Named after Coxsackie, New York, where they were discovered, the coxsackie viruses are part of the enterovirus family of viruses (which also includes echoviruses, 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. In tropical parts of the world, they infect people year-round, but in cooler climates, outbreaks of coxsackie virus most often occur in the summer and fall.

Signs and Symptoms

About half of all children with coxsackie virus infection have no symptoms. Some children suddenly develop fevers of 101 to 104 degrees Fahrenheit (38.3 to 40 degrees Celsius), headache, and muscle aches. Some also develop a mild sore throat, abdominal discomfort, or nausea. A child with coxsackie virus 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, meaning that 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:

• Hand, foot, and mouth disease, a type of coxsackie virus syndrome, causes painful red blisters in the throat and on the tongue, gums, inside of the cheeks, and the palms of hands and soles of the 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.
• 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.
• Hemorrhagic conjunctivitis is an infection that affects the whites of the eyes. Hemorrhagic conjunctivitis usually starts out as eye pain and is suddenly followed by red, watery eyes, swelling, light sensitivity, and blurry vision.

Coxsackie viruses can also cause meningitis, an infection of the meninges (the three membranes that envelop the brain and spinal cord), and rarely, encephalitis, a brain infection. They may also cause myocarditis, an infection of the heart muscle.

Newborns, who can be infected from their mothers during or shortly after birth, are more at risk for developing serious infection, including myocarditis, hepatitis, and meningoencephalitis (an inflammation of the brain and meninges).

Symptoms usually occur within 2 weeks after birth and can include fever, poor feeding, irritability, and lethargy. Infants with coxsackie myocarditis have trouble breathing and sometimes develop cyanosis, a bluish color of the skin, lips, and nails caused by too little oxygen in the blood.

Contagiousness

Coxsackie viruses are very contagious. They're usually passed from person to person on unwashed hands and surfaces contaminated by feces. They can also be spread through droplets of fluid sprayed into the air when someone sneezes or coughs.

When an outbreak of coxsackie virus affects a community, risk for infection is highest among infants and children younger than 5. The virus spreads easily in group settings like schools, child-care centers, or summer camps. People who are infected with a coxsackie virus are most contagious the first week they're sick.

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, 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.

Children who are sick with a coxsackie virus should be kept out of school or child care for a few days to avoid spreading the infection.

Incubation

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

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.

Revised 3.23.09