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CoxsackievirusesCoxsackievirusesan 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 at the New York State Department of Health in Albany, New York.
Dr.T.V.Rao MD 2
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
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-oral route.
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Coxsackie's belongs to Coxsackie'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 contaminated by feces, where they can live for several days.
Dr.T.V.Rao MD 6
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,
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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.
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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
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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
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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.
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Diseases Caused by Diseases 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
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Pathophysiologyof 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.
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Symptoms related to Symptoms related to Coxsackievirus 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
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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
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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
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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.
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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
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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.
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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.
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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.
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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,.
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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
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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
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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.
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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 infection
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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.
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Is Coxsackie Contagious?• VERY contagious• Passed on by:
– Unwashed hands– Surfaced
contaminated by feces
– Sneezes or coughs
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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.
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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
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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.
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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
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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
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• Programme Created by Dr.T.V.Rao MD for Medical and Paramedical Students in
the Developing World• Email
• [email protected]@gmail.com
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