Coxsackie Viruses

Signs and Symptoms:
About half of all children with coxsackie virus infection have no symptoms. Some children suddenly develop fever of 101 to 104 degrees Fahrenheit (38.33 to 40 degrees Celsius), headache, and muscle aches. Some also develop a mild sore throat, abdominal discomfort, or nausea. A child with a coxsackie virus fever may simply feel hot but have no other symptoms. In most children, the fever lasts about 3 days, then disappears; in others, the fever is biphasic: it appears for 1 day, then disappears for 2 to 3 days, then returns for 2 to 4 days more.

Besides causing a simple fever, coxsackie viruses can cause several different patterns of symptoms that affect different body parts. For example, hand, foot, and mouth syndrome, another type of coxsackie virus syndrome, causes sores on the tongue and inside the cheeks, and small blisters (3 mm to 7 mm or .11 to .28 in) on the hands and feet. Herpangina, a coxsackie virus infection of the throat, causes red-ringed blisters and ulcers on the tonsils and soft palate, the fleshy back portion of the roof of the mouth.

Coxsackie viruses can also cause myositis, a muscle infection; meningitis, an infection of the membranes that cover the brain; and encephalitis, a brain infection.

Coxsackie viruses are also a common cause of hemorrhagic conjunctivitis, an infection that affects the whites of the eyes. In hemorrhagic conjunctivitis, eye pain usually begins suddenly. The eyes water and become abnormally sensitive to light, and vision becomes blurry. The whites of the eyes become very congested, red, and swollen, with tiny areas of bleeding under the surface.

Pleurodynia (also called Bornholm disease) is a related coxsackie virus infection that causes painful spasms in the muscles of the chest and upper abdomen. Boys with pleurodynia may also have pain in the testicles beginning about 2 weeks after the chest pain starts.

Coxsackie viruses may rarely cause myocarditis (an infection of the heart muscle), especially in newborns, who can be infected from their mothers. Infants with coxsackie myocarditis develop a fever within 2 weeks after birth and have trouble breathing. They may eat poorly, move very little, and sometimes develop cyanosis - a bluish color to the skin, lips, and nails caused by too little oxygen in the blood.

Description:
The coxsackie viruses are part of the enterovirus family of viruses (including ECHO, polio, and hepatitis A viruses) that live in the human digestive tract. They can spread from person to person, usually on unwashed hands and surfaces contaminated by feces, where they can live for several days. They can even survive freezing temperatures outdoors. In tropical parts of the world, they infect humans year-round, but in cooler climates, outbreaks of coxsackie virus most often occur in the summer and fall.

Duration:
The duration of coxsackie virus infection varies, depending on the specific type. For coxsackie fever without other symptoms, 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.

Contagiousness:
Coxsackie viruses can be passed from person to person on unwashed hands and surfaces contaminated by feces. When an outbreak of coxsackie virus affects a community, risk for infection is highest among very young children. Older children may be exposed to coxsackie virus infections in summer camps and child care centers.

Incubation:
The incubation period for most coxsackie virus infections is about 2 to 10 days.

Prevention:
There is no vaccine to prevent coxsackie virus infection. Hand washing is the best prevention. Remind the members of your family to wash their hands frequently, especially after using the toilet, after changing a diaper, before meals, and before preparing food.

When to Call Your Child's Doctor:
Call your child's doctor immediately if your newborn baby develops any of the following symptoms:

• fever
• poor appetite
• trouble feeding
• vomiting
• diarrhea
• difficulty breathing
• convulsions
• unusual sleepiness

Even if your child doesn't have a fever, call your child's doctor for any of the following:

• severe pain in the muscles of the chest or abdomen
• sores on the skin or inside the mouth
• severe sore throat
• red, swollen, and watery eyes
• chest pain or shortness of breath
• severe headache, especially with vomiting, confusion, unusual sleepiness, or convulsions
• pain in one or both testicles

If you are pregnant and have a fever, call your doctor immediately, especially if you are near your due date.

Professional Treatment:
Because antibiotics only work against bacteria, they can't be used to fight a coxsackie virus infection. Most children with coxsackie virus infection recover completely in a few days. Depending on the type of infection and symptoms, your child's doctor may prescribe medications to make her feel more comfortable.

The most severe forms of coxsackie virus infection, myocarditis and encephalitis, can be fatal, especially in newborns. Even older children with coxsackie myocarditis or encephalitis may need special care in a hospital. However, these complications are rare.

Home Treatment:
Most children with a simple coxsackie fever recover completely after a few days at home. If your child has a fever without any other symptoms, she should rest in bed or play quietly indoors. Offer plenty of fluids to prevent dehydration, and give her acetaminophen (such as Tylenol) to relieve any minor aches and pains. If the fever lasts for more than 24 hours, or your child has any symptoms of a more serious coxsackie infection, call your child's doctor.

A mixture of 1 teaspoon each of mylanta, kaopectate and benadryl (that you make up yourself) can be painted on the inside of the mouth and will provide some additional comfort before meals. Cool/ cold liquids and frozen deserts are always helpful. Sometimes we prescribe narcotics such as Tylenol with codeine in severe cases.