Coxsackie 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]

Coxsackie Virus

Overview

Classification

Coxsackie A virus
Coxsackie B virus
Coxsackie B4 virus

Differential Diagnosis

Overview

Coxsackie (virus) is a cytolytic virus of the picornaviridae family, an enterovirus (a group containing the polioviruses, coxsackieviruses, and echoviruses). There are 61 non-polio enteroviruses that can cause disease in humans, of which 23 are coxsackie A viruses (6 are Coxsackie B viruses). Enterovirus are the second most common viral infectious agents in humans (after the rhinoviruses)

Classification

Coxsackie viruses consist of coxsackie A virus and coxsackie B virus. Coxsackie B virus has 6 serotypes, one of the significant serotypes is called coxsackie B4 virus.

 
 
 
 
 
 
 
 
 
 
 
 
Coxsackie Virus
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Coxsackie A virus
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Coxsackie B virus[1]
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Common Coxsackie B virus diseases
 
 
 
 
 
Coxsackie B4 virus diseases
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hand, foot and mouth disease
Acute hemorrhagic conjunctivitis
Herpangina
Aseptic meningitis
 
 
 
 
 
 
 
 
 
 
 
Pericarditis
Myocarditis
Pericardial effusion
Pleurodynia
Hepatitis
Sjogren's syndorme
 
 
 
 
 
Diabetes mellitus
• Acute flaccid myelitis[2]
 
 

Differential Diagnosis

Coxsackie A virus and coxsackie B virus can cause multiple diseases in humans. The wide array of diseases caused by coxsackie viruses can be differentiated from one another easily on the basis of involvement of the organs systems, clinical presentation and diagnostic techniques.

Virus Type Disease Clinical Features Diagnosis Image
Coxscakie A virus Hand foot and mouth disease Hand foot and mouth disease
Acute hemorrhagic conjunctivitis
  • Rapidly progressive
  • Infection starts ipsilaterally, but rapidly involves the fellow eye within 1 or 2 days
  • Eyelids swelling
  • Tearing
  • Eye redness
  • Severe eye pain
  • Purulent discharge
  • Subconjunctival hemorrhage
Viral conjunctivitis
Herpangina
  • Primarily clinical
  • Pharyngeal viral cultures may be helpful
  • Approximately 1 week after infection, type-specific antibodies appear in the blood
Herpangina
Aseptic Meningitis
Coxsackie B virus Pericarditis Pericarditis
Myocarditis 400px
Pericardial effusion
  • Clinical
  • Thoracic X-ray showing the presence of an enlarged cardiac silhouette with clear lungs
  • CT scan
Pericardial effusion
Pleurodynia
  • Fever
  • Headache
  • Attacks of severe pain in the lower chest, often on one side
  • Pleuritic pain with the slightest movement of the rib cage
  • Dyspnea
  • Very few have classic muscle pain in the chest and upper abdomen
  • May be accompanied by a panic attack
Hepatitis
Sjogren's syndrome Sjogren's syndrome


Coxsackie virus oral lesions must be differentiated from other mouth lesions such as oral candidiasis and aphthous ulcer

Oral Involvement

Oral lesions of coxackie virus infection must be differentiated from other diseases causing oral lesions such as leukoplakia and herpes simplex virus infection.

Disease Presentation Risk Factors Diagnosis Affected Organ Systems Important features Picture
Diseases predominantly affecting the oral cavity
Oral Candidiasis
  • Denture users
  • As a side effect of medication, most commonly having taken antibiotics. Inhaled corticosteroids for the treatment of lung conditions (e.g, asthma or COPD) may also result in oral candidiasis which may be reduced by regularly rinsing the mouth with water after taking the medication.
  • Clinical diagnosis
  • Confirmatory tests rarely needed
Localized candidiasis

