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CoxsackievirusesCoxsackieviruses
an updatean update
Dr.T.V.Rao MD
Dr.T.V.Rao MD 1
History of Coxsackieviruses
• The Coxsackieviruses
were discovered in
1948-49 by Dr.
Gilbert Dalldorf, a
scientist working...
Coxsackie, New York
• The virus family
discovered was
eventually given the
name Coxsackie, for
the town of Coxsackie,
New ...
The Virus belongs to ..
• Coxsackievirus is a virus that belongs to a
family of nonenvelopedd, linear,
positive-sense ssRN...
Coxsackie's belongs toCoxsackie's belongs to
EnterovirusEnterovirus
Dr.T.V.Rao MD 5
Coxsackievirus spreadCoxsackievirus spread
• They can spread
from person to
person, usually on
unwashed hands
and surfaces...
Coxsackievirus
• Coxsackievirus (sometimes written
as two words, Coxsackie's virus)
belongs to a group of viruses called
e...
The Virus belongs to Two
Groups
• Coxsackievirus are divided into group A and
group B viruses based on early observations ...
Coxsackie's virus Infects Suckling Mice but not
Adult Mice
Dr.T.V.Rao MD 9
Several Serotypes
• At least 23
serotypes (1-
22, 24) of
group A and 6
serotypes (1-6)
of group B are
recognized
Dr.T.V.Ra...
Sources of Coxsackie's viral
infections
• Infection usually is spread
by fecal-oral contamination,
although occasionally t...
Coxsackie virus spread through
• They can spread
from person to
person, usually on
unwashed hands
and surfaces
contaminate...
Diseases Caused byDiseases Caused by
CoxsackievirusCoxsackievirus• Herpangina
–coxsackie A virus
• Hand-foot-and-mouth dis...
Pathophysiology
of Coxsackie's virus
• Coxsackieviruses are transmitted primarily via the
fecal -oral route and respirator...
Symptoms related toSymptoms related to
CoxsackievirusCoxsackievirus
• Upper respiratory tract symptoms, including
sore thr...
Coxsackie virus infection present with
• Both group A and
group B
Coxsackievirus can
cause nonspecific
febrile illnesses,
...
Coxsackie virus infection present with
• In general, group A
coxsackieviruses
tend to infect the
skin and mucous
membranes...
Coxsackie virus – Can cause
Acute haemorrhagic
conjunctivitis
• Rare complications
include keratitis and
motor paralysis.
...
Hand, Foot, and Mouth Disease
• Type of Coxsackie Virus
syndrome
• Causes painful red
blisters on:
– Throat
– Tongue
– Gum...
Coxsackievirus syndrome
• Hand, foot, and mouth
disease, a type of
Coxsackievirus
syndrome, causes
painful red blisters in...
Herpangina,
• Herpangina, an
infection of the
throat which causes
red-ringed blisters
and ulcers on the
tonsils and soft
p...
Hand, Foot, and Mouth DiseaseHand, Foot, and Mouth Disease
• Hand, foot and mouth disease usually
affects infants and chil...
Hand, Foot, and Mouth DiseaseHand, Foot, and Mouth Disease
• Although HFM is most
often associated with
Coxsackievirus A16...
Myocarditis can be a serious diseaseMyocarditis can be a serious disease
• Group B
Coxsackievirus tend
to infect the heart...
Coxsackie B3 - MyocarditisCoxsackie B3 - Myocarditis
• Coxsackie B3 has been
found to be one of the main
causes of certain...
Born Holm disease present with…Born Holm disease present with…
• Pain on inspiration is similar
to Pleuritic pain and
pulm...
Difficult to Diagnose ?
• Many infections are caused by Coxsackie
viruses, most of which are never diagnosed
precisely.
• ...
Emerging Diagnostic Methods
• All the Conjunctival swabs from Coxsackievirus
A24 variant related outbreak and the 41
Coxsa...
Is Coxsackie Contagious?
• VERY contagious
• Passed on by:
–Unwashed hands
–Surfaced
contaminated by
feces
–Sneezes or cou...
To prevent spread into society
• Children who feel ill or have a
fever should be excluded from
group settings until the fe...
Treatment and Prevention
• Treatment usually
consists of simple
analgesia for sore
throat/aches,
adequate fluid
intake, an...
FDA-approved specific therapyFDA-approved specific therapy
• While there is no FDA-
approved specific
therapy for
Coxsacki...
Newer treatments ?
• Specific antiviral
therapy such as
Pleconaril shows
promise in the
treatment of meningitis
and other ...
Prevention
• Coxsackie virus is
transmitted by
contamination with
feces, which means you
can catch the virus by
touching y...
• Programme Created by Dr.T.V.Rao MD
for Medical and Paramedical Students in
the Developing World
• Email
• doctortvrao@gm...
