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Coxsackie and Echovirus
Coxsackie and echoviruses belong to a class known as enteroviruses. Enteroviruses
are transmitted orally (by ingestion of contaminated food) through what
is known as the faeco-oral route. Enteroviruses are the most common cause
of aseptic meningitis and nonspecific febrile illnesses of neonates. Certain
clinical syndromes are more likely to be caused by certain serotypes, but
there is much overlap.
Nonspecific Febrile Illness (Summer Grippe) The most common clinical
manifestation of enterovirus infection is a nonspecific febrile illness.
Generalized Disease of the Newborn Neonates often present with
an illness resembling bacterial sepsis, with fever, irritability, and lethargy.
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Aseptic Meningitis and Encephalitis Enteroviruses are the cause
of up to 90% of cases of aseptic meningitis in children and young adults
in which an etiologic agent can be identified. Patients with aseptic meningitis
typically present with an acute onset of fever, chills, headache, photophobia,
and pain on eye movement. Nausea and vomiting are also common.
Pleurodynia (Bornholm Disease) Patients with pleurodynia present
with an acute onset of fever and spasms of pleuritic chest or upper abdominal
pain. Chest pain is more frequent in adults, and abdominal pain is more
common in children.
Myocarditis and Pericarditis Enteroviruses are estimated to cause
up to one-third of cases of acute myocarditis. Coxsackievirus B and its
RNA have been detected in pericardial fluid and myocardial tissue in some
cases of acute myocarditis and pericarditis. Most cases of enteroviral myocarditis
or pericarditis occur in newborns, adolescents, or young adults.
Exanthems Enterovirus infection is the leading cause of exanthems
in children in the summer and fall. While exanthems are associated with
many enteroviruses, certain types have been linked to specific syndromes.
Hand-Foot-and-Mouth Disease Patients with hand-foot-and-mouth
disease present with fever, anorexia, and malaise; these manifestations
are followed by the development of sore throat and vesicles on the buccal
mucosa and often on the tongue and then by the appearance of tender vesicular
lesions on the dorsum of the hands, sometimes with involvement of the palms.
The vesicles may form bullae (ballooning of the skin) and quickly ulcerate.
About one-third of patients also have lesions on the palate, uvula, or tonsillar
pillars, and one-third have a rash on the feet (including the soles) or
on the buttocks. The disease is highly infectious.
Herpangina Herpangina is usually caused by coxsackievirus A and
presents as acute-onset fever, sore throat, dysphagia, and grayish-white
papulovesicular lesions on an erythematous base that ulcerate.
Acute Hemorrhagic Conjunctivitis Patients with acute hemorrhagic
conjunctivitis present with an acute onset of severe eye pain, blurred vision,
photophobia, and watery discharge from the eye.