Coxsackievirus vs. Hand Foot Mouth Disease (HFMD)

Hand, foot, and mouth disease is a viral condition that most often occurs in childhood.

Coxsackieviruses are a common cause of infection. These viruses can cause diseases that range from very mild to life-threatening. Coxsackievirus infection is contagious and the virus can spread by coming into contact with respiratory secretions from infected patients.

Hand, foot, and mouth disease is a common childhood illness caused by a virus, coxsackievirus A-16. The illness most often occurs in the spring and fall and is most frequently seen in young children, infants, and toddlers.

• Symptoms of coxsackievirus infections are usually mild. The coxsackievirus is one cause of the common cold or mild red rash. Symptoms of coxsackievirus may also include diarrhea, sore throat,
• Less commonly, symptoms of severe coxsackievirus infection may include meningitis, encephalitis, chest pain, and inflammation of the heart.
• Initial symptoms of hand, foot, and mouth disease include fever and general malaise (poor appetite, aches and pains, etc.). After one to two days a blister-like rash develops on the hands, feet, and in the mouth. Blisters may also develop on the gums, inner cheeks, and tongue, causing mouth pain, sore throat, drooling, avoidance of swallowing, and refusing to drink or eat. Infants may become dehydrated due to the refusal to drink.
• There is no specific medicine or treatment that has been shown to kill the coxsackievirus but the body's immune system is usually able to destroy the virus on its own. Over-the-counter (OTC) pain relievers can be used to reduce pain and fever. OTC cold medicines (decongestants, cough syrup) may reduce symptoms in adults.
• There is no specific treatment for hand, foot, and mouth disease. Fever management and prevention of dehydration are the primary goals. A mouthwash may be prescribed that is a mix of several oral liquid medications, usually including a topical anesthetic and diphenhydramine (Benadryl) used to decrease pain associated with oral lesions, decrease the inflammatory response, and encourage eating and drinking.
• Most people who get coxsackievirus infections have no symptoms or are only mildly ill and soon recover. Severe coxsackievirus infections in newborns are fatal in approximately one-half of cases.
• Children infected with the hand, foot, and mouth disease virus generally have mild illness and recover within one week of developing symptoms. The illness is typically mild and self-limited, and children generally cannot develop the illness more than once.

Coxsackieviruses are a common cause of infection in adults and children. The spectrum of disease caused by these viruses ranges from very mild to life-threatening. No vaccine is available, and there is no drug that specifically kills the virus. Coxsackievirus infection is contagious from person to person. The key to prevention of coxsackievirus infection is good hand washing and covering the mouth when coughing or sneezing.

Being in settings where there is a high risk of exposure increases the risk of developing both viral and bacterial illnesses. Children attending day care, preschool, and grammar school may spread the infection among their peers. Newborn infants, as a consequence of their limited immune response, are extremely vulnerable to suffer substantial complications (including death) should they develop a coxsackievirus infection. Other older individuals with an underlying immune system weakness (for example, those receiving cancer chemotherapy) are also more likely to experience serious consequences should they develop a coxsackievirus infection.

The virus is present in the secretions and bodily fluids of infected people. The virus may be spread by coming into contact with respiratory secretions from infected patients. If infected people rub their runny noses and then touch a surface, that surface can harbor the virus and become a source of infection. The infection is spread when another person touches the contaminated surface and then touches his or her mouth or nose.

People who have infected eyes (conjunctivitis) can spread the virus by touching their eyes and touching other people or touching a surface. Conjunctivitis may spread rapidly and appear within one day of exposure to the virus. Coxsackieviruses are also shed in stool, which may be a source of transmission among young children. The virus can be spread if unwashed hands get contaminated with fecal matter and then touch the face. This is particularly important for spread within day-care centers or nurseries where diapers are handled. Diarrhea is the most common sign of coxsackievirus intestinal infection.

Like many contagious respiratory or intestinal illnesses, once the coxsackievirus enters the body, it takes an average of one to two days for symptoms to develop (incubation period). People are most contagious in the first week of illness, but the virus may still be present up to one week after symptoms resolve. The virus may be reside longer in children and those whose immune system is weak.

