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Coxsackie Virus Diagnosis Treatment and Prevention


Diagnosis Treatment and Prevention of Coxsackie Virus


Coxsackievirus (Coxsackie Virus) is an enterovirus. It is divided into two types, A and B. It is a common virus that infects the human body through the respiratory and digestive tracts. After infection, people will develop fever, sneezing and cough. Wait for cold symptoms.




Coxsackie virus was first obtained in a stool sample in 1948 by Dr. Gillbert Dalldorf and his colleagues in the search for a cure for polio disease, and was named after it was found in Coxsackie, New York. 

Like other types of enteroviruses, coxsackie virus can be transmitted through fecal-oral and oral-oral routes. Among them, contact with contaminated water, food and soil of infected people can cause fecal-oral transmission.

Under normal circumstances, most infants and young children are recessive.  While under 5 years of age, especially children under 3 years of age, detoxification can last up to one month. After the virus infects the human body, it can cause diseases such as upper respiratory tract infection and acute myocarditis, which poses a serious threat to the health of infants and young children.

Scientific name:    Coxsackie virus

Latin scientific name:    Coxsachievirus

Boundary:    Virology

Branch:    Picornaviridae

Genus:    Enteroviruses

Gene structure:    Single-strand positive strand small RNA virus

Classification:    Group A has type 23 virus and group B has type 6 virus

Table of Content

    1 Biological traits

    2 Pathogenicity

    3 Clinical manifestations

    ▪ Encephalitis and myelitis

    ▪ Myocarditis, pericarditis

     ▪ Epidemic myalgia or chest pain

    ▪ Herpes angina

    ▪ Respiratory infections

    ▪ Infant diarrhea

    ▪ Rash fever

    ▪ Newborn systemic infection

    4 Diagnosis

    5 Prevention

    ▪ Prevention

    ▪ Treatment

    ▪ Prognosis

What are the Biological traits of Coxsackie Virus?

The biological characteristics of this virus are similar to those of polio. The diameter of the virion is 28nm, and the nucleic acid is single-stranded RNA. The virus can proliferate in a variety of tissue cells and cause cytopathic changes. Newborn suckling rats have higher sensitivity.
 According to the different pathogenic characteristics of the virus in suckling mouse cells, it was divided into two groups, A and B. Group A has 23 serotypes, which can cause newborn skeletal rats to develop generalized skeletal myositis, leading to flaccid paralysis; component B is 6 serotypes, which cause neonatal neonatal rats to be characterized by focal myositis, encephalitis, etc.

Pathogenic

Coxsackie virus is very sensitive to suckling mice.

Coxsackie virus infection

Coxsackieviruses can be divided into A and B groups based on the lesions they infect suckling mice. Group A has type 23 virus and group B has type 6 virus. Various types can be identified through type-specific antigens, neutralization tests, and elisa methods.

All group B and group A type 9 have a common group-specific antigen, and there is a cross-reaction between viruses in group B, but group A viruses do not have a common group-specific antigen. Group A specific type-specific antigens can cause human O-type erythrocyte agglutination at 37 ° C.

The source of infection, the route of transmission and the pathogenic mechanism are similar to those of poliovirus. Recessive infections are common and manifest as symptoms of mild upper respiratory infection or diarrhea. In recent years, reports of serious infections caused by the virus have been increasing, especially in infants and young children, which has led to a deeper understanding of the virus. Coxsackie virus invades multiple target organs and tissues and is related to specific serotypes. Diversification of clinical manifestations is a characteristic of its pathogenicity. 

What is the Clinical Manifestation Coxsackie Virus?

Diagnosis of Coxsackie Virus: Coxsackie virus infection in humans can easily cause changes such as herpes angina and non-paralytic polio. Clinical manifestations are complex and diverse, including aseptic meningitis, encephalitis, myocarditis, pericarditis, epidemic pectoral myalgia, and herpetic angina, etc., and some are similar to polio.

After infection, people will have cold symptoms such as fever, sneezing and cough. Infection during pregnancy can cause non-paralytic poliomyelitis and cause intrauterine infection and teratogenesis in the fetus. Coxsackie virus can cause meningitis and mild paralysis, pleural pain, intercostal pain, Herpangina, respiratory disease, conjunctivitis and hand-foot-mouth syndrome.

Many of the patients with hand, foot and mouth disease are related to Coxsackie A virus 16 infection, which is an important cause of hand, foot and mouth disease outbreak. Other Coxsackie viruses such as CoxA4, CoxA5, CoxA9, CoxA10 and CoxB5 can also cause hand, foot and mouth disease .

