Coxsackieviruses Follow-up

  • Author: Parul Kaushik, MD, MPH; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Sep 28, 2011
 

Further Inpatient Care

  • Severe aseptic meningitis and/or encephalitis, seizures, myopericarditis, and heart failure require admission for workup and treatment. Antibiotics may be used until bacterial meningitis is ruled out. Supportive inpatient or intensive care may be necessary for severe cases.
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Further Outpatient Care

  • No outpatient care, other than usual follow-up care, is required for patients with mild symptoms.
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Inpatient & Outpatient Medications

  • Inpatient medications indicated are based on the patient's presentation at admission (eg, phenytoin for seizure prophylaxis and/or suppression in patients with aseptic meningitis/encephalitis, digoxin in patients with heart failure).
  • Antipyretics (eg, acetaminophen) for fever and NSAIDs for pain should be adequate in patients with mild symptoms who do not require hospital admission.
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Transfer

  • Transfer to a tertiary facility may be necessary for specialized consultations or surgeries.
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Deterrence/Prevention

  • Minimize respiratory contact with the infected patient if possible.
  • To prevent further transmission, strict handwashing should be encouraged and sharing of towels should be avoided.
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Complications

  • See History and Physical, which discuss the many presentations of coxsackievirus infections.
  • Complications of aseptic meningitis include lethargy, seizures, coma, and movement disorders (5-10%).
  • Complications of myopericarditis include pericardial effusion, arrhythmia, heart block, valvular dysfunction, and dilated cardiomyopathy.
  • Rare complications of acute hemorrhagic conjunctivitis (AHC) include keratitis and motor paralysis.
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Prognosis

  • In general, the prognosis is very good, with 90% of patients having no symptoms or experiencing mild, self-limited, nonspecific febrile illnesses or rashes.
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Patient Education

  • Patients should be aware of the need for good hygiene practices to avoid transmission.
  • Patients need to be reassured that they have a self-limited viral illness that does not require any antibiotics for treatment.
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Contributor Information and Disclosures
Author

Parul Kaushik, MD, MPH  Fellow, Department of Medicine, Division of Infectious Disease, Drexel University College of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Mashiul H Chowdhury, MD  Assistant Professor, Department of Medicine, Division of Infectious Disease, Program Director, Infectious Disease Fellowship, Director, TravelHealth Center, Drexel University College of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Maria D Mileno, MD  Associate Professor of Medicine, Division of Infectious Diseases, The Warren Alpert Medical School of Brown University

Maria D Mileno, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, International Society of Travel Medicine, and Sigma Xi

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

John W King, MD  Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University Health Sciences Center; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center

John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, and Sigma Xi

Disclosure: emedicine $50.00 Author of chapter; MERCK None Other

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Nhat M Doan, MD, and Michael Rajnik, MD, to the development and writing of this article.

References

  1. Khetsuriani N, Lamonte A, Oberste MS, et al. Neonatal enterovirus infections reported to the national enterovirus surveillance system in the United States, 1983-2003. Pediatr Infect Dis J. Oct 2006;25(10):889-93. [Medline].

  2. King RL, Lorch SA, Cohen DM, et al. Routine cerebrospinal fluid enterovirus polymerase chain reaction testing reduces hospitalization and antibiotic use for infants 90 days of age or younger. Pediatrics. Sep 2007;120(3):489-96. [Medline].

  3. Schiff GM, Sherwood JR. Clinical activity of pleconaril in an experimentally induced coxsackievirus A21 respiratory infection. J Infect Dis. Jan 2000;181(1):20-6. [Medline].

  4. Brunetti L, DeSantis ER. Treatment of viral myocarditis caused by coxsackievirus B. Am J Health Syst Pharm. Jan 15 2008;65(2):132-7. [Medline].

  5. Yue-Chun L, LiSha G, Jiang-Hua R, Peng-Lin Y, Jia-Feng L, Ji-Fei T, et al. Protective effects of carvedilol in murine model with the coxsackievirus B3-induced viral myocarditis. J Cardiovas Pharmacol. Jan/2008;51:92-98. [Medline].

  6. Shi L, Xiong H, He J, et al. Antiviral activity of arbidol against influenza A virus, respiratory syncytial virus, rhinovirus, coxsackie virus and adenovirus in vitro and in vivo. Arch Virol. 2007;152(8):1447-55. [Medline].

  7. Ang LW, Koh BK, Chan KP, Chua LT, James L, Goh KT. Epidemiology and control of hand, foot and mouth disease in Singapore, 2001-2007. Ann Acad Med Singapore. Feb 2009;38(2):106-12. [Medline].

  8. Bergman I, Painter MJ, Wald ER, et al. Outcome in children with enteroviral meningitis during the first year of life. J Pediatr. May 1987;110(5):705-9. [Medline].

  9. Berlin LE, Rorabaugh ML, Heldrich F, et al. Aseptic meningitis in infants < 2 years of age: diagnosis and etiology. J Infect Dis. Oct 1993;168(4):888-92. [Medline].

  10. Cheung CT, Deisher TA, Luo H, et al. Neutralizing anti-4-1BBL treatment improves cardiac function in viral myocarditis. Lab Invest. Jul 2007;87(7):651-61. [Medline].

