Cox­sack­ievirus­es are a type of enterovirus­es and close rel­a­tives of echovirus­es (ECHO). There can be many man­i­fes­ta­tions, but the main signs, as a rule, are a sharp dete­ri­o­ra­tion in the gen­er­al con­di­tion, nau­sea, vom­it­ing, diar­rhea, and some oth­ers.

Coxsackie virus

Infec­tion with the Cox­sack­ie virus can occur with vary­ing degrees of sever­i­ty, from mild ail­ment to life-threat­en­ing con­di­tions. Of course, it is always bet­ter to pre­vent a dis­ease than to treat it after it.

Cox­sack­ievirus is a type of enterovirus and a close rel­a­tive of echovirus­es (ECHO). There can be many man­i­fes­ta­tions, but the main signs, as a rule, are a sharp dete­ri­o­ra­tion in the gen­er­al con­di­tion, nau­sea, vom­it­ing, diar­rhea, and some oth­ers.

This virus is con­sid­ered “chil­dren’s”, since chil­dren from 3 to 10 years old get sick main­ly. How­ev­er, some­times the dis­ease occurs in adults, espe­cial­ly if they have a weak­ened immune sys­tem.

Cox­sack­ievirus is a high­ly con­ta­gious RNA virus with excel­lent sur­viv­abil­i­ty and prefers the acidic envi­ron­ment of the stom­ach. How­ev­er, it set­tles not only in the human gas­troin­testi­nal tract, prac­ti­cal­ly any tis­sues and organs can become its tar­get. The ner­vous sys­tem is often affect­ed dur­ing infec­tion. But the most like­ly man­i­fes­ta­tion of infec­tion is diar­rhea, gen­er­al intox­i­ca­tion, and a char­ac­ter­is­tic rash. The dis­ease is char­ac­ter­ized main­ly by a favor­able course, how­ev­er, in some cas­es, dan­ger­ous com­pli­ca­tions devel­op.

What are the types of Coxsackie viruses and what they can cause

Cox­sack­ievirus­es are divid­ed into two groups:

The researchers observed the effect of this virus on new­ly born mice.

Cox­sack­ie A virus has caused mus­cle injury, paral­y­sis and death in rodents.

Cox­sack­ievirus type B — to organ dam­age, less severe con­se­quences. More than 24 dif­fer­ent serotypes of the virus are known to sci­ence.

Type A virus­es are the source of her­pang­i­na: painful blis­ters in the mouth, throat, arms, legs, or all of these areas. This dis­ease has a very catchy name: “hands, feet, mouth” (eng. HFMD is the com­mon name for this viral infec­tion). Cox­sack­ievirus A16 (CVA16) caus­es most cas­es of this rash in the Unit­ed States. Most often it occurs in chil­dren (aged 10 years and younger), but adults can also get sick. Type A virus also caus­es inflam­ma­tion of the eye­lids and the white area of ​​the eyes (con­junc­tivi­tis). Cox­sack­ievirus A6 (CVA6) has been the cause of her­pang­i­na in infants.

Type B virus­es are caus­ing an epi­dem­ic of pleu­ro­dy­nia (fever, mild abdom­i­nal pain with headache that lasts two to twelve days and goes away). Epi­dem­ic pleu­ro­dy­nia is also called Born­holm’s dis­ease. As many as six serotypes of the Cox­sack­ie B virus are known (1–6). Inter­est­ing­ly, the Cox­sack­ie B4 virus is even con­sid­ered by some sci­en­tists as a pos­si­ble cause of dia­betes.

Both type A and type B virus­es can cause menin­gi­tis, myocardi­tis and peri­cardi­tis, but to pre­vent pan­ic, let’s say right away that such things rarely hap­pen. In this respect, Cox­sack­ie virus dis­ease is sim­i­lar to chick­en­pox.

coxsackie virus B4

Cox­sack­ie virus B4 under the micro­scope

How can you get infected with the Coxsackie virus

Any enterovirus infec­tions are con­sid­ered dis­eases of dirty hands, and the Cox­sack­ie virus is no excep­tion.

