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7/28/2019 Coxsackievirus an update
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Coxsackievirusesan updateDr.T.V.Rao MD
Dr.T.V.Rao MD 1
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History of Coxsackieviruses The Coxsackieviruses
were discovered in1948-49 by Dr.Gilbert Dalldorf, ascientist working atthe New York State
Department of Health in Albany,New York.
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Coxsackie, New York The virus family
discovered waseventually given the
name Coxsackie, forthe town of Coxsackie,New York, a smalltown on the Hudson
River where Dalldorf had obtained the firstfaecal specimens
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The Virus belongs to .. Coxsackievirus is a virus that belongs to a
family of nonenvelopedd, linear, positive-
sense ssRNA viruses, Picornaviridae andthe genus Enterovirus, which alsoincludes poliovirus and echovirus.
Enterovirus are among the mostcommon and important humanpathogens, and ordinarily its members
are transmitted by the fecal-oral route.Dr.T.V.Rao MD 4
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Coxsackie's belongs toEnterovirus
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Coxsackievirus spread They can spread
from person to
person , usually onunwashed handsand surfaces
contaminated byfeces, where theycan live for several
days. Dr.T.V.Rao MD 6
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Coxsackievirus Coxsackievirus (sometimes written as
two words, Coxsackie's virus)belongs to a group of viruses calledenterovirus. Coxsackievirusinfections occur most often during
summer and fall Coxsackievirus infections occur most
often in young children,Dr.T.V.Rao MD 7
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The Virus belongs to TwoGroups
Coxsackievirus are divided into group A andgroup B viruses based on early observations of their pathogenicity in mice. Group A
coxsackieviruses were noted to cause a flaccidparalysis (which was caused by generalizedmyositis) while group B coxsackieviruses were
noted to cause a spastic paralysis (due to focalmuscle injury and degeneration of neuronaltissue). At least 23 serotypes (1-22, 24) of groupA and six serotypes (1- 6 of group B arerecognized. Dr.T.V.Rao MD 8
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Coxsackie's virus Infects Suckling Mice but notAdult Mice
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Several Serotypes At least 23
serotypes (1-22, 24) of group A and 6
serotypes (1-6)of group B arerecognized
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Sources of Coxsackie's viralinfections
Infection usually is spreadby fecal-oral contamination,although occasionally thevirus is spread by droplets
expelled by infectedindividuals. Items likeutensils, diaper-changingtables, and toys that comein contact with body fluids
that contain the virus mayalso transmit them to otherindividuals
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Coxsackie virus spread through
They can spreadfrom person to
person, usually onunwashed handsand surfaces
contaminated byfeces, where theycan live for several
days.Dr.T.V.Rao MD 12
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Diseases Caused byCoxsackievirus
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 echovirusDr.T.V.Rao MD 13
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Pathophysiologyof Coxsackie's virus
Coxsackieviruses are transmitted primarily via thefecal -oral route and respiratory aerosols, althoughtransmission via fomites is possible. The virusesinitially replicate in the upper respiratory tract andthe distal small bowel. They have been found in therespiratory tract up to 3 weeks after initial infectionand in feces up to 8 weeks after initial infection. Theviruses have been found to replicate in the submucosal lymph tissue and disseminate to theReticuloendothelial system. Further dissemination totarget organs occurs following a secondary Viremia.
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Symptoms related toCoxsackievirus
Upper respiratory tract symptoms, includingsore throat, rhinitis, and dry cough
Constitutional symptoms, including headaches(50%), fever, and malaise
GI symptoms, including nausea, vomiting,diarrhea (50%); abdominal pain (usually in theepigastria area) in children
Testicular pain (i.e., orchids) in 10% of male
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Coxsackie virus infection present with
Both group A andgroup BCoxsackievirus cancause nonspecificfebrile illnesses,rashes, upper
respiratory tractdisease, and asepticmeningitis
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Coxsackie virus infection present with
In general, group Acoxsackievirusestend to infect the
skin and mucousmembranes, causingherpangina, acute
haemorrhagicconjunctivitis (AHC),and hand-foot-and-mouth (HFM)disease
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Coxsackie virus Can causeAcute haemorrhagic conjunctivitis
Rare complicationsinclude keratitis andmotor paralysis.
