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.
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.
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.
Author's Bio
Name: Ian Skyler
Education: MBBS, MD
Occupation: Medical Doctor
Specialization: Community Medicine, General Surgery, Natural Treatment
Experience: 18 Years as a Medical Practitioner
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