  • You can get infect­ed with the Cox­sack­ie virus from a human car­ri­er, both sick and in the absence of signs of the dis­ease.
  • The virus is spread by the oral-fecal route — that is, it is brought into the mouth with dirty hands.
  • Enterovirus­es, includ­ing the Cox­sack­ie virus, get­ting on the oral mucosa, are absorbed into the blood and through the blood­stream are in the intestines, where the virus mul­ti­plies and exits with feces.
  • The Cox­sack­ie virus can remain viable in the exter­nal envi­ron­ment for a long time, infec­tion is pos­si­ble by air­borne droplets, through con­t­a­m­i­nat­ed prod­ucts that have not under­gone heat treat­ment, and even water.

The out­come of the infec­tion is deter­mined by the type of virus and the per­son­al char­ac­ter­is­tics of the patien­t’s body:

  1. The per­son recov­ers com­plete­ly (all viral par­ti­cles are destroyed).
  2. The process becomes chron­ic (neu­rons and inter­nal organs retain the virus indef­i­nite­ly).
  3. The patient becomes a virus car­ri­er.

How long are Coxsackie virus patients infectious?

The patient is most con­ta­gious dur­ing the first week, start­ing from the onset of the first symp­toms. How­ev­er, viable cox­sack­ievirus­es were found in the res­pi­ra­to­ry tract three weeks after the onset of the dis­ease, and were present in fae­ces even up to eight weeks, but dur­ing this time the virus­es became less infec­tious.

Thus, a per­son remains con­ta­gious with the Cox­sack­ie virus for sev­er­al weeks after recov­ery, although not as much as at the begin­ning of the dis­ease.

Who is at risk of contracting the Coxsackievirus?

Who is at risk of contracting the Coxsackievirus?

It is believed that chil­dren under 3 months of age are pro­tect­ed from this enterovirus, and after 10–12 years, almost every­one already has expe­ri­ence of infec­tion behind them, after which sta­ble immu­ni­ty is devel­oped.

Thus, chil­dren old­er than 3 months and up to 12 years of age are at risk of con­tract­ing the Cox­sack­ie virus, but the peak of the dis­ease falls on the peri­od from 3 to 10 years. It is believed that it is impos­si­ble to raise a child and nev­er encounter an enterovirus infec­tion.

In addi­tion, the Cox­sack­ie virus is dan­ger­ous for weak­ened adults:

  • preg­nant women
  • elder­ly peo­ple,
  • peo­ple who have just had anoth­er acute ill­ness or who have been debil­i­tat­ed by a chron­ic ill­ness,
  • hav­ing prob­lems with the immune sys­tem and/or tak­ing immuno­sup­pres­sive drugs (drugs that sup­press the immune sys­tem).

Symptoms and signs of Coxsackie virus infection

The incu­ba­tion peri­od is from 2 to 10 days, most often the dis­ease man­i­fests itself on the 3rd-4th day.

Starts abrupt­ly:

  • the tem­per­a­ture ris­es to 37–39 degrees and above,
  • the patient feels weak­ness and severe malaise,
  • may feel pain in the mus­cles,
  • a com­mon symp­tom is com­plaints of headache.

These are signs of gen­er­al intox­i­ca­tion, when virus­es mas­sive­ly pen­e­trate into the blood­stream. The very next day, the char­ac­ter­is­tic signs of the Cox­sack­ie virus appear:

  • small bub­bles appear on the mucous mem­brane of the mouth and throat, dam­age to the ton­sils is pos­si­ble.
  • the skin may turn red, espe­cial­ly in the upper body, and scle­ra.
  • very often in chil­dren the sub­mandibu­lar and cer­vi­cal lymph nodes are enlarged and painful.
  • the rash appears on the palms and feet, and it resem­bles chick­en­pox in terms of speed of spread and appear­ance — small bub­bles filled with liq­uid. Unlike chick­en pox, the rash does not itch or spread through­out the body, although it can appear on the but­tocks, inner fore­arm, and thighs, for exam­ple.
  • hand-foot-mouth syn­drome — a rash appears simul­ta­ne­ous­ly on the oral mucosa, palms and feet.
  • the patient feels sick and severe diar­rhea begins, up to 5–10 times a day. The stool is watery, free of mucus or blood.

hand-foot-mouth syn­drome


Also, infec­tion with the Cox­sack­ie virus can occur in sev­er­al more com­plex and dan­ger­ous forms.

