is a virus that belongs to a family of non enveloped linear positive-sense ssRNA viruses, Picornaviridae
and the genus Enterovirus
Enteroviruses are a genus of ssRNA viruses associated with several human and mammalian diseases. Serologic studies have distinguished 66 human enterovirus serotypes on the basis of antibody neutralization tests. Additional antigenic variants have been defined within several of the serotypes on the...
, which also includes poliovirus and echovirus
An ECHO virus, is a type of RNA virus that belongs to the genus Enterovirus of the Picornaviridae family...
. Enteroviruses are among the most common and important human pathogens and ordinarily its members are transmitted by the fecal-oral route. Coxsackieviruses share many characteristics with poliovirus. With control of poliovirus infections in much of the world, more attention has been focused on understanding the nonpolio enteroviruses such as coxsackievirus.
Coxsackieviruses are among the leading causes of 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...
, the other usual suspects are echovirus and mumps virus.
Coxsackieviruses are divided into group A and group B viruses based on early observations of their pathogenicity in mice. Group A coxsackieviruses were noted to cause a flaccid paralysis, which was caused by generalized myositis, while group B coxsackieviruses were noted to cause a spastic paralysis due to focal muscle injury and degeneration of neuronal tissue. At least 23 serotypes (1-22, 24) of group A and 6 serotypes (1-6) of group B are recognized.
In general, group A coxsackieviruses tend to infect the skin and mucous membranes, causing herpangina
Herpangina, also called mouth blisters, is the name of a painful mouth infection caused by coxsackieviruses. Usually, herpangina is produced by one particular strain of coxsackie virus A but it can also be caused by coxsackievirus B or echoviruses. Most cases of herpangina occur in the summer,...
, acute hemorrhagic conjunctivitis
Conjunctivitis refers to inflammation of the conjunctiva...
(AHC), and hand, foot and mouth (HFM) 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 ....
. Both group A and group B coxsackieviruses can cause nonspecific febrile illnesses, rashes, upper respiratory tract disease, and aseptic meningitis.
Group B coxsackieviruses tend to infect the heart, pleura, pancreas, and liver, causing pleurodynia, myocarditis, pericarditis, and hepatitis (inflammation of the liver not related to the hepatotropic viruses
Viral hepatitis is liver inflammation due to a viral infection. It may present in acute or chronic forms. The most common causes of viral hepatitis are the five unrelated hepatotropic viruses Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, and Hepatitis E...
). Coxsackie B infection of the heart can lead to pericardial effusion. Muffled heart sounds and pulsus paradoxus
In medicine, a pulsus paradoxus , also paradoxic pulse or paradoxical pulse, is defined as an exaggeration of the normal variation during the inspiratory phase of respiration, in which the blood pressure declines as one inhales and increases as one exhales...
are signs of this.
The development of insulin-dependent diabetes (IDDM) has recently been associated with recent enteroviral infection, particularly coxsackievirus B pancreatitis. This relationship is currently being studied further.
Sjögren's syndrome , also known as "Mikulicz disease" and "Sicca syndrome", is a systemic autoimmune disease in which immune cells attack and destroy the exocrine glands that produce tears and saliva....
is also being studied in connection with coxsackievirus, as of January 2010.
The coxsackieviruses were discovered in 1948-49 by Gilbert Dalldorf, a scientist working at the New York State Department of Health in Albany, New York
Albany is the capital city of the U.S. state of New York, the seat of Albany County, and the central city of New York's Capital District. Roughly north of New York City, Albany sits on the west bank of the Hudson River, about south of its confluence with the Mohawk River...
Dr. Dalldorf, in collaboration with Grace Sickles, had been searching for a cure for the dreaded disease polio. Earlier work Dalldorf had done in monkeys suggested that fluid collected from a non-polio virus preparation could protect against the crippling effects of polio. Using newborn mice as a vehicle, Dalldorf attempted to isolate such protective viruses from the feces of polio patients. In carrying out these experiments, he discovered viruses that often mimicked mild or nonparalytic polio. The virus family he discovered was eventually given the name Coxsackie, for the town of Coxsackie, New York
Coxsackie is the name of more than one place in New York, USA.*Coxsackie , New York*Coxsackie , New York*Coxsackie Correctional Facility...
, a small town on the Hudson River where Dalldorf had obtained the first fecal specimens.
Dalldorf also collaborated with Gifford on many early papers.
The Coxsackie viruses subsequently were found to cause a variety of infections, including epidemic pleurodynia (Bornholm disease), and were subdivided into groups A and B based on their pathology in newborn mice. (Coxsackie A virus causes paralysis and death of the mice, with extensive skeletal muscle necrosis; Coxsackie B causes less severe infection in the mice, but with damage to more organ systems, such as heart, brain, liver, pancreas, and skeletal muscles.)
The use of suckling mice was not Dalldorf's idea, but was brought to his attention in a paper written by Danish scientists Orskov and Andersen in 1947, who were using such mice to study a mouse virus. The discovery of the Coxsackie viruses stimulated many virologists to use this system and ultimately resulted in the isolation of a large number of so-called enteric viruses
from the gastrointestinal tract that were unrelated to poliovirus, and some of which were oncogenic (cancer-causing).
The discovery of the Coxsackie viruses yielded further evidence that viruses can sometimes interfere with each other's growth and replication within a host animal. Other researchers found that this interference can be mediated by a substance produced by the host animal, a protein now known as interferon
Interferons are proteins made and released by host cells in response to the presence of pathogens—such as viruses, bacteria, or parasites—or tumor cells. They allow communication between cells to trigger the protective defenses of the immune system that eradicate pathogens or tumors.IFNs belong to...
. Interferon has since become prominent in the treatment of a variety of cancers and infectious diseases.
In 2007, an outbreak of Coxsackie virus occurred in Eastern China. It has been reported that 22 children died. More than 800 people were affected, with 200 children hospitalized.