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: Dec 21, 2009

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
Further Reading
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References

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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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