1. Enterovirus exanthema.

The main dis­tin­guish­ing fea­ture of this form is a rash on the arms, chest and even the head. Emerg­ing bub­bles burst with the for­ma­tion of crusts. In these places, the skin can peel off and exfo­li­ate. At the same time, the child’s body tem­per­a­ture ris­es. This man­i­fes­ta­tion of the dis­ease is often con­fused with rubel­la or chick­en pox. But it pass­es, like the flu-like form, rather quick­ly (from 3 to 5 days) and with­out con­se­quences. This vari­ety is often called “Boston Fever”, as it was first described after an epi­dem­ic in Boston in the mid­dle of the last cen­tu­ry.

2. Herpangina

The incu­ba­tion peri­od for such an infec­tion is 1–2 weeks. In this case, the virus infects the pha­ryn­geal mucosa. Signs of the dis­ease: high fever, weak­ness, sore throat. Although this form was called angi­na, there are no symp­toms of the usu­al form of ton­sil­li­tis. The con­di­tion is exac­er­bat­ed by headache. Lymph nodes may enlarge and a run­ny nose may begin.

Unlike clas­sic ton­sil­li­tis, bub­bles with liq­uid appear on the mucous mem­brane of the ton­sils and oral cav­i­ty. After a while they burst. On exam­i­na­tion, one can observe an accu­mu­la­tion of small ero­sions cov­ered with a white coat­ing. The dis­ease is even more like stom­ati­tis than a sore throat. All symp­toms go away in about a week.


Her­pang­i­na — the oral cav­i­ty is affect­ed by the Cox­sack­ie virus

3. Hemorrhagic conjunctivitis

It devel­ops at light­ning speed — no more than 2 days pass from the moment of infec­tion to the first signs. This form of infec­tion is char­ac­ter­ized by a feel­ing of sand in the eyes, pain, pho­to­pho­bia, lacrima­tion, swelling of the eye­lids, numer­ous hem­or­rhages, and puru­lent dis­charge from the eyes. Usu­al­ly one eye is affect­ed first, then symp­toms appear in the oth­er eye. At the same time, the patient feels rel­a­tive­ly well. The ill­ness con­tin­ues for two weeks.

4. Intestinal form of Coxsackie virus

Symp­toms typ­i­cal of intesti­nal infec­tions: dark-col­ored diar­rhea (up to 8 times a day), vom­it­ing. The con­di­tion is exac­er­bat­ed by abdom­i­nal pain, fever. In young chil­dren, in addi­tion to intesti­nal symp­toms, a run­ny nose and sore throat may begin. Usu­al­ly diar­rhea lasts from 1 to 3 days, com­plete recov­ery of intesti­nal func­tions occurs after 10–14 days.

5. Polio-like form

All man­i­fes­ta­tions as in poliomyelitis. But unlike him, paral­y­sis devel­ops at light­ning speed, not so heavy, the affect­ed mus­cles recov­er quick­ly. With this form, as with oth­ers, all the clas­sic symp­toms of Cox­sack­ie virus dam­age can be not­ed: rash, fever, diar­rhea.

6. Hepatitis

Cox­sack­ievirus can attack liv­er cells. The organ increas­es in size, there is a feel­ing of heav­i­ness in the right side.

7. Pleurodynia

The dis­ease man­i­fests itself in the form of mus­cle lesions. When the virus set­tles in the mus­cles, myosi­tis devel­ops. Pain is not­ed in dif­fer­ent parts of the body. Very often, painful man­i­fes­ta­tions are local­ized in the inter­costal mus­cles. In this case, breath­ing may be dif­fi­cult, but the pleu­ra is not dam­aged, despite the name “pleu­ro­dy­nia”. When walk­ing or per­form­ing some oth­er move­ments, the pain inten­si­fies. Usu­al­ly they are undu­lat­ing in nature (repeat­ing after a cer­tain peri­od of time). There­fore, some­times this form of the dis­ease is called “dev­il’s fight.” The tem­per­a­ture may per­sist for sev­er­al days. For­tu­nate­ly, this form is quite rare.