(1) Coxsackievirus A infection

Coxsackievirus A infection is more common in children, with adult infection accounting for 21.7%. The incubation period is 1 to 3 days. Upper respiratory tract infections occur, the onset is rapid, runny nose, cough, sore throat, fever and general malaise. 

Typical symptoms are herpetic angina, that is, small herpes in the nasopharynx, epiglottis, tongue, and soft palate, reddening and swelling of mucous membranes, hyperplasia and exudation of lymphatic follicles, tonsil enlargement, difficulty swallowing, and decreased appetite. According to investigations, 79% of acute fever with oropharyngeal herpes and rash are caused by Cossack A virus.

In addition to the above clinical manifestations, the main features are acute fever, rash, meningoencephalitis with Guillain-Barré syndrome and acute viral cardiomyopathy. The rash can be herpes and maculopapular rash, which is mainly distributed on the peripheral side of the trunk, the back, and the back of the limbs. It has a centrifugal distribution. It is especially common on the face, fingers, toes and back.

(2) Coxsackievirus type B infection

Causes characteristic infectious thoracic pain. May be combined with meningoencephalitis, myocarditis, fever, Guillain-Ba-rré syndrome, hepatitis, hemolytic anemia, and pneumonia.

Encephalitis and myelitis


Fever, headache, vomiting, myalgia, meningeal irritation signs within 1-2 days. The number of cerebrospinal fluid cells (0.1-0.2) × 109 / L, a few> × 109 / L neutrophils dominated at the beginning of the disease, and then the proportion of lymphocytes increased. Sugar and chloride are normal, and protein is slightly higher. Some patients have temporary hypotonia. There are very few people with paralysis, and recovery is faster. A few patients have a disturbance of consciousness, similar to JE.

Myocarditis, Pericarditis

Myocarditis often occurs in newborns, and it occurs more than one week after birth. The onset is acute, fever, symptoms of upper respiratory tract infections, poor appetite, loose stools, followed by dyspnea, cyanosis, pale face, tachycardia, etc. Heart failure soon appeared. It is not uncommon to find adults and older children in recent years.

Respiratory symptoms often occur first, the pericardium can be affected at the same time, or the endocardium can be involved, followed by pain in the anterior region of the heart, pericardial friction sounds, half of which have muscle and joint pain. X-ray showed pericardial effusion, often accompanied by left pleural effusion. ECG showed arrhythmia, conduction block and pericarditis.

Epidemic myalgia or chest pain

Paroxysmal severe myalgias can affect muscles throughout the body. Adults and older children often have chest pain, often in the ribs of the quarters, which can involve shoulders and backs. Infants and young children have more common abdominal pain, which is mostly in the upper abdomen, and occasionally misdiagnosed as appendicitis. In addition, there are fever, sore throat, headache, anorexia, vomiting and so on.

Herpetic angina

Fever, sore throat, gray-white herpes on the pharynx, ulceration to form superficial ulcers, a few can be found in the vulva, and headaches, nausea, vomiting, and abdominal pain can also occur. The other is acute lymphadenitis pharyngitis in children, with pale or pale yellow nodules in the pharynx, which does not form herpes and ulcers.

Respiratory infections

Upper respiratory tract infections are the most common and can cause laryngitis, bronchitis, bronchitis, and bronchiolitis and pneumonia.

Infant diarrhea

Yellow-green dilute water, several times a day, no pus and mucus.

 

Eruptive fever

Fever and rash, including spotted rash, maculopapular rash, urticaria, herpes, and silt spots. Does not itch or flake. A few cases of herpes appear on the skin of the hands, feet, and oral mucosa. Also known as hand, foot and mouth disease.

Neonatal systemic infection

Sudden onset, antifeeding, vomiting, convulsions, dyspnea, cyanosis, arrhythmia, and sudden enlargement of the heart and liver. The mortality rate is extremely high. Autopsy revealed encephalitis, myocarditis, hepatitis, pancreatitis, and adrenal lesions.
Coxsackie Virus Microscopic View


What is the Diagnosis of Coxsackie Virus?

Peripheral white blood cell count may be normal decrease or increase, classified as normal or mild nuclear shift to the left .

