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Coxsackie Viruses

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.

Diagnosis

Doctors diagnose a coxsackie virus by performing a physical exam and looking for any of the telltale symptoms, such as rash or blisters. They might also test stool or fluids from the back of the throat to see if the virus is present.

Treatment

Depending on the type of infection and symptoms, the doctor may prescribe
medications to make your child feel more comfortable. However, because antibiotics only work against bacteria, they can't be used to fight a coxsackie virus infection. For meningitis due to coxsackie virus, there's an effective antiviral medication, though it's not yet widely available.

The most severe forms of coxsackie virus infection, myocarditis and encephalitis, can be fatal, especially in newborns. Even older children with coxsackie myocarditis or encephalitis may need special care in a hospital. However, these complications are rare.

Most children with a simple coxsackie infection recover completely after a few days at home. If your child has a fever without any other symptoms, he or she should rest in bed or play quietly indoors.
Offer plenty of fluids to prevent
dehydration. Acetaminophen may be given to relieve any minor aches and pains. If the fever lasts for more than 24 hours or if your child has any symptoms of a more serious coxsackie infection, call your child's doctor.

Complications

Children with coxsackie virus may become dehydrated because mouth sores can make it painful to eat and drink. If the dehydration is severe, intravenous (IV) fluids may be necessary.

When to Call Your Child's Doctor

Call your child's doctor immediately if your child develops any of the following symptoms:

fever (higher than 100.4 degrees Fahrenheit, or 38 degrees Celsius, for infants younger than 6 months of age and higher than 102 degrees Fahrenheit, or 38.8 degrees Celsius, for an older child)
poor appetite
trouble feeding
vomiting
diarrhea
difficulty breathing
convulsions
unusual sleepiness


Even if your child doesn't have a fever, call the doctor for any of the following:

pain in the chest or abdomen
sores on the skin or inside the mouth
difficulty breathing
severe sore throat
severe headache, especially with vomiting, confusion, unusual sleepiness, or convulsions
neck stiffness
red, swollen, and watery eyes
pain in one or both testicles


Source: Yahoo! Health News



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