Invasive candidasis

Tongue infected with oral candidiasis - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg
Herpes simplex oral lesions
  • Stress
  • Recent URTI
  • Female sex
  • The symptoms of primary HSV infection generally resolve within two weeks
Oral herpes simplex infection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg
Aphthous ulcers
  • Painful, red spot or bump that develops into an open ulcer
  • Physical examination
  • Diagnosis of exclusion
  • Oral cavity
  • Self-limiting , Pain decreases in 7 to 10 days, with complete healing in 1 to 3 weeks
Apthous ulcer on the lower surface of the tongue - By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358
Squamous cell carcinoma
Squamous cell carcinoma - By Luca Pastore, Maria Luisa Fiorella, Raffaele Fiorella, Lorenzo Lo Muzio - http://www.plosmedicine.org/article/showImageLarge.action?uri=info%3Adoi%2F10.1371%2Fjournal.pmed.0050212.g001, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=15252632
Leukoplakia
  • Vulvar lesions occur independent of oral lesions
Leukoplakia - By Aitor III - Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=9873087
Melanoma
Oral melanoma - By Emmanouil K Symvoulakis, Dionysios E Kyrmizakis, Emmanouil I Drivas, Anastassios V Koutsopoulos, Stylianos G Malandrakis, Charalambos E Skoulakis and John G Bizakis - Symvoulakis et al. Head & Face Medicine 2006 2:7 doi:10.1186/1746-160X-2-7 (Open Access), [1], CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=9839811
Fordyce spots
Fordyce spots - Por Perene - Obra do próprio, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=19772899
Burning mouth syndrome
Torus palatinus
Torus palatinus - By Photo taken by dozenist, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=846591
Diseases involving oral cavity and other organ systems
Behcet's disease
Crohn's disease
Agranulocytosis
Syphilis[6]
Coxsackie virus
  • Symptomatic treatment
Coxsackie virus stomatitis - Adapted from Dermatology Atlas.[7]
Chicken pox
Chickenpox - By James Heilman, MD - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=52872565
Measles
  • Unvaccinated individuals[8][9]
  • Crowded and/or unsanitary conditions
  • Traveling to less developed and developing countries
  • Immunocompromized
  • Winter and spring seasons
  • Born after 1956 and never fully vaccinated
  • Health care workers
  1. Fields, Bernard N. (1985). Fields Virology. New York: Raven Press. pp. 739–794. ISBN 0-88167-026-X. Unknown parameter |coauthors= ignored (help)
  2. Cho SM, MacDonald S, Frontera JA (2017). "Coxsackie B3/B4-Related Acute Flaccid Myelitis". Neurocrit Care. doi:10.1007/s12028-017-0377-8. PMID 28324262.
  3. Smith SC, Ladenson JH, Mason JW, Jaffe AS (1997). "Elevations of cardiac troponin I associated with myocarditis. Experimental and clinical correlates". Circulation. 95 (1): 163–8. PMID 8994432.
  4. Ann M. Gillenwater, Nadarajah Vigneswaran, Hanadi Fatani, Pierre Saintigny & Adel K. El-Naggar (2013). "Proliferative verrucous leukoplakia (PVL): a review of an elusive pathologic entity!". Advances in anatomic pathology. 20 (6): 416–423. doi:10.1097/PAP.0b013e3182a92df1. PMID 24113312. Unknown parameter |month= ignored (help)
  5. Andrès E, Zimmer J, Affenberger S, Federici L, Alt M, Maloisel F. (2006). "Idiosyncratic drug-induced agranulocytosis: Update of an old disorder". Eur J Intern Med. 17 (8): 529–35. Text "pmid 17142169" ignored (help)
  6. title="By Internet Archive Book Images [No restrictions], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File:A_manual_of_syphilis_and_the_venereal_diseases%2C_(1900)_(14595882378).jpg"
  7. "Dermatology Atlas".
  8. Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE (2000). "Individual and community risks of measles and pertussis associated with personal exemptions to immunization". JAMA. 284 (24): 3145–50. PMID 11135778.
  9. Ratnam S, West R, Gadag V, Williams B, Oates E (1996). "Immunity against measles in school-aged children: implications for measles revaccination strategies". Can J Public Health. 87 (6): 407–10. PMID 9009400.


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