This condition ishighly contagiousand has resulted inepidemics andpandemics.
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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, causespainful red blisters inthe throat and on thetongue, gums, hard
palate, inside of thecheeks, and the palmsof hands and soles of the feet.
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Herpangina , Herpangina , an
infection of thethroat which causesred-ringed blistersand ulcers on thetonsils and soft
palate, the fleshyback portion of theroof of the mouth.
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Hand, Foot, and Mouth Disease Although HFM is most
often associated withCoxsackievirus A16, theprocess does occur withother enterovirusstrains (enterovirus 71& others). A child will
develop immunity to anindividual strain after anillness but besusceptible to other
unrelated strains,. Dr.T.V.Rao MD 23
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Myocarditis can be a serious disease
Group BCoxsackievirus tendto infect the heart,pleura, pancreas,and liver, causingPleurodynia,
myocarditis,pericarditis, andhepatitis
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Coxsackie B3 - Myocarditis Coxsackie B3 has been
found to be one of the maincauses of certaindebilitating or life-threatening diseases, such
as viral myocarditis. In about 20% of the cases,
there can be progressivedisease or recurrence of symptoms; the heart
damage can be extensive,causing arrhythmias,weakened left ventricularfunctions
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Born Holm disease present with Pain on inspiration is similar
to Pleuritic pain andpulmonary embolism maybe suspected.
The muscles are locallytender.
There will be nohaemoptysis.
There may be a slight
sensation of dyspnoea orpain on breathing
Born Holm word is aplace where the
disease is identified.Dr.T.V.Rao MD 26
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Difficult to Diagnose ? Many infections are caused by Coxsackie
viruses, most of which are never diagnosedprecisely.
Coxsackie type A usually is associated withsurface rashes (exanthemas) while type Btypically causes internal symptoms(Pleurodynia, myocarditis) but both can also
cause paralytic disease or mild respiratorytract infection. The latter can be caused byseveral Coxsackie virus types and byEchoviruses and the symptoms are much like arhinovirus infection Dr.T.V.Rao MD 27
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Emerging Diagnostic Methods All the Conjunctival swabs from Coxsackievirus
A24 variant related outbreak and the 41Coxsackievirus A24 variant strains were testedpositive by the RT-PCR assay within 4 h. Thisnovel single-tube real-time RT-PCR assay issensitive and specific, and consists in a reliable
and faster alternative to the viral culture forrecent and future acute haemorrhagicconjunctivitis outbreaks caused by
Coxsackievirus A24 variant.Dr.T.V.Rao MD 28
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Is Coxsackie Contagious? VERY contagious Passed on by:
Unwashed hands Surfaced
contaminated byfeces
Sneezes or coughs
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To prevent spread into society
Children who feel ill or have afever should be excluded from
group settings until the fever isgone and the child feels well.
Thorough hand washing and carewith diaper changing practices isimportant.
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Treatment and Prevention Treatment usually
consists of simpleanalgesia for sorethroat/aches,adequate fluidintake, and rest
There is no vaccineagainst theCoxsackie's virus
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FDA-approved specific therapy While there is no FDA-
approved specifictherapy forCoxsackievirusinfection, a recentstudy demonstratedthat fluoxetine(marketed as Prozac in
the US) appears toinhibit replication of viral RNA in vitro.
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Newer treatments ? Specific antiviral
therapy such asPleconaril shows
promise in thetreatment of meningitisand other lifethreatening infections
due to enterovirus. However, the safety or
efficacy of this drug tobe considered withmore tails Dr.T.V.Rao MD 33
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Prevention
Coxsackie virus istransmitted bycontamination withfeces, which means you
can catch the virus bytouching your mouth oreating withoutthoroughly washingyour hands. Good handwash reduces thespread of infection insociety
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Programme Created by Dr.T.V.Rao MD
for Medical and Paramedical Students inthe Developing World Email
doctortvrao@gmail.com
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