Coxsackieviruses and echoviruses are enteroviruses that can cause aseptic meningitis and other diseases. They are spherical, non-enveloped viruses that infect the intestines and respiratory tract. Common illnesses include hand-foot-and-mouth disease, herpangina, myocarditis, and pleurodynia. While symptoms are generally mild and self-limiting, last several days, in rare cases they can cause long-term complications like diabetes. Diagnosis involves identifying viruses from stool or throat swabs using PCR or serum antibody tests. Treatment is supportive with fluids and acetaminophen for fever.

1. Coxsackievirus

2. LEARNING OBJECTIVES
1. Enumerate the viruses causing aseptic
meningitis
2. Describe the important characteristics &
virulence factor of Coxackie and echoviruses and
their clinical significance
3. Enumerate the diseases caused by
coxackie viruses & echoviruses
4. Describe the pathogenicity and lab
diagnosis of coxackie viruses & echoviruses

3. Aseptic causes of Meningitis
Viruses that cause meningitis include
1. Enteroviruses (Coxasckie & Echo viruses)
2. Mumps
3. Herpesvirus, including Epstein-Barr virus,
herpes simplex viruses, varicella-zoster
virus (which also causes chicken pox and
shingles), measles, and influenza
4. arboviruses ( spread through mosquitoes
and other insects)
5. In rare cases LCMV (lymphocytic
choriomeningitis virus), which is spread by
rodents, can cause viral meningitis

4. Enteroviruses
Virus family Serotypes
Polio 1-3
Coxsackie A 1-22, 24
Coxsackie B 1-6
Echovirus
Enteric, cytopathic, human, orphan
1-9, 11-27, 29-34
Hepatitis A Enterovirus 72
Other Enteroviruses 68-71

5. • Kayla Nicole
Clingerman of
Woollum, KY
was tragically
taken from us at
the age of 6
from Viral
Meningitis.
October 13,
1997 - October
11, 2004

6. • This is a picture
of Seven month
old Olivia Grace
Hamilton at
Cayuga Lake in
2004. Viral
Meningitis.
tragically took
her life.

7. Introduction
• Late summer or early fall…It’s not yet cold or flu
season, but your child is sick. Consider coxsackie
virus.
• It’s often the culprit when parents leave a
doctor’s appointment without knowing what
disease their child has.

8. Definition
• Coxsackie viruses, a family of enteroviruses. These
viruses share in common that they infect the human
intestines (and stool), but they can cause symptoms
throughout the body.
• Coxsackie viruses are typical enteroviruses, with a
diameter of 28 nm.

9. Common biological properties
• 24-30nm
• spherical
• naked, icosahedral
• +ssRNA
• multiply in the cytoplasm
• Resistance
– resistant -- ether, acid (tolerate pH3-5)
– sensitive -- drying, heat and UV
– survive for a long period in water and sewage

10. • spherical,20-30nm.
• Icosahedral
symmetry,
• non-enveloped.
• Capsid:VP1-VP4
• +ssRNA.

11. Features of coxsackievirus infection
in man
• Coxsackievirus A 1-24
• Asptic meningitis
• Febrile illness
• Herpangina
• Hand-foot-and-mouth disease
• Coxsackievirus B 1-6
• Neonatal disease
• Myocarditis, hepatitis
• Meningitis

12. COXSACKIE VIRUSES
They produce a variety of ill­nesses in human beings,
including aseptic meningitis, herpangina, pleurodynia,
hand, foot, and mouth disease, myo­ and pericarditis,
common colds, and possibly diabetes.
Coxsackie viruses have been divided into 2 groups,
A and B, having different pathogenic potentials for
mice. Coxsackie B viruses are the most commonly
identified causative agents of viral heart disease in
humans.

13. Group A viruses produce widespread myositis
in the skeletal muscles of newborn mice,
resulting in flaccid paralysis without other
observable lesions.
Group B viruses may produce focal myositis,
encephalitis, and, most typically, necrotizing
steatitis involving mainly fetal fat lobules.

14. Pathogenesis of enterovirus infection
Rhino,echo,
coxsackie,polio
Replication in
oropharynx
Primary viremia
Target
Tissue
Secondary
viremia
Skin Muscle Brain Meninges Liver
Echo
Coxsackie
A
Echo
Coxsackie
A, B
Polio
Coxsackie
Echo
Polio
Coxsackie
Echo
Coxsackie

16. Pathogenic mechanism
• CV are characterized by their ability to cause CPE in
tissue culture and by their capacity to initiate acute
disease by inducing apoptosis within targeted organs in
vivo. So,these viruses are considered highly cytolytic.
• CV can establish persistence in susceptible cells,
indicating that a regulatory mechanism may exist to
shut off viral protein synthesis and replication under
certain situations.
 To cell

