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Coxsackie virus (also written as coxsackievirus) is a member of the Picornaviridae family of viruses in the genus termed Enterovirus. Coxsackie viruses are subtype members of Enterovirus that have a single strand of ribonucleic acid (RNA) for its genetic material. The Enteroviruses are also referred to as picornaviruses (pico means "small," so, "small RNA viruses"). Coxsackie virus was first isolated from human feces in the town of Coxsackie, New York, in 1948 by G. Dalldorf.
The most well known Coxsackie A disease is hand, foot and mouth disease (unrelated to foot and mouth disease), a common childhood illness which affect mostly children aged 10 or under, often produced by Coxsackie A16. In most cases infection is asymptomatic or causes only mild symptoms. In others, infection produces short-lived (7-10 days) fever and painful blisters in the mouth (a condition known as herpangina), on the palms and fingers of the hand, or on the soles of the feet. There can also be blisters in the throat, or on or above the tonsils. Adults can also be affected.
These diseases tend to be self-limiting. They are very common in pregnancy, especially at times of the year when prevalence is high, but the outcome is usually benign if the mother was asymptomatic. As many as 65% of women who give birth to infants with proven enteroviral infection have symptomatic disease during the perinatal period. Maternal echovirus or Coxsackie virus B infections are not associated with an increased risk of spontaneous abortions, but stillbirths late in pregnancy have been described.
The early symptoms of the coxsackie-induced cardiac myopathy include some generalized viral symptoms-fever, fatigue, malaise-with the addition of chest pains. As the virus enters the heart cells, the immune system attacks and damages both infected and normal heart cells; the affected individual feels severe fatigue when there is significant impairment of heart function. In most cases, the disease is resolved spontaneously without any treatment, though some permanent heart damage may have occurred.
The coxsackie B virus initially replicates in the gut and spleen and eventually spreads to its target organ, the heart. Once in the heart, replication of the virus causes damage to the heart cells and induces migration of white blood cells into the heart tissue. The white blood cells subsequently activate an autoimmune process in which the white blood cells kill the virus infected heart cells and normal heart cells which are not infected. This autoimmune process persists long after viral particles are no longer detected. The destruction and damage to the heart cells results in myocarditis and heart failure.
Coxsackie outbreaks are not unique events in history. The largest epidemic in Britain happened in 1994. It was Type A, and involved "hand, foot and mouth" disease. Most of the 952 cases were children aged one to four. Previous epidemics occurred in 1988 and 1990. Most strains of Coxsackie A don't attack the heart. However, one strain called Coxsackie A16 does attack the heart but this is rare. Coxsackie A is associated with "hand, foot and mouth" disease and was first documented in 1957, nearly a decade after the virus was first identified.
There is no vaccine to prevent coxsackievirus infection. Hand washing is the best protection. Remind everyone in your family to wash their hands frequently, particularly after using the toilet (especially those in public places), after changing a diaper, before meals, and before preparing food. Shared toys in child-care centers should be routinely cleaned with a disinfectant because the virus can live on these objects for days.
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