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.


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