Coxsackie B

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Coxsackie B virus
Coxsackie B4 virus
Coxsackie B4 virus
Virus classification
Group: Group IV ((+)ssRNA)
Family: Picornaviridae
Genus: Enterovirus
Species: Human enterovirus B
Subtype

Coxsackie B virus

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

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Overview

Coxsackie B is the name of a group of six serotypes of pathogenic enteroviruses that trigger illness ranging from mild gastrointestinal distress to full-fledged pericarditis, myocarditis, pericardial effusion, pleurodynia and hepatitis.[1]

Viral Structure and Function

Coxsackie B viruses are single-strange positive-sense RNA viruses that are resistant to a wide variety of chemical treatments. The viral particles themselves are roughly 30nm icosahedrons.[2] The virus is most frequently distributed via the fecal-oral route, and infection commonly occurs after eating contaminated food. Coxsackie B viruses are cytolytic, and Coxsackie B2 and B5 viruses have been implicated in hand, foot and mouth disease as well as respiratory infection.[1] Infection in infants is mostly asymptomatic, but sometimes results in the death of the infant, often due to myocarditis.[3] Birth defects may also be present in a coxsackie B infected infant.

Associated Conditions

Epidemiology and Demographics

The various members of the Coxsackie B group were discovered almost entirely in the United States, appearing originally in Connecticut, Ohio, New York, and Kentucky, although a sixth member of the group has been found in the Philippines.[1] That said, all six serotypes have a global distribution and are a relatively common cause of gastrointestinal upset.

Diagnosis

History and Symptoms

Symptoms of infection with viruses in the Coxsackie B grouping include fever, headache, sore throat, gastrointestinal distress, as well as chest and muscle pain. This presentation is known as pleurodynia or Bornholmes disease in many areas. Patients with chest pain should see a doctor immediately as it can progress to myocarditis or pericarditis, which result in permanent heart damage or death. Coxsackie B virus infection may also induce aseptic meningitis. As a group, they are the most common cause of unexpected sudden death, and may account for up to 50% of such cases.[5] The incubation period for the Coxsackie B viruses is, like most of the Enteroviridae, highly variable, ranging from 2 to 35 days, and illness may last for up to two weeks, but may resolve as quickly as two days. Infection usually occurs between the months of June and October.[1]

Laboratory Findings

Enterovirus infection is diagnosed mainly via serological tests such as ELISA[6] and from cell culture.[1] Because the same level and type of care is given regardless of type of Coxsackie B infection, it is mostly unnecessary for treatment purposes to diagnose which virus is causing the symptoms in question, though it may be epidemiologically useful.

Treatment

Medical Therapy

As of 2007, there is no treatment for the Coxsackie B group of viruses.[1] Pallative care is available, however, and patients suffering chest pain or stiffness of the neck should be examined for signs of cardiac or central nervous system involvement, respectively. Some measure of prevention can usually be achieved by basic sanitation on the part of food-service workers, though the viruses are highly contagious. Care should be taken in washing ones hands and in cleaning the body after swimming. In the event of Coxsackie-induced myocarditis or pericarditis, antiinflammatories can be given to reduce damage to the heart muscle. There is no vaccine for any member of the group.

Prevention

Some measure of prevention can usually be achieved by basic sanitation on the part of food-service workers, though the viruses are highly contagious. Care should be taken in washing ones hands and in cleaning the body after swimming. In the event of Coxsackie-induced myocarditis or pericarditis,antiinflammatories can be given to reduce damage to the heart muscle. There is no vaccine for any member of the group.

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 Fields, Bernard N. (1985). Fields Virology. New York: Raven Press. pp. 739–794. ISBN 0-88167-026-X. 
  2. Libby, Karen (2000). "Coxsackie B virus pathogen card". Retrieved September 2nd, 2007. 
  3. Kaplan, M. H. (1983 Nov-Dec). "Group B coxsackievirus infections in infants younger than three months of age: a serious childhood illness.". Reviews of Infectious Diseases. 5 (6): 1019–1032. 
  4. Cho SM, MacDonald S, Frontera JA (2017). "Coxsackie B3/B4-Related Acute Flaccid Myelitis.". Neurocrit Care. PMID 28324262. doi:10.1007/s12028-017-0377-8. 
  5. Maze, S. S. (1990 Feb). "Myocarditis: unresolved issues in diagnosis and treatment". Clinical Cardiology. 13 (2): 69–79. 
  6. Bell, Eleanor J. (1986). "Mu-Antibody capture elisa for the rapid diagnosis of enterovirus infections in patients with aseptic meningitis". Journal of Medical Virology. 19 (3): 213–217. 

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