Coxsackie B
Encyclopedia
Coxsackie B is the name of a group of six serotypes of pathogenic enteroviruses that trigger illness ranging from mild gastrointestinal distress to full-fledged pericarditis
and myocarditis
.
, Ohio
, New York
, and Kentucky
, although a sixth member of the group has been found in the Philippines
. That said, all six serotypes have a global distribution and are a relatively common cause of gastrointestinal upset.
, headache
, sore throat
, gastrointestinal distress, as well as chest
and muscle pain. This presentation is known as pleurodynia
or Bornholm disease in many areas. Sufferers of chest pain should see a doctor immediately - in some cases, viruses in the Coxsackie B family progress to myocarditis or pericarditis, which can result in permanent heart damage or death. Coxsackie B virus infection may also induce aseptic meningitis
. As a group, they are the most common cause of unexpected sudden death
, and may account for up to 50% of such cases. The incubation period for the Coxsackie B viruses is, like most of the Enteroviridae, highly variable, ranging from 2 to 35 days, and illness may last for up to two weeks, but may resolve as quickly as two days. Infection usually occurs between the months of June and October.
and from cell culture. Because the same level and type of care is given regardless of type of Coxsackie B infection, it is mostly unnecessary for treatment purposes to diagnose which virus is causing the symptoms in question, though it may be epidemiologically useful.
s. The virus is most frequently distributed via the fecal-oral route
, and infection commonly occurs after eating contaminated food. Coxsackie B viruses are cytolytic, and Coxsackie B2 and B5 viruses have been implicated in hand, foot and mouth disease
as well as respiratory infection. Infection in infants is mostly asymptomatic, but sometimes results in the death of the infant, often due to myocarditis. Birth defects may also be present in a Coxsackie B infected infant.
.
is available, however, and patients suffering chest pain or stiffness of the neck should be examined for signs of cardiac or central nervous system
involvement, respectively. Some measure of prevention can usually be achieved by basic sanitation on the part of food-service workers, though the viruses are highly contagious. Care should be taken in washing ones hands and in cleaning the body after swimming. In the event of Coxsackie-induced myocarditis or pericarditis, antiinflammatories can be given to reduce damage to the heart muscle.
Pericarditis
Pericarditis is an inflammation of the pericardium . A characteristic chest pain is often present.The causes of pericarditis are varied, including viral infections of the pericardium, idiopathic causes, uremic pericarditis, bacterial infections of the precardium Pericarditis is an inflammation of...
and myocarditis
Myocarditis
Myocarditis is inflammation of heart muscle . It resembles a heart attack but coronary arteries are not blocked.Myocarditis is most often due to infection by common viruses, such as parvovirus B19, less commonly non-viral pathogens such as Borrelia burgdorferi or Trypanosoma cruzi, or as a...
.
Geographic distribution
The various members of the Coxsackie B group were discovered almost entirely in the United States, appearing originally in ConnecticutConnecticut
Connecticut is a state in the New England region of the northeastern United States. It is bordered by Rhode Island to the east, Massachusetts to the north, and the state of New York to the west and the south .Connecticut is named for the Connecticut River, the major U.S. river that approximately...
, Ohio
Ohio
Ohio is a Midwestern state in the United States. The 34th largest state by area in the U.S.,it is the 7th‑most populous with over 11.5 million residents, containing several major American cities and seven metropolitan areas with populations of 500,000 or more.The state's capital is Columbus...
, New York
New York
New York is a state in the Northeastern region of the United States. It is the nation's third most populous state. New York is bordered by New Jersey and Pennsylvania to the south, and by Connecticut, Massachusetts and Vermont to the east...
, and Kentucky
Kentucky
The Commonwealth of Kentucky is a state located in the East Central United States of America. As classified by the United States Census Bureau, Kentucky is a Southern state, more specifically in the East South Central region. Kentucky is one of four U.S. states constituted as a commonwealth...
, although a sixth member of the group has been found in the Philippines
Philippines
The Philippines , officially known as the Republic of the Philippines , is a country in Southeast Asia in the western Pacific Ocean. To its north across the Luzon Strait lies Taiwan. West across the South China Sea sits Vietnam...
. That said, all six serotypes have a global distribution and are a relatively common cause of gastrointestinal upset.
Symptoms
Symptoms of infection with viruses in the Coxsackie B grouping include feverFever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
, headache
Headache
A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...
, sore throat
Sore throat
A sore throat or throat pain is a common physical symptom usually caused by acute pharyngitis, or throat inflammation, though it also occurs in a number of other situations, such as post trauma and in diphtheria. It can cause mild to extreme pain....
