and alter the antigenic configuration there.

Second, the body's defence system reads the signals wrongly. It deploys killer white cells to attack the enemy. The white cells do two things. One, it fires virus-seeking missiles called antibodies to neutralise Coxsackie B and removes it. Two, the white cells also attack the wrong target: the heart. the white cells attack one of its own life support systems.

To defence system

Immunity

sIgA is very important to resist absorption and replication of virus in alimentery tract.

Neutralizing Ab in serum can prevent the diffusion of virus,which can last for several years,even all the life.

Inapparant infectors also get firm immunity.

Incubation The incubation period (the time bet

ween infection and the onset of symptoms) for most coxsackie virus infections is about 2 to 10 days

symptoms

Hand-foot-and-mouth disease

mainly affecting young children Rash. Nonspecific fever, headache Herpangina. Respiratory Infection. Gastrointestinal Infection.

Hand-foot-and-mouth disease

rash

conjunctivitis Herpangina

Meningitis

Viral myocarditis

Duration

The duration usually varies, depending on the specific type.

Coxsackie fever often asymptoms, 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.

Diagnose

Diagnosis is made based on the history and physical exam

Lab tests are available test stool or fluids from the back of the throat Serum test for specific Ab

PCR for viral nucleic acid

Susceptible group Most common in young people. Adults can be infected, but this is much

less common Most infections occur in the summer or

early fall, with a peak from August to October in the northern hemisphere.

Transmission Coxsackieviruses are present both in th

e stool and in the respiratory secretions

Fecal-oral transmissionDroplet transmissionContact transmission

Prevention

There is no vaccine to prevent coxsackie virus infection

Hand washing is the best prevention,especially after toileting and before eating—can help reduce their spread

Treatment Antibiotics do not help with coxsackievirus

infections Plenty of fluids is useful Acetaminophen (such as Tylenol) may be gi

ven to relieve any minor aches and pains Most children with a simple coxsackie infecti

on recover completely after a few days at home.

Last year, a drug called acyclovir, an anti-viral chemical normally used to treat herpes simplex,made a surprising success in treating patients with Coxsackie A16. The study was not conclusive.

It speculated that in these patients, something else was at work: these are the interferons, which are chemical messages sent from cell to cell like warnings to uninfected cells to defend themselves. .