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Coxsackieviruses an update

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  1. 1. CoxsackievirusesCoxsackieviruses an updatean update Dr.T.V.Rao MD Dr.T.V.Rao MD 1
  2. 2. History of Coxsackieviruses • The Coxsackieviruses were discovered in 1948-49 by Dr. Gilbert Dalldorf, a scientist working at the New York State Department of Health in Albany, New York. Dr.T.V.Rao MD 2
  3. 3. Coxsackie, New York • The virus family discovered was eventually given the name Coxsackie, for the town of Coxsackie, New York, a small town on the Hudson River where Dalldorf had obtained the first faecal specimens Dr.T.V.Rao MD 3
  4. 4. The Virus belongs to .. • Coxsackievirus is a virus that belongs to a family of nonenvelopedd, linear, positive-sense ssRNA viruses, Picornaviridae and the genus Enterovirus, which also includes poliovirus and echovirus. Enterovirus are among the most common and important human pathogens, and ordinarily its members are transmitted by the fecal-Dr.T.V.Rao MD 4
  5. 5. Coxsackie's belongs toCoxsackie's belongs to EnterovirusEnterovirus Dr.T.V.Rao MD 5
  6. 6. Coxsackievirus spreadCoxsackievirus spread • They can spread from person to person, usually on unwashed hands and surfaces contaminated by feces, where they can live for several days. Dr.T.V.Rao MD 6
  7. 7. Coxsackievirus • Coxsackievirus (sometimes written as two words, Coxsackie's virus) belongs to a group of viruses called enterovirus. Coxsackievirus infections occur most often during summer and fall • Coxsackievirus infections occur most often in young children, Dr.T.V.Rao MD 7
  8. 8. The Virus belongs to Two Groups • Coxsackievirus are divided into group A and group B viruses based on early observations of their pathogenicity in mice. Group A coxsackieviruses were noted to cause a flaccid paralysis (which was caused by generalized myositis) while group B coxsackieviruses were noted to cause a spastic paralysis (due to focal muscle injury and degeneration of neuronal tissue). At least 23 serotypes (1-22, 24) of group A and six serotypes (1- 6 of group B are recognized. Dr.T.V.Rao MD 8
  9. 9. Coxsackie's virus Infects Suckling Mice but not Adult Mice Dr.T.V.Rao MD 9
  10. 10. Several Serotypes • At least 23 serotypes (1- 22, 24) of group A and 6 serotypes (1-6) of group B are recognized Dr.T.V.Rao MD 10
  11. 11. Sources of Coxsackie's viral infections • Infection usually is spread by fecal-oral contamination, although occasionally the virus is spread by droplets expelled by infected individuals. Items like utensils, diaper-changing tables, and toys that come in contact with body fluids that contain the virus may also transmit them to other individuals Dr.T.V.Rao MD 11
  12. 12. Coxsackie virus spread through • They can spread from person to person, usually on unwashed hands and surfaces contaminated by feces, where they can live for several days.Dr.T.V.Rao MD 12
  13. 13. Diseases Caused byDiseases Caused by CoxsackievirusCoxsackievirus• Herpangina –coxsackie A virus • Hand-foot-and-mouth disease –Coxsackievirus A16 and enterovirus 71 • Pleurodynia –coxsackie B virus • Myocardial and pericardial infections –coxsackie B virus. (B3) • Viral meningitis –Coxsackievirus or echovirus Dr.T.V.Rao MD 13
  14. 14. Pathophysiology of Coxsackie's virus • Coxsackieviruses are transmitted primarily via the fecal -oral route and respiratory aerosols, although transmission via fomites is possible. The viruses initially replicate in the upper respiratory tract and the distal small bowel. They have been found in the respiratory tract up to 3 weeks after initial infection and in feces up to 8 weeks after initial infection. The viruses have been found to replicate in the sub mucosal lymph tissue and disseminate to the Reticuloendothelial system. Further dissemination to target organs occurs following a secondary Viremia. Dr.T.V.Rao MD 14
  15. 15. Symptoms related toSymptoms related to CoxsackievirusCoxsackievirus • Upper respiratory tract symptoms, including sore throat, rhinitis, and dry cough • Constitutional symptoms, including headaches (50%), fever, and malaise • GI symptoms, including nausea, vomiting, diarrhea (50%); abdominal pain (usually in the epigastria area) in children • Testicular pain (i.e., orchids) in 10% of male Dr.T.V.Rao MD 15
  16. 16. Coxsackie virus infection present with • Both group A and group B Coxsackievirus can cause nonspecific febrile illnesses, rashes, upper respiratory tract disease, and aseptic meningitis Dr.T.V.Rao MD 16
  17. 17. Coxsackie virus infection present with • In general, group A coxsackieviruses tend to infect the skin and mucous membranes, causing herpangina, acute haemorrhagic conjunctivitis (AHC), and hand-foot-and- mouth (HFM) disease Dr.T.V.Rao MD 17
  18. 18. Coxsackie virus – Can cause Acute haemorrhagic conjunctivitis • Rare complications include keratitis and motor paralysis. • This condition is highly contagious and has resulted in epidemics and pandemics. Dr.T.V.Rao MD 18
