CoxsackievirusesDr.T.V.Rao MD

1. Coxsackieviruses
Dr.T.V.Rao MD
Dr.T.V.Rao MD 1

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. 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. 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 faecal-oral route.
Dr.T.V.Rao MD 4

5. Coxsackie's belongs to
Enterovirus
Dr.T.V.Rao MD 5

6. Coxsackievirus 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. 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. 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)
Dr.T.V.Rao MD 8

9. Group B coxsackieviruses
• 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 9

10. Coxsackie's virus Infects Suckling Mice but not
Adult Mice
Dr.T.V.Rao MD 10

11. 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 11

12. Sources of Coxsackie's viral
infections
• Infection usually is spread
by faecal-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 12

13. 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 13

14. Diseases Caused by
Coxsackievirus
• 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 14

15. Pathophysiology
of Coxsackie's virus
• Coxsackieviruses are transmitted
primarily via the faecal -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.
Dr.T.V.Rao MD 15

16. Pathophysiology
• 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 16

17. Symptoms related to
Coxsackievirus
• 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 17

18. 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 18

19. 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 19

20. 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 20

21. 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 21

22. 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 22

23. 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 23

24. Hand, 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 24

25. Hand, 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 25

26. Myocarditis 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 26

27. Coxsackie 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.
Dr.T.V.Rao MD 27

28. 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 28

29. 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.
Dr.T.V.Rao MD 29

30. 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.
Dr.T.V.Rao MD 30

31. Is Coxsackie Contagious?
• VERY contagious
• Passed on by:
–Unwashed hands
–Surfaced
contaminated by
feces
–Sneezes or coughs
Dr.T.V.Rao MD 31

32. 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 32

33. 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 33

34. FDA-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 34

35. 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 35

36. 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 36

37. ECHOVIRUSES
Dr.T.V.Rao MD 37

38. ECHOVIRUSES
• Not asociated with any particular diseases
called as Orphans
• Described as Enteric cytopathogenic Human
orphan viruses
• Describe as 34 serotypes
• Number 10 A Reovirus
• Number 28 as Rhinovirus
Dr.T.V.Rao MD 38

39. Clinical Features
• Many manifest with
Asymptomatic
• Clinical features are like Coxsackie
virus infections
• Aseptic meningitis
• Feco oral transmission
Dr.T.V.Rao MD 39

40. Laboratory Diagnosis
• Feces , throat
swabs , CSF
inoculated into
monkey kidney
tissue cultures
Dr.T.V.Rao MD 40

41. New Entero virus types
68 - 71
• 68 from Pharyngeal secretions,
• Type 70 associated with Acute
haemorrhagic conjunctivitis
• Type 71 meningitis and
Encephalitis
Dr.T.V.Rao MD 41

42. Acute Haemorrhagic Conjunctivitis
• India and middle east
countries
• Incubation 24 hours
• Sudden swelling,
congestion, watering an
d pain the eye
• May be like polio
• Caused by EV type 70
• Grows I He la cells
Dr.T.V.Rao MD 42

43. Rhinovirus
Dr.T.V.Rao MD 43

44. Common cold Pharyng Tracheobronchitis Pneumonia
RHINOVIRUSES
INFLUENZA type A
INFLUENZA type B
CORONAVIRUSES
ADENOVIRUSES (types 1-5,7)
EPSTEIN-BARR VIRUS
RSV
PARAINFLUENZA (types 1-3)
COXSACKIE (group A & B)
ECHOVIRUS
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Viral Organisms in U.R.I.
Adults
Dr.T.V.Rao MD 44

45. Coryza Pharyngitis Croup Tr.bronchitis Pneumonia
RSV
PARAINFLUENZA (type 3)
PARAINFLUENZA (type 2)
PARAINFLUENZA (type 1)
RHINOVIRUSES
INFLUENZA type A
INFLUENZA type B
ADENOVIRUSES (types 1-3,5)
CORONAVIRUSES
EPSTEIN-BARR VIRUS
COXSACKIE (group A & B)
ECHOVIRUS
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Viral Organisms in U.R.I.
Children
Dr.T.V.Rao MD 45