8. Violations in the work of the heart

Endo­cardi­tis, peri­cardi­tis, myocardi­tis may devel­op. There is pain in the chest, weak­ness. The dis­ease devel­ops when infect­ed with type B virus­es. A very severe form. Blood pres­sure may drop, the tem­per­a­ture ris­es, the child con­stant­ly wants to sleep. There are also fre­quent man­i­fes­ta­tions of tachy­car­dia, short­ness of breath, arrhyth­mias, ede­ma and liv­er enlarge­ment. If the cen­tral ner­vous sys­tem is affect­ed, then con­vul­sive seizures are observed. A child can die just a few hours after the first signs appear. This form of infec­tion often devel­ops in new­borns, but may occur in old­er chil­dren and adults.

9. Serous meningitis

In anoth­er way, this type of menin­gi­tis is called viral, as it occurs as a result of a viral infec­tion. It can be caused by var­i­ous virus­es, includ­ing the Cox­sack­ie virus. With the devel­op­ment of the dis­ease, the meninges are affect­ed. Menin­gi­tis is char­ac­ter­ized by:

  • Acute onset;
  • fever;
  • mus­cle pain and cramps;
  • Gen­er­al malaise;
  • Lack of appetite;
  • abdom­i­nal pain and diar­rhea;
  • sore throat, cough, run­ny nose;
  • drowsi­ness;
  • Faint­ing;
  • Pare­sis.

The clin­i­cal pic­ture becomes less pro­nounced after 3–5 days. Time­ly iden­ti­fied and prop­er­ly treat­ed serous menin­gi­tis resolves with­out com­pli­ca­tions.

Possible Complications

It is believed that infec­tion with the Cox­sack­ievirus and echovirus is not dan­ger­ous for a child or adult, and in the vast major­i­ty of cas­es pass­es with­out con­se­quences with prop­er care.

How­ev­er, the man­i­fes­ta­tions of enterovirus­es are so diverse that the like­li­hood of com­pli­ca­tions always exists.

Much depends on the type of Cox­sack­ie virus (groups A and B), con­cen­tra­tion and luck. The dan­ger of dehy­dra­tion always exists when the patient has a fever and diar­rhea. The younger the child, the more dan­ger­ous and more like­ly dehy­dra­tion is for him. In any case, the doc­tor should make a diag­no­sis, as well as pre­scribe the appro­pri­ate treat­ment. For­tu­nate­ly, in the vast major­i­ty of cas­es, the dis­ease resolves with­out con­se­quences and with­out hos­pi­tal­iza­tion.

Impor­tant: Viral infec­tions are not treat­ed with antibi­otics! More­over, they can sig­nif­i­cant­ly wors­en the con­di­tion of the patient, espe­cial­ly the child. The doc­tor may pre­scribe antibi­otics if a bac­te­r­i­al infec­tion has joined the viral infec­tion.

Basi­cal­ly, infec­tion with the Cox­sack­ie virus pass­es with­out com­pli­ca­tions. But in some cas­es, the dis­ease has con­se­quences. The heav­i­est of them:

  • Menin­gi­tis;
  • Encephali­tis;
  • Paral­y­sis;
  • Heart fail­ure;
  • Dia­betes is insulin depen­dent.

Treatment of Coxsackie virus

If the dis­ease pro­ceeds with­out com­pli­ca­tions, then it is treat­ed in the same way as con­ven­tion­al ARVI. Basi­cal­ly, it is enough to be treat­ed at home.