  19. 19. Hand, Foot, and Mouth Disease • Type of Coxsackie Virus syndrome • Causes painful red blisters on: – Throat – Tongue – Gums – Cheeks – Palms of hands – Soles of Feet Dr.T.V.Rao MD 19
  20. 20. Coxsackievirus syndrome • Hand, foot, and mouth disease, a type of Coxsackievirus syndrome, causes painful red blisters in the throat and on the tongue, gums, hard palate, inside of the cheeks, and the palms of hands and soles of the feet. Dr.T.V.Rao MD 20
  21. 21. Herpangina, • Herpangina, an infection of the throat which causes red-ringed blisters and ulcers on the tonsils and soft palate, the fleshy back portion of the roof of the mouth. Dr.T.V.Rao MD 21
  22. 22. Hand, Foot, and Mouth DiseaseHand, Foot, and Mouth Disease • Hand, foot and mouth disease usually affects infants and children, and is quite common. It is highly contagious and is spread through direct contact with the mucus or faeces of an infected person. It typically occurs in small epidemics in nursery schools or kindergartens, usually during the summer and autumn months. Dr.T.V.Rao MD 22
  23. 23. Hand, Foot, and Mouth DiseaseHand, Foot, and Mouth Disease • Although HFM is most often associated with Coxsackievirus A16, the process does occur with other enterovirus strains (enterovirus 71 & others). A child will develop immunity to an individual strain after an illness but be susceptible to other unrelated strains,. Dr.T.V.Rao MD 23
  24. 24. Myocarditis can be a serious diseaseMyocarditis can be a serious disease • Group B Coxsackievirus tend to infect the heart, pleura, pancreas, and liver, causing Pleurodynia, myocarditis, pericarditis, and hepatitis Dr.T.V.Rao MD 24
  25. 25. Coxsackie B3 - MyocarditisCoxsackie B3 - Myocarditis • Coxsackie B3 has been found to be one of the main causes of certain debilitating or life- threatening diseases, such as viral myocarditis. • In about 20% of the cases, there can be progressive disease or recurrence of symptoms; the heart damage can be extensive, causing arrhythmias, weakened left ventricular functions Dr.T.V.Rao MD 25
  26. 26. Born Holm disease present with…Born Holm disease present with… • Pain on inspiration is similar to Pleuritic pain and pulmonary embolism may be suspected. • The muscles are locally tender. • There will be no haemoptysis. • There may be a slight sensation of dyspnoea or pain on breathing • Born Holm word is a place where the disease is identified.Dr.T.V.Rao MD 26
  27. 27. Difficult to Diagnose ? • Many infections are caused by Coxsackie viruses, most of which are never diagnosed precisely. • Coxsackie type A usually is associated with surface rashes (exanthemas) while type B typically causes internal symptoms (Pleurodynia, myocarditis) but both can also cause paralytic disease or mild respiratory tract infection. The latter can be caused by several Coxsackie virus types and by Echoviruses and the symptoms are much like a rhinovirus infectionDr.T.V.Rao MD 27
  28. 28. Emerging Diagnostic Methods • All the Conjunctival swabs from Coxsackievirus A24 variant related outbreak and the 41 Coxsackievirus A24 variant strains were tested positive by the RT-PCR assay within 4 h. This novel single-tube real-time RT-PCR assay is sensitive and specific, and consists in a reliable and faster alternative to the viral culture for recent and future acute haemorrhagic conjunctivitis outbreaks caused by Coxsackievirus A24 variant.Dr.T.V.Rao MD 28
  29. 29. Is Coxsackie Contagious? • VERY contagious • Passed on by: –Unwashed hands –Surfaced contaminated by feces –Sneezes or coughs Dr.T.V.Rao MD 29
  30. 30. To prevent spread into society • Children who feel ill or have a fever should be excluded from group settings until the fever is gone and the child feels well. Thorough hand washing and care with diaper changing practices is important. Dr.T.V.Rao MD 30
  31. 31. Treatment and Prevention • Treatment usually consists of simple analgesia for sore throat/aches, adequate fluid intake, and rest There is no vaccine against the Coxsackie's virus Dr.T.V.Rao MD 31
  32. 32. FDA-approved specific therapyFDA-approved specific therapy • While there is no FDA- approved specific therapy for Coxsackievirus infection, a recent study demonstrated that fluoxetine (marketed as Prozac in the US) appears to inhibit replication of viral RNA in vitro. Dr.T.V.Rao MD 32
  33. 33. Newer treatments ? • Specific antiviral therapy such as Pleconaril shows promise in the treatment of meningitis and other life threatening infections due to enterovirus. • However, the safety or efficacy of this drug to be considered with more tails Dr.T.V.Rao MD 33
  34. 34. Prevention • Coxsackie virus is transmitted by contamination with feces, which means you can catch the virus by touching your mouth or eating without thoroughly washing your hands. Good hand wash reduces the spread of infection in society Dr.T.V.Rao MD 34
  35. 35. • Programme Created by Dr.T.V.Rao MD for Medical and Paramedical Students in the Developing World • Email • doctortvrao@gmail.comdoctortvrao@gmail.com Dr.T.V.Rao MD 35
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