Hand, foot, and mouth disease is a common childhood illness caused by a virus, coxsackievirus A-16. The illness most often occurs in the spring and fall and is most frequently seen in young children, infants, and toddlers. It is characterized by fever and a blister-like rash affecting the palms of the hands and soles of the feet along with blisters inside the mouth. (It is unrelated to foot and mouth disease, which affects livestock.)

There are no tests indicated in obvious cases of hand, foot, and mouth disease. The diagnosis is made based upon the typical symptoms and signs found upon examination. This is due to the fact that the diagnostic laboratory tests that are available generally take two to three weeks to get results, and generally the symptoms of the illness will have resolved already by this time.

Coxsackievirus

Most coxsackievirus infections are mild and may not even cause symptoms. The virus is one cause of the common cold or a generalized mildly erythematous (red) rash, especially seen in the summer months. It may also cause diarrhea or a sore throat that is similar to strep throat.
There are some more severe syndromes caused by the virus, but these are less common. They include meningitis (an infection of the linings of the spinal cord and brain), encephalitis (inflammation of the brain), pleurodynia (chest pain), and myopericarditis (inflammation of the heart). Infection of newborns may be particularly severe.

These syndromes are described below.

Respiratory Illness

It is common for the coxsackievirus to cause a febrile upper respiratory tract infection with sore throat and/or a runny nose. Some patients have a cough resembling bronchitis. Less commonly, coxsackievirus may cause pneumonia.

Rash

Some people with coxsackievirus have a rash. In many, this is a nonspecific generalized red rash or clusters of fine red spots. The rash may not appear until the infection has started to get better. Although it may resemble a light sunburn, the rash does not peel. The rash itself is not contagious.

The virus may also cause small, tender blisters and red spots on the palms, soles of the feet, and inside the mouth. In the mouth, sores occur on the tongue, gums, and cheek. This condition is known as hand-foot-mouth disease (HFMD) and is caused by group A coxsackievirus. HFMD is most common in children under 10 years of age. HFMD usually causes a sore throat, fever, and the characteristic blister rash described above. It is mild and resolves on its own. While the blister fluid is a theoretical source of transmission of the virus, the large majority of those infected develop HFMD from contact with respiratory droplets or stool exposure.

Coxsackievirus also may cause a syndrome called herpangina in children. Herpangina presents with fever, sore throat, and small, tender blisters inside the mouth. It is more common in summer and is usually found among children 3-10 years of age. It may be confused with strep throat at first until test results for strep come back negative.

Eye Infection: Conjunctivitis

Acute hemorrhagic conjunctivitis (AHC) presents with swollen eyelids and red hemorrhages in the whites of the eye. Usually, the infection spreads to the other eye as well. Affected people may feel like there is something in their eye or complain of burning pain. AHC may be caused by coxsackievirus, although it is more commonly caused by a related virus. Symptoms usually resolve in about a week.

Meningitis

Coxsackieviruses, especially those from group B, may cause viral meningitis (inflammation of the linings of the spinal cord and brain). Viral meningitis is also known as "aseptic meningitis" because routine cultures of the spinal fluid show no bacterial growth. This is because routine culture methods test for bacteria and not for viruses. Patients with aseptic meningitis complain of a headache and fever with mild neck stiffness. A rash may be present. In children, symptoms may be less specific, including change in personality or becoming lethargic. Febrile seizures may occur in children. Seizures are less common in adults, although adults may complain of fatigue that lasts for weeks after the meningitis resolves.

Less commonly, coxsackievirus may cause inflammation of the brain tissue (meningoencephalitis), as well. People with meningoencephalitis usually have fever and are lethargic or confused. Meningoencephalitis is more common in small children.

Weakness and Paralysis

Another rare symptom is weakness in an arm or leg or even partial paralysis. The symptoms are similar to, but milder than, those caused by poliomyelitis. Paralysis or weakness may follow a bout of AHC or may occur on its own. Weakness and paralysis caused by coxsackievirus usually are not permanent.

Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease usually occurs in the spring and fall seasons but may occur at any time during the year. The initial symptoms include.

• fever and
• general malaise (poor appetite, aches and pains, etc.).