At the same time, symp­to­matic treat­ment is still need­ed. Means to reduce fever, relieve itch­ing — anti­his­t­a­mines, sore throat — sprays, lozenges, etc. It is rec­om­mend­ed to pre­vent dehy­dra­tion by drink­ing liq­uids, how­ev­er, juices, fruit drinks, and acidic foods can irri­tate mouth ulcers. Cool milk will come to the res­cue, which will help soothe this pain and soothe the throat. It is use­ful to drink cool chamomile tea, as well as brew chamomile in milk.

In some cas­es, the Cox­sack­ie virus is con­fused in clin­i­cal man­i­fes­ta­tions with her­pes or bac­te­r­i­al ton­sil­li­tis and, accord­ing­ly, the anti­her­pet­ic acy­clovir and antibi­otics are pre­scribed. You need to know that acy­clovir does not help with Cox­sack­ie enterovirus at all, but it can dam­age the body, because. is hepa­to­tox­ic.

rash with coxsackie
rash with coxsackie

rash when infect­ed with the Cox­sack­ie virus An urgent call to a doc­tor is nec­es­sary if:

1. Pale­ness of the skin;
2. The appear­ance of blue on the body, near the ears, between the fin­gers;
3. The appear­ance of signs of dehy­dra­tion: lethar­gy, dry lips, decreased uri­na­tion, increased drowsi­ness, delir­i­um, dizzi­ness;
4. Sharp headache;
5. Refusal of food;
6. Long fever.

With severe infec­tion, urgent hos­pi­tal­iza­tion is nec­es­sary. Rel­a­tive­ly rare com­pli­ca­tions of cox­sack­ievirus infec­tions (for exam­ple, heart or head infec­tions) require spe­cial indi­vid­ual treat­ment, which is pre­scribed by an infec­tious dis­ease spe­cial­ist and often in a hos­pi­tal set­ting.

What specialists treat the Coxsackie virus

When symp­toms of infec­tion appear, they turn to a pedi­a­tri­cian, internist and / or infec­tious dis­ease spe­cial­ist, if the attend­ing physi­cian con­sid­ers it nec­es­sary.

Usu­al­ly Cox­sack­ie infec­tion is diag­nosed by their clin­i­cal man­i­fes­ta­tion — by symp­toms. Painful blisters—usually on the arms, legs, and in the mouth (near the mouth) com­bined with fever—are con­sid­ered grounds for a diag­no­sis of cox­sack­ievirus infec­tion. Tests for the Cox­sack­ie virus are expen­sive, the results come in approx­i­mate­ly 10 days, dur­ing which time the patient has time to recov­er and begin nor­mal activ­i­ties.

How to prevent infection: prevention of the Coxsackie virus

To date, a vac­cine against the Cox­sack­ie virus, how­ev­er, as well as from oth­er enterovirus­es, has not been received. The only pre­ven­tion is per­son­al hygiene. But since the main route of trans­mis­sion of the virus is still air­borne, then this method is not a panacea.

In gen­er­al, if there are already a lot of sick peo­ple in a set­tle­ment, doc­tors rec­om­mend stay­ing less in crowd­ed places, wash­ing your hands reg­u­lar­ly, drink­ing enough flu­ids, get­ting enough sleep and eat­ing well — these are all pos­si­ble ways to pre­vent the Cox­sack­ie virus.

Preg­nant women need to be espe­cial­ly vig­i­lant and avoid con­tact with chil­dren (or adults) with Cox­sack­ie infec­tion. Some stud­ies show that the virus can adverse­ly affect the baby.

A recov­ered per­son is immune to a par­tic­u­lar type of Cox­sack­ie virus, but this does not pro­tect him from infec­tion by oth­er types. For exam­ple, a per­son may become immune to cox­sack­ievirus type B4, but still be sus­cep­ti­ble to all oth­er types of cox­sack­ievirus­es (eg CVA16). In addi­tion, there are oth­er virus­es, such as enterovirus 71 and human enteric virus­es (ECHO), that can still cause hand-foot-mouth symp­toms. Some peo­ple may there­fore have mul­ti­ple infec­tions with rash symp­toms in these areas. At the same time, recur­ring infec­tions are known to occur rarely.

Dr. Komarovsky about the Coxsackie virus

based on mate­ri­als