, gastrointestinal distress, as well as chest
Chest pain
Chest pain may be a symptom of a number of serious conditions and is generally considered a medical emergency. Even though it may be determined that the pain is non-cardiac in origin, this is often a diagnosis of exclusion made after ruling out more serious causes of the pain.-Differential...
and muscle pain. This presentation is known as pleurodynia
Bornholm disease
Bornholm disease or epidemic pleurodynia or epidemic myalgia is a disease caused by the Coxsackie B virus or other viruses.It is named after the Danish island Bornholm where early cases occurred.-Signs and symptoms:...
or Bornholm disease in many areas. Sufferers of chest pain should see a doctor immediately - in some cases, viruses in the Coxsackie B family progress to myocarditis or pericarditis, which can result in permanent heart damage or death. Coxsackie B virus infection may also induce aseptic meningitis
Aseptic meningitis
Aseptic meningitis, or sterile meningitis, is a condition in which the layers lining the brain, meninges, become inflamed and a pyogenic bacterial source is not to blame. Meningitis is diagnosed on a history of characteristic symptoms and certain examination findings...
. As a group, they are the most common cause of unexpected sudden death
Sudden death
In a sport or game, sudden death is a form of competition where play ends as soon as one competitor is ahead of the others, with that competitor becoming the winner. Sudden death is typically used as a tiebreaker when a contest is tied at the end of the normal playing time or the completion of...
, and may account for up to 50% of such cases. The incubation period for the Coxsackie B viruses is, like most of the Enteroviridae, highly variable, ranging from 2 to 35 days, and illness may last for up to two weeks, but may resolve as quickly as two days. Infection usually occurs between the months of June and October.
Diagnosis
Enterovirus infection is diagnosed mainly via serological tests such as ELISAELISA
Enzyme-linked immunosorbent assay , is a popular format of a "wet-lab" type analytic biochemistry assay that uses one sub-type of heterogeneous, solid-phase enzyme immunoassay to detect the presence of a substance in a liquid sample."Wet lab" analytic biochemistry assays involves detection of an...
and from cell culture. Because the same level and type of care is given regardless of type of Coxsackie B infection, it is mostly unnecessary for treatment purposes to diagnose which virus is causing the symptoms in question, though it may be epidemiologically useful.
Viral structure and function
Coxsackie B viruses are single-strand positive-sense RNA viruses that are resistant to a wide variety of chemical treatments. The viral particles themselves are roughly 30 nm icosahedronIcosahedron
In geometry, an icosahedron is a regular polyhedron with 20 identical equilateral triangular faces, 30 edges and 12 vertices. It is one of the five Platonic solids....
s. The virus is most frequently distributed via the fecal-oral route
Fecal-oral route
The fecal-oral route, or alternatively, the oral-fecal route or orofecal route is a route of transmission of diseases, in which they are passed when pathogens in fecal particles from one host are introduced into the oral cavity of another potential host.There are usually intermediate steps,...
, and infection commonly occurs after eating contaminated food. Coxsackie B viruses are cytolytic, and Coxsackie B2 and B5 viruses have been implicated in hand, foot and mouth disease
Hand, foot and mouth disease
Hand, foot and mouth disease is a human syndrome caused by intestinal viruses of the Picornaviridae family. The most common strains causing HFMD are Coxsackie A virus and Enterovirus 71 ....
as well as respiratory infection. Infection in infants is mostly asymptomatic, but sometimes results in the death of the infant, often due to myocarditis. Birth defects may also be present in a Coxsackie B infected infant.
Diabetes
The B4 strain of Coxsackie viruses has been discovered to be a possible cause of Diabetes mellitus type 1Diabetes mellitus type 1
Diabetes mellitus type 1 is a form of diabetes mellitus that results from autoimmune destruction of insulin-producing beta cells of the pancreas. The subsequent lack of insulin leads to increased blood and urine glucose...
.
Treatment and prevention
, there is no well-accepted treatment for the Coxsackie B group of viruses. Palliative carePalliative care
Palliative care is a specialized area of healthcare that focuses on relieving and preventing the suffering of patients...
is available, however, and patients suffering chest pain or stiffness of the neck should be examined for signs of cardiac or central nervous system
Central nervous system
The central nervous system is the part of the nervous system that integrates the information that it receives from, and coordinates the activity of, all parts of the bodies of bilaterian animals—that is, all multicellular animals except sponges and radially symmetric animals such as jellyfish...
involvement, respectively. Some measure of prevention can usually be achieved by basic sanitation on the part of food-service workers, though the viruses are highly contagious. Care should be taken in washing ones hands and in cleaning the body after swimming. In the event of Coxsackie-induced myocarditis or pericarditis, antiinflammatories can be given to reduce damage to the heart muscle.