  11. Dagan R, Jenista JA, Menegus MA. Association of clinical presentation, laboratory findings, and virus serotypes with the presence of meningitis in hospitalized infants with enterovirus infection. J Pediatr. Dec 1988;113(6):975-8. [Medline].

  12. Dagan R, Menegus MA. A combination of four cell types for rapid detection of enteroviruses in clinical specimens. J Med Virol. Jul 1986;19(3):219-28. [Medline].

  13. Dulbecco R, Ginsberg H. Virology. 2nd ed. 1988:207-209.

  14. Enterovirus surveillance--United States, 2002-2004. MMWR Morb Mortal Wkly Rep. Feb 17 2006;55(6):153-6. [Medline].

  15. Jaïdane H, Hober D. Role of coxsackievirus B4 in the pathogenesis of type 1 diabetes. Diabetes Metab. Dec 2008;34(6 Pt 1):537-48. [Medline].

  16. Jenista JA, Powell KR, Menegus MA. Epidemiology of neonatal enterovirus infection. J Pediatr. May 1984;104(5):685-90. [Medline].

  17. Levinson W, Jawetz E. Medical Microbiology & Immunology: Examination & Board Review. 6th ed. New York, NY: McGraw Hill Text; 2000:238-239.

  18. Modlin JF. Coxsackieviruses, Echoviruses, Newer Enteroviruses, and Parechoviruses. In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Churchill-Livingstone; 2009:2353-2365.

  19. Moore M. Centers for Disease Control. Enteroviral disease in the United States, 1970-1979. J Infect Dis. Jul 1982;146(1):103-8. [Medline].

  20. Morens DM, Pallansch MA. Epidemiology. Human Enterovirus Infections. 1995;1.

  21. Pallansch MA, Anderson LJ. Coxsackievirus, echovirus, and other enteroviruses. In: Gorbach SL, ed. Infectious Diseases. 2nd ed. Philadelphia, Pa: WB Saunders Co; 1998:2164-2170.

  22. Piqueur MA, Verstrepen WA, Bruynseels P, Mertens AH. Improvement of a real-time RT-PCR assay for the detection of enterovirus RNA. Virol J. Jul 7 2009;6:95. [Medline].

  23. Rantala H, Uhari M. Occurrence of childhood encephalitis: a population-based study. Pediatr Infect Dis J. Jul 1989;8(7):426-30. [Medline].

  24. Richer MJ, Horwitz MS. Coxsackievirus infection as an environmental factor in the etiology of type 1 diabetes. Autoimmun Rev. Jun 2009;8(7):611-5. [Medline].

  25. Rorabaugh ML, Berlin LE, Heldrich F, et al. Aseptic meningitis in infants younger than 2 years of age: acute illness and neurologic complications. Pediatrics. Aug 1993;92(2):206-11. [Medline].

  26. Rotbart HA. Pleconaril therapy of potentially life-threatening enterovirus infections. 36th Annual Meeting of the Infectious Disease Society of America. 1998.

  27. Rotbart HA. Pleconaril treatment of enterovirus and rhinovirus infections. Infect Med. 2000;17:488.

  28. Rotbart HA. Treatment of picornavirus infections. Antiviral Res. Feb 2002;53(2):83-98. [Medline].

  29. Rotbart HA, Ahmed A, Hickey S, et al. Diagnosis of enterovirus infection by polymerase chain reaction of multiple specimen types. Pediatr Infect Dis J. Apr 1997;16(4):409-11. [Medline].

  30. Rotbart HA, McCracken GH Jr, Whitley RJ, et al. Clinical significance of enteroviruses in serious summer febrile illnesses of children. Pediatr Infect Dis J. Oct 1999;18(10):869-74. [Medline].

  31. Rotbart HA, Webster AD. Treatment of potentially life-threatening enterovirus infections with pleconaril. Clin Infect Dis. Jan 15 2001;32(2):228-35. [Medline].

  32. Sauter P, Hober D. Mechanisms and results of the antibody-dependent enhancement of viral infections and role in the pathogenesis of coxsackievirus B-induced diseases. Microbes Infect. Apr 2009;11(4):443-51. [Medline].

  33. Sawyer MH, Holland D, Aintablian N, et al. Diagnosis of enteroviral central nervous system infection by polymerase chain reaction during a large community outbreak. Pediatr Infect Dis J. Mar 1994;13(3):177-82. [Medline].

  34. Tebruegge M, Curtis N. Enterovirus infections in neonates. Semin Fetal Neonatal Med. Aug 2009;14(4):222-7. [Medline].

  35. Voroshilova MK, Chumakov MP. Poliomyelitis-like properties of AB-IV Coxsackie A7 group of viruses. Prog Med Virol. 1959;2:106.

  36. Weller TH, Enders JF, Buckingham M, et al. The etiology of epidemic pleurodynia: a study of two viruses isolated from a typical outbreak. J Immunol. Sep 1950;65(3):337-46. [Medline].

  37. Yeung WC, Rawlinson WD, Craig ME. Enterovirus infection and type 1 diabetes mellitus: systematic review and meta-analysis of observational molecular studies. BMJ [serial online]. 3 February 2011;342:1-9. Accessed 06/29/2011. [Medline]. Available at http://www.bmj.com/content/342/bmj.d35.long.

 
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