COXSACKIEVIRUSES

Structure & Property	Transmission	Pathogenesis	Clinical findings	Laboratory diagnosis	Treatment	
Family: picorna

Genome: single-strand RNA, positive polarity

Size: 22-30nm

Icosahedral nucleocapsid

Nonenveloped

Group A: 23 serotypes
Group B: 6 serotypes	Transmitted primarily by fecal-oral route and respiratory secretions.

Replicate in the oropharynx and intestinal tract. 

Humans are only natural hosts.

Immunity is provided by type-specific IgG antibody	Group A viruses infect mainly the skin and mucous membranes.

Group B viruses cause disease in various organs such as the heart, pleura, pancreas and liver.

Both group A and B affect meninges and motor neurons to cause paralysis.

Disseminate via bloodstream to other sites from oropharynx and gut.	Group A:
Herpangina:
- fever
- sore throat
- tender vesicles in oropharynx
Hand-foot-mouth disease:
- vesicular rash on hands and feet.
- ulcerations in mouth
- mainly in children.
Myositis: flaccid paralysis.

Group B:
Bornholm disease:
- fever
- severe chest pain due to inflammation of intercostal muscles.
Myocarditis and pericarditis:
- fever
- chest pain
- signs of congestive failure.

Both groups cause:
- aseptic meningitis
- upper respiratory infections
- minor febrile illnesses	Diagnosis:
- viral isolation in cell culture or suckling mice.
- rise in antibody titer

Isolation:
- feces
- throat swab

Serologic tests are of little value.

Inoculate:
- suckling mice
- group A coxsackieviruse cause flaccid paralysis due to myositis.
- group B coxsackieviruses cause spastic paralysis due to cerebral lesions.
- look out for signs of disease.

ELISA test used to 
detect IgM to group B coxsackieviruses.

PCR can be used to detect viral RNA in tissues and CSF.	No antiviral drug therapy or passive immunization is available.