eMedicine Specialties > Infectious Diseases > Viral Infections

Coxsackieviruses: Follow-up

Author: Michael Rajnik, MD, Assistant Professor, Department of Pediatrics, Acting Program Director, Pediatric Infectious Disease Fellowship Program, Uniformed Services University of the Health Sciences
Coauthor(s): Nhat M Doan, MD, Fellow, Department of Internal Medicine, Division of Infectious Diseases, Washington Hospital Center
Contributor Information and Disclosures

Updated: Dec 21, 2009

Follow-up

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.

Further Outpatient Care

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

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.

Transfer

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

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.

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.

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.

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.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose bacterial meningitis may result in a poor outcome. All patients who have symptoms or CSF profiles suggestive of bacterial meningitis (WBC count >1000 cells/μL, neutrophil predominance, hypoglycorrhachia, elevated protein levels) should be managed with antibiotics until cultures are negative for bacteria. Patients with severe courses and encephalitis should be evaluated for alternative causes of encephalitis (herpes simplex virus, arboviruses) that may be treatable.
  • Failure to diagnose myocarditis promptly may result in cardiovascular complications (eg, severe heart failure).
  • Failure to obtain appropriate consultations early (eg, neurologist, neurosurgeon, cardiologist, cardiothoracic surgeon) could lead to delays in definitive management.

Special Concerns

  • In addition to fecal-oral and respiratory transmission, be aware that spread of coxsackieviruses via fomites is possible; therefore, appropriate actions should be taken. Careful handwashing and disposal of contaminated objects should decrease the spread of enteroviruses.
 


More on Coxsackieviruses

Overview: Coxsackieviruses
Differential Diagnoses & Workup: Coxsackieviruses
Treatment & Medication: Coxsackieviruses
Follow-up: Coxsackieviruses
References
Further Reading
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Keywords

coxsackieviruses, coxsackie viruses, coxsackie virus A, coxsackievirus A, hand-foot-and-mouth disease, hand-foot-mouth disease, HFM disease, vesicular stomatitis with exanthem, coxsackievirus B, coxsackie virus B, Bamle disease, Bornholm disease, Daae disease, Sylvest disease, benign dry pleurisy, epidemic pleurodynia, devil's grip, devil's grippe, diaphragmatic pleurisy, epidemic benign dry pleurisy, epidemic diaphragmatic pleurisy, epidemic myalgia, epidemic myositis, myositis epidemica acuta, epidemic transient diaphragmatic spasm, aseptic meningitis, acute hemorrhagic conjunctivitis, AHC, enteroviral infection

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Contributor Information and Disclosures

Author

Michael Rajnik, MD, Assistant Professor, Department of Pediatrics, Acting Program Director, Pediatric Infectious Disease Fellowship Program, Uniformed Services University of the Health Sciences
Michael Rajnik, MD is a member of the following medical societies: American Academy of Pediatrics, Armed Forces Infectious Diseases Society, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Coauthor(s)

Nhat M Doan, MD, Fellow, Department of Internal Medicine, Division of Infectious Diseases, Washington Hospital Center
Nhat M Doan, MD is a member of the following medical societies: American Medical Association and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

Maria D Mileno, MD, Assistant Professor, Department of Internal Medicine, Division of Infectious Diseases, 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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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

CME Editor

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.

 
 
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