Coxsackievirus Infection Symptoms, Causes, and More (2024)

Coxsackievirus is a type of non-polio enterovirus, like the norovirus that leads to digestive tract infection. Coxsackievirus strain A16 is known ashand, foot, and mouth disease (HFMD). There are, however, 29 types of coxsackievirus that can cause infection in humans.

Most people recover well from coxsackievirus infection, and HFMD symptoms may go away on their own in a few days. But HFMD also can have fatal complications, including encephalitis (brain inflammation) and pulmonary edema (fluid in your lungs). Enterovirus D68, another virus in the group, caused a respiratory infection outbreak associated with acute flaccid paralysis.

This article discusses different co*cksackievirus types and the conditions they can cause, some of them life-threatening. It offers information about how contagious coxsackievirus can be, how it is spread, and how to prevent infection.

What Is co*cksackie Virus Infection?

Altogether, more than 100 enteroviruses have been reported worldwide. Among them are a number of coxsackievirus types that can cause infections in people, including:

• Coxsackievirus A2-8, A10, A12, A14, A16 (a type of Human enterovirus A)
• Coxsackievirus A9 (a type of Human enterovirus B)
• Coxsackievirus B1-6 (a type of Human enterovirus B)
• Coxsackievirus A1, A11, A13, A17, A19-22, A24 (a type of Human enterovirus C)

Since it was first identified in 2008, coxsackievirus A6 has been causing more severe and atypical cases of HFMD in the United States and worldwide, including in adults.

Coxsackievirus Infection Symptoms

Not all enterovirus infections cause symptoms. and about 50% of people infected with them are symptom-free. However, many people will still experience gastrointestinal symptoms with coxsackievirus, which also can cause:

• Rash
• Fever
• Breathing problems

Children, as well as adults living with compromised immune systems, are typically more at risk of severe complications including sepsis (systemic infection), and myocarditis (heart muscle inflammation). They can cause heart and breathing problems like apnea and arrhythmias.

A 2021 review of 237 severe enterovirus infections in newborns identified coxsackievirus B infection in 52% of them. In the overall study, almost a third of these babies (30%) died from complications. Infant coxsackievirus B infections that become severe can be life-threatening and have long-term effects, including permanent heart damage.

Different Coxsackievirus Infections

Again, HFMD, with ulcers in a child's mouth and blisters on their hands and feet, is typically the most well-known infection caused by the coxsackievirus, butcoxsackievirus is also associated with:

• Congenital Infections: Infections in pregnancy that spread to the fetus
• Neonatal Infections: Rare, but can cause bleeding problems, hepatitis, meningitis, meningoencephalitis, myocarditis, and sepsis
• Acute Hemorrhagic Conjunctivitis:Coxsackievirus A24 can cause outbreaks of a pink eye with subconjunctival hemorrhages
• Gastrointestinal Disease:Coxsackievirus can cause hepatitis, nonbacterial diarrhea, or gastroenteritis, and hemolytic uremic syndrome (HUS).
• Herpangina: Similar to HFMD, with oral ulcers, but without a rash or blisters on the child's hands or feet
• Meningitis: Aseptic meningitis can be fatal, and may be caused by enterovirus infection
• Myopericarditis:inflammation and damage to the heart muscle and sac surrounding the heart, which can be caused by coxsackievirus B1, B2, and B5 infections
• Myositis: inflammation of a muscle, which can be caused by coxsackievirus infections
• Petechial and Purpuric Rashes: especially with coxsackievirus A9, which could get confused with Henoch-Schonlein purpura (HSP)
• Pleurodynia: sudden onset of chest pain caused by inflammation of the diaphragm and linked to a coxsackievirus infection
• Respiratory Illnesses: usually with a mild cough, runny nose, and sore throat and can be caused by coxsackievirus A21 and A24.

The coxsackievirus can also cause nonspecific febrile illnesses and a roseola-like illness—fever for two to three days followed by a rash for one to five days. Some people experience skin and nail changes, like peeling skin or Beau's lines, after a coxsackievirus infection.

How Do You Get Coxsackievirus Infections?

Children can get sick about three to six days after being exposed to someone with a coxsackievirus infection (the incubation period). The coxsackievirus is spread by both fecal-oral (direct or indirect contact with stool) and respiratory transmission (someone coughs or sneezes on you).

People also can also get these infections by touching a contaminated object (fomite). The Centers for Disease Control and Prevention warn that you might get infected by kissing someone who has the hand, foot, and mouth disease or by touching a doorknob that has viruses on it, then touching your eyes, mouth, or nose.

Outbreaks can be hard to control as the coxsackievirus remains in the stool and respiratory tract secretions (saliva and nasal secretions) for weeks after infection. The CDC recommends staying at home with any symptoms of hand, foot, and mouth disease, but the HFMD virus may be present.

How Is Coxsackievirus Treated?

There is not yet an antiviral treatment for coxsackievirus infection that leads to HFMD. Respiratory support (oxygen and ventilation) and intravenous immunoglobulin (IVIG) therapy have been used in severe cases.

Regardless,handwashing, avoiding respiratory secretions, and disinfecting contaminated surfaces is more important than ever to help avoid getting sick and spreading these infections.

Testing can be done for most types of coxsackievirus, including by reverse transcriptase-polymerase chain reaction (PCR) assay and culture, but it is not something that can be routinely or quickly done in a pediatrician's office. It is typically not necessary either.

If you are pregnant and think you may have been exposed, the CDC recommends that you contact your healthcare provider.

Summary

Coxsackievirus is a type of enterovirus. There are many strains that lead to infection, including the A6 virus common with infections in adults and the coxsackie virus B types that can lead to severe infection.

About half of all people with an infection have no symptoms. Others may feel ill for a few days but their symptoms improve on their own. In some cases, a coxsackievirus infection can lead to long-term effects or even prove fatal.

Having an infection with one coxsackievirus serotype doesn't give you immunity to any of the others, so you can, and likely will, get coxsackievirus infections multiple times in your life. Talk with your healthcare provider if you have concerns or questions about coxsackievirus.

By Vincent Iannelli, MD
Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years.