Family doctor

Overview

Coxsackie viruses originate from the gut (enteroviruses) .

They are a common cause of sore throats, especially in children.

Half those affected do not show any symptoms. Symptoms include sore throat, fever and aches.

Mild cases will pass between 7-10 days.

Treatment usually consists of rest, keeping up fluids and symptomatic treatment of the sore throat.

Antibiotics are ineffective and there is no vaccine.

More serious but rare infections by coxsackie virus include infections of the muscles, brain and heart.

Other variations include hand-foot-and-mouth disease, ulcers to the throat and mouth, muscle pains or eye problems.

Newborn babies need special care if they develop a serious case of coxsackie virus.

Severe symptoms need medical advice to rule out more serious varieties of the virus.

Hand washing is the best preventative measure.

What is coxsackie virus?

Coxsackie viruses are a common cause of sore throats, especially for children, often in spring and summer. Typical symptoms are a fever, and sore throat and tongue in some cases.

Coxsackie viruses are very common and form a set of viruses called enteroviruses originating in the human digestive tract. Other enterovirus strains include Polio and Hepatitis A.

Coxsackie viruses are very hardy - they are spread through saliva, for instance through coughing, or via faeces on unwashed hands and surfaces. They survive for several days outside the body, even in frozen outdoor conditions.

How common is it?

Although anyone is at risk of being infected by coxsackie viruses, children are more usually affected. Half of all children infected will not show any symptoms. Some have very mild symptoms or just feel hot. Others may suffer other complications, causing pain to the eyes, chest or abdomen.

In rare cases the viruses may cause: muscle infection known as myositis; meningitis where the fluid surrounding the brain becomes infected; or a brain infection known as encephalitis. Cardiac myositis (infection of the heart muscle) can be fatal to newborn babies.

What are the symptoms?

Most sufferers will have no symptoms at all. Those who feel symptoms usually feel mild 'flu like symptoms including fever, head and muscle aches and perhaps a rash. A mild sore throat is usual, and sometimes nausea or abdominal pain is present.

Some children develop a condition known as hand-foot-and-mouth disease, where small painful blisters appear in the mouth, on the tongue and inside of the cheeks, and on the palms and soles of the feet.

Others develop painful blisters and ulcers in the back of the throat known as herpangina. These can appear on the tonsils and soft palate - the soft fleshy part on the roof of the mouth.

Some suffer chest pain when breathing.

Other variations of the coxsackie virus include myositis, a muscle infection; meningitis, an infection of the membranes that cover the brain; and encephalitis, a brain infection. These can be dangerous, and fatal in some cases.

How long will the virus symptoms last?

The duration of the symptoms depends on the specific type of coxsackie virus.

In the majority of cases symptoms disappear after 7-10 days, with the first 3 or so days being the worst. In some cases the fever comes and goes - it appears for a day, only to reappear a few days later.

What conditions are related to coxsackie viruses?

Although coxsackie virus generally results in mild symptoms, there are more serious conditions related to it:

Coxsackie virus is the common cause of haemorrhagic conjunctivitis - infection affecting the whites of the eyes. With this condition eye pain begins suddenly, with blurry vision and watering, and intolerance of light. The whites of the eyes look red and swollen.

Bornholm disease also known as pleurodynia, is a variety of coxsackie virus infection. It results in muscle spasm pain in the chest muscles and upper abdomen.

Newborn babies can be infected from their mothers resulting in myocarditis - infection of the heart muscle. They develop fever within a fortnight of birth and have difficulty breathing. They feed poorly and are not active, and sometimes have a faint blue colouring to skin, lips and nails from lack of blood oxygen. This condition can be fatal and medical help is essential.

How is it diagnosed and treated?

It is best to seek medical help and examination to exclude other conditions which may be very similar and potentially dangerous.

Initially a throat swab may be taken to rule out bacterial infection such as strep throat.

Antibiotics are not effective, as this is a virus, not bacterial infection.

Most children recover completely following a few days of rest. The most effective treatment includes rest, plenty of fluids and easing of painful symptoms. Ice blocks, milkshakes and similar cool soft foods are helpful to ease sore throats and keep fluid intake up. Gargling a warm salty water solution may soothe a sore throat as well.

Generally fever and discomfort can be eased using pain relief medication containing the drugs acetaminophen or ibuprofen. Suitable medication for children, such as Tylenol, may be recommended by the doctor.

ASPIRIN SHOULD NOT BE GIVEN TO CHILDREN UNDER 12.

When is coxsackie virus dangerous?

The most severe forms of coxsackie virus can be fatal, especially in newborn babies. These forms include myocarditis (muscle infection) and encephalitis (brain infection). Hospital care is needed, even for older children.

Medical help should be sought immediately if a newborn baby develops: 

• fever
• difficulty feeding
• low appetite
• vomiting
• diarrhoea
• convulsions
• difficulty breathing
• over sleepiness.

If a child does not have a fever but has any of the following, seek medical help:

• severe sore throat
• red swollen watery eyes
• sores inside the mouth or on skin
• severe muscle pain in the chest and abdomen
• shortness of breath and chest pain
• severe headaches with vomiting, over sleepiness, convulsions or confusion
• testicle pain.

If a fever arises during pregnancy, medical advice should be sought, especially near the baby's due date.

How is it spread and can it be prevented?

Coxsackie virus is spread from saliva or faeces. Outbreaks are more usual in warm climates and seasons. When an outbreak occurs, small children are most at risk. Older children may be exposed to coxsackie virus infection whilst in close knit environments such as school camps and childcare centres.

Vaccines are not available. Simple hand washing is the best form of prevention. Careful hand washing after changing nappies and before preparing food can help stop the spread. Teaching small children to get into the habit of washing their hands frequently, especially following toileting and before meals, can help enormously.