These symptoms generally last one to two days before a blister-like rash develops on the hands, feet, and in the mouth. The rash initially appears as small red spots but then develops into vesicles (blisters). The blisters may develop on the gums, inner cheeks, and tongue, and patients may complain of mouth pain and a sore throat.

These young patients tend to drool and avoid swallowing and may refuse to drink or eat because of the discomfort. Very young infants may even become dehydrated due to the refusal to drink.

Rarely, other more serious complications occur, including viral meningitis (aseptic meningitis) and encephalitis. The symptoms associated with these complications include

• high fever,
• headache,
• legarthy,
• irritability,
• stiff neck, and
• back pain.

If your child has any of these additional symptoms, you should seek medical attention.

Coxsackievirus

Coxsackieviruses are part of a viral genus called Enterovirus. They are divided into two groups: group A coxsackievirus and group B coxsackievirus. Each group is further divided into several serotypes. The virus is not destroyed by the acid in the stomach, and it can live on surfaces for several hours.

Hand, Foot, and Mouth Disease

• Hand, foot, and mouth disease is generally caused by coxsackievirus A-16, which is a member of the enterovirus family.
• There are other types of enteroviruses that can cause the symptoms as well, but these are less common.

Children usually become infected with the virus from other children in an fecal-oral pattern; that is, infection is acquired from exposure to infected fecal material or oral secretions (nasal discharge, saliva, etc.).

The incubation period (time between exposure and symptoms) is usually five days.

Coxsackievirus

There is no specific medicine that has been shown to kill the coxsackievirus. Fortunately, the body's immune system is usually able to destroy the virus. In cases of severe disease, physicians have sometimes turned to therapies that seem promising but which have not been thoroughly tested to see if they really work. For example, some reports suggest there might be a benefit to intravenous immune globulin (IVIG), which is made from human serums, which contains antibodies.

Treatment for myopericarditis is supportive. This includes using medicines to support the blood pressure if the heart is pumping too poorly to do so by itself. In extreme cases, heart transplantation may be needed.

Acetaminophen, ibuprofen, and similar agents can be used to reduce pain and fever. Avoid the use of aspirin in children and teenagers, because of the risk of a serious liver disorder (Reye's syndrome).

Over-the-counter cold preparations (decongestants, cough syrup) may reduce symptoms in adults, although they will not speed recovery and may cause side effects including drowsiness and dry mouth. The efficacy of these products has recently been challenged by the U.S. Food and Drug Administration (FDA), which recommends against their use in children under 6 years of age. There are no studies showing that over-the-counter medicines work in older children.

Hand, Foot, and Mouth Disease

There is no specific treatment for hand, foot, and mouth disease. Supportive care, including fever management, and prevention of dehydration are the primary goals. Occasionally, "magic mouthwash" is prescribed by the provider. This is a mix of several oral liquid medications, generally including a topical anesthetic and diphenhydramine (Benadryl). This is then applied to the mouth ulcers to decrease the pain associated with the oral lesions, decrease the inflammatory response, and encourage the affected infant to increase oral intake.

If your child's fever remains elevated despite appropriate fever-reducing drugs, or if he/she develops any signs or symptoms of dehydration (dry skin and mucous membranes, weight loss, persistent irritability, lethargy, or decreased urine output), you should seek immediate medical attention. Obviously, when concerned or in doubt, contact your child's health-care provider.

Coxsackievirus

Most people who get coxsackievirus infections have no symptoms or are only mildly ill and soon recover. People who have fever or feel ill should stay home, because the infection is contagious.

Most patients with myopericarditis recover completely, but up to one-third will continue to have some degree of heart failure. Children with myopericarditis usually fare better than adults. Severe coxsackievirus infections in newborns are fatal in approximately one-half of cases.

Hand, Foot, and Mouth Disease

Appropriate infection control practices are recommended to prevent the spread of hand, foot, and mouth disease. Good hand hygiene (washing hands) is always important. Children infected with the virus causing hand, foot, and mouth disease generally have mild illness and recover within one week of developing symptoms. There is no vaccine; however, the illness is typically mild and self-limited, and children generally cannot develop the illness twice. In addition, most adults have persistent immunity and cannot become infected either.