46. Rhinoviruses
• Rhinoviruses (from the Greek (gen.) "nose")
are the most common viral infective agents in
humans and are the predominant cause of the
common cold. Rhinovirus infection
proliferates in temperatures between 33–35
°C (91–95 °F), and this may be why it occurs
primarily in the nose. Rhinovirus is a species in
the genus Enterovirus of the Picornaviridae
family of viruses.
Dr.T.V.Rao MD 46

47. Viral Rhinitis
 sites infected
Rhinovirus nose > pharynx > saliva
90%70% 50%
Coronavirus ?nose
Parainfluenza, RSV, adenovirus U & L.RT
Influenza extensive destruction of U & L.RT
(ciliated, intermediate and basal
cells of epithelium)
Ebisava et al, 1969)
Dr.T.V.Rao MD 47

48.  Rhinoviruses are the most commonly
isolated viruses from persons with mild
upper respiratory illness.
 Rhinoviruses are a genus of picornaviridae
 In contrast to enteroviruses they do not
replicate in the intestinal tract, they have an
extreme species specificity and more
fastidious growth requirements
Rhinoviruses are ..
Dr.T.V.Rao MD 48

49. RHINOVIRUS GROUP
• Produces Common Cold.
• Mild respiratory Illness.
• More than 100 serotypes
• Nasal secretions are infective.
Mistaken with Infections with
Corona viruses,
Adenovirus.
Para influenza viruses.
Influenza viruses
Dr.T.V.Rao MD 49

50. Properties of Rhinoviruses.
• Gross appearance like Entero viruses,
• Acid Labile destroyed at 3.0 pH.
• Grown in
Human Cell lines,
WI – 38
MRC -5
• Cultivated at 330 c
Dr.T.V.Rao MD 50

51. Rhinovirus
• Picornoviridae family
• Size
• Single stranded
• Incubation period of 1
to 3 days
• Optimum growth occurs
between 33 and 34 deg
Celsius (93 deg F)
• Not stable below the pH
of 5-6
Dr.T.V.Rao MD 51

52. Rhino Virus
Dr.T.V.Rao MD 52

53. Structure
Dr.T.V.Rao MD 53

54. Understanding – Common cold
• leading cause of doctor visits and lost hours
both at school and the workplace over >100
different viruses found to cause symptoms
of the common cold responsible for about
70% of the cases where a virus has been
found one of the most common illnesses to
man 35 to 50% of the total number of
common colds
Hand to hand contact
Dr.T.V.Rao MD 54

55. Transmission of Rhinoviruses
• There are two
modes of
transmission: via
aerosols of
respiratory droplets
and from
contaminated
surfaces, including
direct person-to-
person contact. Dr.T.V.Rao MD 55

56. Pathogenesis - Rhinoviruses
• Entry through Respiratory tract.
• Nasal Mucosa, can infect Lower Respiratory
tract.
• Chilling, wearing wet cloths do not produce
infection.
• But common cold starts with chills.
• Local inflammation and cytokines may be
responsible for the symptoms of common
cold.
• Interferon production occurs early and specific
antibody appears in nasal secretions
Dr.T.V.Rao MD 56

57. Pathogenesis
Epithelial destruction hypothesis:
intact nasal epithelium (Winther et
al)
rhinovirus replication in extremely
small number of cells (Arrunda et al)
viral quantity does not influence
duration nor severity of colds
Dr.T.V.Rao MD 57

58. Pathogenesis
• Inflammatory
cascade
hypothesis:
Common cold
symptoms result
from an
inflammatory
cascade triggered
by a viral infection
Dr.T.V.Rao MD 58

