eMedicine Specialties > Infectious Diseases > Viral Infections

Coxsackieviruses: Treatment & Medication

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: Jun 30, 2008

Treatment

Medical Care

Medical care is generally supportive and can be offered on an outpatient basis. More severe symptoms may require inpatient admission for further workup and intervention.

  • Aseptic meningitis
    • Treatment is mainly supportive.
    • Pleconaril, an enteroviral capsid-stabilizing drug, appeared to reduce symptoms in a randomized double-blind study (N = 33),3 but has not been licensed by the Food and Drug Administration (FDA).
    • Not all patients require hospitalization, but consider admission for patients with changes in mental status or neurologic deficits.
  • Myopericarditis: IVIG has been of anecdotal benefit, but no randomized trials have been conducted. A large prospective trial of prednisone with cyclosporine or azathioprine showed no difference compared to supportive treatment alone.4 Recent experiments have shown that carvedilol, a nonselective beta-blocker, attenuates myocardial lesions and decreases myocardial virus replication in a murine model. However, this intervention has not been evaluated in humans.5  
  • Epidemic pleurodynia: Analgesics, narcotics, and heating pads are the mainstays of therapy. All patients recover completely within 1 week.
  • Acute hemorrhagic conjunctivitis (AHC): Treatment is symptomatic, and no antimicrobial agent is necessary in the absence of bacterial superinfection.
  • Immunodeficiency: Both IVIG and pleconaril have been used in immunocompromised patients with enteroviral infections (neonates and B-cell immunodeficient) with varying success.
  • In vitro studies have suggested that arbidol may have potential as a future antiviral agent with activity against coxsackievirus, but no trials in humans have yet been performed.6

Surgical Care

No surgical intervention is necessary unless patients develop complications such as meningitis and/or encephalitis with increased intracranial pressure, which requires ventriculostomy, or heart failure, which requires valve repair or cardiac transplant.

Consultations

Consultations play an important role in patients with complex presentations.

  • A neurologist may help to evaluate patients who present with abnormal neurologic symptoms or to manage rare complications associated with meningitis.
  • A neurosurgeon may be needed to assist with obtaining brain biopsies or placing a ventriculostomy tube because of increased intracranial pressure.
  • A cardiologist helps with diagnosis and management of arrhythmia, heart failure, and heart block associated with myocarditis.

Diet

Diet is as tolerated.

Activity

Bedrest is indicated for some patients.

Medication

No FDA-approved therapy exists for the treatment of enteroviral infections. IVIG and pleconaril have been used in severe illness. Supportive use of analgesics and antipyretics are usually necessary.

More on Coxsackieviruses

Overview: Coxsackieviruses
Differential Diagnoses & Workup: Coxsackieviruses
Treatment & Medication: Coxsackieviruses
Follow-up: Coxsackieviruses
References
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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. 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].

  8. 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].

  9. 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].

  10. 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].

  11. 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].

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

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

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

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

  16. Modlin JF. Coxsackieviruses, echoviruses, and newer enteroviruses. In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 5th ed. Philadelphia, Pa: Churchill-Livingstone; 2000:1904-1919.

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

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

  19. 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.

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

  21. 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].

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

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

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

  25. 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].

  26. 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].

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

  28. 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].

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

  30. 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].

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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: Nothing to disclose.

Managing Editor

John W King, MD, Professor of Medicine, Section of Infectious Diseases, Louisiana State University Health Sciences Center; Director, Viral Therapeutics Clinics for Hepatitis; Consulting Staff, Department of Infectious Diseases, Overton Brook 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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