Cerebrospinal fluid examination has important reference significance. The number of cells is generally (100 - 300) × 106 / L, and no more than 500 × 106 / L. The number of cases caused by B5 virus is often high. Some cases can be <10 × 106L.
 Early neutrophils accounted for the majority, reaching more than 80%, and after 48 hours, most monocytes reached 90%. Cerebrospinal fluid protein is slightly increased or normal, and sugar and chloride are normal. Cerebrospinal fluid changes usually last 7 to 10 days, and generally do not exceed 14 days. The virus Coxsackie virus can be isolated from both cerebrospinal fluid, pharyngeal gargle, and feces. The positive rate of isolation from cerebrospinal fluid in the first week of the disease course is very high, and the positive rate decreases significantly after the first week. Sometimes the virus can be isolated from the blood early in the course of the disease.

Due to the presence of such viruses in the intestines of healthy people, such conclusions cannot be drawn on the basis of coxsackie virus isolated only from a patient's stool or anal swab. The diagnosis should be based on the following points: 
i. Isolate the virus from the patient's various body fluids or secretions such as cerebrospinal fluid, blood, vesicular serous fluid, pleural effusion, etc., or autopsy organs such as heart, brain, liver, spleen, etc.
ii. Using double serum for neutralization test (or other serological tests) antibody titer increased by more than 4 times.
iii. The virus isolation rate in patients was much higher than the normal control group of non-contact patients.
iv. No other known pathogens This kind of syndrome is caused, but the same virus can be repeatedly isolated from patients' throat swabs, throat swabs, fecal anus swabs, etc. and the same virus is also detected from surrounding contacts.

How can we Prevent Coxsackie Virus?

Prevention of Coxsackie Virus: There are no significant differences in fetal malformations, neonatal cardio-cerebral disorders, vertical mother-to-infant transmission, and cesarean delivery at different stages of pregnancy. This may be related to the use of interferon and antiviral drugs. It also suggests that regular prenatal screening for Coxsackie virus in pregnant women is of great significance in controlling the development and spread of the virus. 

Patients should be quarantined for 2 weeks, and the focus of managing the source of infection should be placed in childcare institutions and delivery rooms. Pregnant women with intestinal viral diseases pose a great threat to the newborn and should be quarantined. Strengthen diet management and personal hygiene, avoid eating food contaminated with dirty water or flies, and avoid swimming in sewage. 

Tap water should be boiled after drinking. Because the patient's oropharynx may excrete the virus, a mask should be worn when contacting these patients, and collective activity should be reduced during the epidemic. Patients' feces need to be added with 20% quicklime and chlorine-containing lime suspension in equal amounts. After being mixed for 2 hours, they can be discharged into the sewer. Infants and young children who come into contact with the patient can be injected intramuscularly with 3 to 6 ml of gamma globulin to prevent infection. It is not necessary for older children and young people. 

Oral polio vaccine OPV can also be tried. Using its interference in the intestinal tract, it is possible to control the meningitis epidemic. Applying a vaccine made by Coxsackie Group B virus to high-risk groups may prevent the epidemic of infant myocarditis.
Coxsackie Virus

How can we Treat Coxsackie Virus?

Coxsackie Virus Treatment: There is currently no specific treatment, and general and supportive therapies should be emphasized. Try ribavirin or interferon. Neonatal myocarditis progresses rapidly. Oxygen should be given and kept quiet. Rapid digitalis therapy should be used early in the event of heart failure. Give appropriate antibacterials to prevent secondary bacterial infections. Patients with convulsions and severe myalgia should be given a sedative or procaine locally, and anesthetics such as morphine and pethidine should not be easily used.

Adrenocortical hormone can be considered for patients with myocarditis with heart failure, cardiogenic shock, severe arrhythmia (such as high atrioventricular block, sick sinus node syndrome, etc.), and pericarditis, which is expected to achieve certain results. In view of the fact that this hormone can inhibit the body's immune function and is conducive to virus replication, it should not be used in general cases.

Prognosis

The prognosis is generally good. Even with more severe meningitis and encephalitis, most cases recover quickly within a few days, and only a few patients have a disease course that lasts for several weeks.

Although muscle loss is more common, it also recovers quickly. Only about 5% of meningitis cases can have the sequelae of muscle tension and mental retardation. Infants with systemic infections such as myocarditis and pneumonia have a poor prognosis and a high mortality rate. The fatality rate of severe neonatal infections can reach 80% to 90%.

The prognosis of myocarditis in older children and young adults is good. Most patients are cured after proper treatment. A small number of patients have become chronic with undulating or recurrent attacks. In some cases, progressive cardiac enlargement, cardiac hypofunction, Arrhythmia, etc., and prone to embolism complications.




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