59. Cytokines initiate pathogenic process
Small number of virus
infected cells elaborate a
variety of cytokines
initiating a host
inflammatory response,
which orchestrate
chemotaxis and expression
of endothelial adhesion
receptor molecules resulting
in the typical common cold
symptoms.
Dr.T.V.Rao MD 59

60. Interleukin-1
• T-cell activation
• B-cell profileration, antibody synthesis
• up-regulation adhesion molecule expression
• mediator, cytokine, growth factor induction
• increased vascular permeabilitiy
• up-regulation kinin receptor expression
• hematopoietic progenitor cell stimulation
• neuro-endocrine interactions
Dr.T.V.Rao MD 60

61. Clinical Findings.
• Incubation 2-4 days,
• Last for 7 days.
• Sneezing, Nasal
Obstruction, Sore
throat,
• May lead to
secondary infection
with Bacteria.
Dr.T.V.Rao MD 61

62. The common cold, nasal congestion is
caused by a vasodilation of the subepithelial
capillaries and of the cavernous sinuses, by
edema in the lamina propria and by
inflammatory processes in which neutrophils
and kinins play an important role.
o Histamine plays only a minor role in the
symptoms of common cold
o Little is known about the role of
prostaglandins and leukotrienes in the
common cold. Dr.T.V.Rao MD 62

63. Clinical Findings.
• Incubation 2-4 days,
• Last for 7 days.
• Sneezing, Nasal
Obstruction, Sore
throat,
• May lead to
secondary infection
with Bacteria.
Dr.T.V.Rao MD 63

64. Laboratory Diagnosis
• Isolation of virus
may be obtained
from nasal or
throat swabs
collected early in
infection.
• Culturing on MRC5
or W 138
• Appearing of CPE Dr.T.V.Rao MD 64

65. Immunity – Rhinoviruses.
• Antibodies in
Nose
• Recurrent
infections with
antigenic
variants, may be
2-3 attacks a year.
Dr.T.V.Rao MD 65

66. Prevention and Control
• No specific
treatment.
• Vaccines are
unsuccessful.
• Intranasal spray of
Gamma
Interferon for 5
Days Dr.T.V.Rao MD 66

67. Epidemiology - Rhinoviruses.
• Prevalent all over the
world.
• Close Contact.
• Fingers and Hand
- Hand washing.
• High rate of
infection in Infants
and Children.
Dr.T.V.Rao MD 67

68. CDC Recommends
• The CDC recommends
that children with
symptoms lasting more
than 10 days who are
unresponsive to over-
the-counter
medications or with
fevers over 100.4
degrees Fahrenheit
seek medical attention.
Dr.T.V.Rao MD 68

69. Stop Spreading the Virus
Dr.T.V.Rao MD 69

70. Use Tissue Paper
• Use paper
:Instead of shared
cloth towels.
Individuals with
colds should
always sneeze or
cough into a facial
tissue, and
promptly throw it
Dr.T.V.Rao MD 70

71. Hand washing
• Hand washing is the
simplest and most
effective way to keep
from getting rhinovirus
colds. Children and
adults should wash
hands at key moments
after nose-wiping, after
diapering or toileting,
before eating, and
before preparing food.
Dr.T.V.Rao MD 71

72. Treatments are Still Experimental
• DRACO, a broad-spectrum
antiretroviral therapy being
developed at the Massachusetts
Institute of Technology, has shown
preliminary effectiveness in treating
rhinovirus, as well as a number of
other infectious viruses
Dr.T.V.Rao MD 72

73. Preventing Common Cold
• There is no vaccine to protect you against
the common cold. However, you may be
able to reduce your risk of getting a cold
by taking these steps:
• wash your hands often with soap and
water do not touch your eyes, nose, or
mouth with unwashed hands stay away
from people who are sick
Dr.T.V.Rao MD 73

74. • Program file created by Dr.T.V.Rao
MD for benefit of Medical Nursing
and Paramedical Professionals
• doctortvrao@gmail.com
Dr.T.V.Rao MD 74