17. • Basically, the virus confuses the body's defence system.
• First, the body detects the presence of an enemy using its
antigen recognition system. The virus, meanwhile, may mimic
the protein structure of the heart muscle, and sometimes, may
even interact and alter the antigenic configuration there.
• Second, the body's defence system reads the signals wrongly. It
deploys killer white cells to attack the enemy. The white cells do
two things. One, it fires virus-seeking missiles called antibodies
to neutralise Coxsackie B and removes it. Two, the white cells
also attack the wrong target: the heart. the white cells attack
one of its own life support systems.
To defence system

18. Immunity
• Serum IgA is very important to resist
absorption and replication of virus in
alimentery tract.
• Neutralizing Ab in serum can prevent the
diffusion of virus,which can last for several
years,even all the life.
• .

19. Incubation
• The incubation period (the time between
infection and the onset of symptoms) for most
coxackie virus infections is about 2 to 10 days

20. Transmission
• Coxsackieviruses are present both in the stool
and in the respiratory secretions
Fecal-oral transmission
Droplet transmission
Contact transmission

21. symptoms
• Hand-foot-and-mouth disease
mainly affecting young children
• Rash.
• Nonspecific fever, headache
• Herpangina.
• Respiratory Infection.
• Gastrointestinal Infection.

22. Herpangina:
There is an abrupt onset of fever, sore throat,
anorexia, dysphagia, vomiting, or abdominal
pain. The pharynx is usually hyperaemic, and
characteristic discrete vesicles occur on the
anterior pillars of the fauces, the palate,
uvula, tonsils, or tongue. The illness is self-
limited and most frequent in small children.
Summer Minor Illnesses:
It occur during the summer or fall and are
without distinctive features.

23. Pleurodynia (Epidemic Myalgia, Bornholm
Disease): by group B viruses--- Fever,
malaise, head-ache, and anorexia. chest pain
(substernal), is intensified by movement,
Abdominal pain occurs in approximately half
of cases, and in children this may be the chief
complaint.

24. Aseptic Meningitis and Mild Paresis:
Fever, malaise, headache, nausea, and
abdominal pain are common early symptoms.
Signs of meningeal irritation, stiff neck or
back, and vomiting may appear 1-2 days
later.
Neonatal Disease: Neonatal disease may be
caused by group B coxsackieviruses. with
lethargy, feeding difficulty, and vomiting, with
or without fever.

25. Colds: A number of the enteroviruses have
been associated with common colds; among
these are coxsackieviruses A10, A21, A24,
and B3.
Hand, Foot, and Mouth Disease:
The syndrome is characterized by oral and
pharyngeal ulcerations and a vesicular rash
of the palms and soles that may spread to
the arms and legs

26. Hand-foot-and-mouth disease

28. Exanthems – Rubelliform rashes

29. Hand-foot-and-mouth disease

30. • rash
 conjunctivitis
 Herpangina

31. • Meningitis  Viral myocarditis

32. Duration
• The duration usually varies, depending on the
specific type.
• Coxsackie fever often asymptoms, 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.

33. Myocardiopathy: Coxsackie virus B infections
are increasingly recognized as a cause of
primary myocardial disease in adults as well as
children.
Acute Hemorrhagic Conjunctivitis:
Coxsackievirus A24 is one of the agents that
can cause this disease (see below).
Diabetes Mellitus: Serologic studies suggest
an association of diabetes of abrupt onset with
past infection by Coxsackievirus B4 and
perhaps other members of the B group.

34. Diagnose
• Diagnosis is made based on the history and physical
exam
• Lab tests are available
test stool or fluids from the back of the throat
• Serum test for specific Ab
• PCR for viral nucleic acid

35. Treatment
• Antibiotics do not help with coxsackievirus
infections
• Plenty of fluids is useful
• Acetaminophen (such as Tylenol) may be
given to relieve any minor aches and pains
• Most children with a simple coxsackie
infection recover completely after a few days
at home.

36. ECHOVIRUSES
The echoviruses (enteric cytopathogenic human
orphan viruses) are grouped together because they
infect the human enteric tract and because they can
be recovered from humans only by inoculation of
certain tissue cultures.
Over 30 serotypes are known, but not all cause
human illness. Aseptic meningitis, febrile illnesses
with or without rash, common colds, and acute
hemorrhagic conjunctivitis are among the diseases
caused by echoviruses.

37. Important Characteristics
• Echoviruses are typical enteroviruses
measuring 24-30 nm.
• Not produce diseases in sucking mice, rabbits,
or monkeys;
• Cause aseptic meningitis, infantile diarrhea,
• Monkey kidney and human embryonated
kidney cell culture