Coxsackie virus infections B34.1

Infection with Coxsackie viruses is associated with the following clinical pictures:

• Coxsackie A
  • Hand-foot-and-mouth disease (most commonly type A 16)
  • Hand-foot-and-mouth disease (atypical)
  • Herpangina (Herpangina Zahorsky)
  • Summer flu
  • Rhinitis
  • Lymphocytic meningitis (meningoencephalitis and poliomyelitis-like clinical pictures with paralysis)
• Coxsackie B
  • Bornholm disease (pleurodynia)
  • Summer flu
  • Myocarditis

  • Lymphocytic meningitis/meningoencephalitis

    
    

Triggering of dermatomyositis by Coxsackie virus infections is also being discussed.

See below Hand-foot-and-mouth disease, Herpangina, Bornholm disease; Acute haemorrhagic infantile oedema.

Laboratory diagnosis in the newborn/infant: Coxsackievirus PCR or ELISA from CSF, serum, throat swab or stool samples.

For confirmation of infection in the mother: Coxsackievirus PCR or ELISA from maternal blood and stool samples and from cord blood at delivery.

In infections with coxsackie echoviruses in the first and second trimesters: Only exceptionally have fetal malformations (CNS, cardiovascular, gastroenteral, urogenital) been described. Abortion or intrauterine fetal death may occasionally occur in highly febrile conditions. The risk of fetal harm at birth is within the range of the so-called normal risk of +/- 3.5%. There is no evidence for an association of maternal enterovirus infection and fetal/child malformations or developmental disorders.

Maternal infection towards the end of the third trimester: Neonates of mothers with acute infection shortly before delivery may present with severe neonatal illness: sepsis, meningoencephalitis, myocarditis, hepatitis, coagulopathy.

The course of disease is usually severe in intrauterine transmitted infections, less severe in early postpartum infection (e.g. by contact with visitors or in neonatal wards).

STAR complex: recurrent arthritides for months , febrile episodes, sore throat and a maculo-papular exanthema.

A specific antiretroviral therapy is not yet available. Successes ( off-label use!) with Pleconaril (virustatic agent, effective for rhinoviruses) have been described in individual case reports.

The value of IVIG therapy, e.g. with Intratect, for newborns and for contact infants or persons, as recommended so far, has not been proven.

Measures to limit infection: Refer maternity unit/neonatal unit for possible maternal infection. Good hygiene measures are important. Rooming-in of mother with child.

1. Ashbourne Excoffon KJ et al (2003) The coxsackie B virus and adenovirus receptor resides in a distinct membrane microdomain. J Virol 77: 2559-2567
2. Bauer S et al (2002) Severe coxsackie virus B infection in preterm newborns treated with pleconaril. Eur J Pediatr 161: 491-493
3. Centers for Disease Control and Prevention (CDC) (2008) Increased detections and severe neonatal disease associated with coxsackievirus B1 infection--United States, 2007. MMWR Morb Mortal Wkly Rep 57: 553-556.
4. Crocker SJ et al (2007) Amelioration of coxsackievirus B3-mediated myocarditis by inhibition of tissue inhibitors of matrix metalloproteinase-1. Am J Pathol 171:1762-1773.

5. Ferrarini A et al (2018) Acute hemorrhagic edema of infancy associated with coxsackie virus infection. Arch Pediatr 25: 244.

6. Foster HD (2002) Coxsackie B virus and myocardial infarction. Lancet 359: 804
7. Hengstman GJ et al (2002) Clinical and serological characteristics of 125 Dutch myositis patients. Myositis specific autoantibodies aid in the differential diagnosis of the idiopathic inflammatory myopathies. J Neurol 249: 69-75
8. Theodoridou M et al (2002) Vesiculopapular rash as a single presentation in intrauterine coxsackie virus infection. Eur J Pediatr 161: 412-413
9. Utzig N et al (2003) Polio-like myelitis due to coxsackie virus B 3: Course Under Treatment with Pleconaril. Clin Padiatr 215: 286-287