Coxsackieviruses and
Other Enteroviruses

The enteroviruses (en-tuh-roVY-rus-sez) are a family of viruses that usually enter the body by infecting the gastrointestinal * tract. They cause several types of infection, mostly in children. Coxsackieviruses (kok-SAHkee-vy-ruh-sez) are some of the most well known enteroviruses.


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Hand, foot, and mouth disease




What Are Enteroviruses?

There are many different kinds of viruses in the enterovirus family, which cause infections with different symptoms, mostly in children. These viruses make their home in the digestive tract and are related to the viruses that cause poliomyelitis * and hepatitis A * . The largest subgroups of the enterovirus family are coxsackieviruses and echoviruses. In most cases, coxsackievirus infection causes fever and sometimes a mild rash in children, but a variety of other symptoms can occur. Coxsackievirus is well known for its link to hand, foot, and mouth disease, which causes red bumps and blisters to appear inside the mouth and on the hands and feet.

Are Enteroviruses Contagious?

Everyone is at risk of contracting enteroviral infections. They most commonly infect infants and children younger than 5 years old and spread easily among children in group settings, such as day-care centers or schools. These viruses are most likely to cause infections during late summer and early fall and are very contagious. People with coxsackievirus are most contagious during the first week that they are sick.

How Are Enteroviruses Spread?

Enteroviruses are usually spread through contact with feces * , especially on unwashed hands and on surfaces that an infected person has touched, such as a countertop, phone, or toy. The viruses can stay alive for days on these surfaces, waiting to be touched by the next person. Parents, babysitters, and day-care workers who change diapers typically have a higher risk of becoming infected with enteroviruses and passing them on to others, especially if they do not wash their hands often. Like many other viruses, enteroviruses also can spread through tiny droplets of fluid that are sprayed into the air when someone sneezes, coughs, or stands close to another person while talking. A person can become infected by breathing in these droplets or by touching something that the infected person has handled, sneezed at, or coughed on.

* gastrointestinal (gas-tro-in-TES-tih-nuhl) means having to do with the organs of the digestive system, the system that processes food. It includes the mouth, esophagus, stomach, intestines, colon, and rectum and other organs involved in digestion, including the liver and pancreas.

* poliomyelitis (po-lee-o-my-uh-LYE-tis) is a condition caused by the polio virus that involves damage of nerve cells. It may lead to weakness and deterioration of the muscles and sometimes paralysis.

* hepatitis A (heh-puh-TIE-tis) is an inflammation of the liver that is caused by an infection with the hepatitis A virus,

* feces (FEE-seez) is the excreted waste from the gastrointestinal tract.

What Are the Signs and Symptoms?

Many people who become infected with enteroviruses have no symptoms or experience only mild symptoms that do not require medical attention. Some have a fever and a rash, while others may get a sore throat, headache, mild abdominal * pain, or nausea. Fever can be as high as 104 degrees Fahrenheit and may come and go over the course of several days. Some enteroviruses can cause conditions characterized by groups of specific symptoms:

  • Hand, foot, and mouth disease: red, painful blisters on the tongue and gums, inside the cheeks, on the palms of hands and the soles of feet, and sometimes on the buttocks.
  • Herpangina (her-pan-JY-na): sore throat with blisters that appear on the tonsils and palate * .
  • Pleurodynia (ploor-o-DIN-e-uh), also known as Bornholm disease: stabbing pain in the chest or upper abdomen.
  • Hemorrhagic conjunctivitis (heh-muh-RAH-jik kon-jung-tih-VY-tis): sudden and severe eye pain with red and watery eyes, eye swelling, and sometimes blurred vision.

Rarely, enteroviruses can cause myositis * , meningitis * , or encephalitis * . Myocarditis * or pericarditis * also can occur. In some cases, these infections can be serious or even lead to death.

How Do Doctors Diagnose and
Treat Enteroviruses?

Usually a doctor will diagnose an enterovirus infection by getting a history of the patient's symptoms and performing a physical, paying particular attention to any rash or blisters. Sometimes doctors use cotton swabs to take a fluid sample from the back of the mouth or throat, which is tested to find out if an enterovirus is present. Samples of bowel movements also might be tested. Like other viral infections, enteroviral infections do not respond to antibiotics, which treat only bacterial infections. New antiviral medications can be used to treat some severe cases of enterovirus infection. Usually, treatment is aimed at relieving discomfort. Doctors recommend that people with these viruses get plenty of rest, drink cool fluids, and take over-the-counter, non-aspirin pain relievers such as acetaminophen (uh-see-teh-MIH-noh-fen) to ease fever, headache, muscle aches, and painful mouth blisters. Doctors may prescribe a medicated cream or gel to numb sores inside the mouth or on the gums or tongue. Rarely, hospitalization is necessary for infants and children who experience complications.

* abdominal (ab-DAH-mih-nul) refers to the area of the body below the ribs and above the hips that contains the stomach, intestines, and other organs.

* palate (PAL-it) is the structure at the roof of the mouth. Damage or poor functioning of the palate can affect swallowing, the voice, and breathing.

* myositis (my-oh-SY-tis) is an inflammation of the muscles.

* meningitis (meh-nin-JY-tis) is an inflammation of the meninges, the membranes that surround the brain and the spinal cord. Meningitis is most often caused by infection with a virus or a bacterium.

* encepholitis (en-seh-fuh-LYE-tis) is an inflammation of the brain, usually caused by a viral infection.

* myocarditis (my-oh-kar-DYE-tis) is an inflammation of the muscular walls of the heart.

* pericarditis (per-ih-kar-DYE-tis) is an inflammation of the sac surrounding the heart.

* dehydration (dee-hi-DRAY-shun) is a condition in which the body is depleted of water, usually caused by excessive and unreplaced loss of body fluids, such as through sweating, vomiting, or diarrhea.

* intravenous (in-tra-VEE-nus) means within or through a vein. For example, medications, fluid, or other substances can be given through a needle or soft tube inserted through the skin's surface directly into a vein.

How Long Do Enterovirus Symptoms Last and
What Are the Complications?

Enteroviruses can cause illness that lasts from 3 days to 2 weeks, depending on the type of infection. Fevers usually last a few days, whereas rash and blisters take longer to disappear. Dehydration * can become a problem, especially in infants and young children, because mouth sores can make eating and drinking painful. In such cases, intravenous * fluids may be required. It is recommended that people with enterovirus infections seek medical attention if they start to experience pain in the chest or abdomen, a sore throat that does not improve, difficulty in breathing, severe headaches, neck stiffness, or vomiting.

How Are Enterovirus Infections Prevented?

There is no vaccine to prevent enterovirus infections. As with most contagious infections, washing hands with soap and water after going to the bathroom, changing diapers, shaking hands with other people, and touching surfaces, especially those in public places, may help prevent the spread of infection. It is a good idea to cover the mouth and nose when coughing and sneezing and to avoid contact with other people who are coughing and sneezing. It is recommended that toys shared by infants and toddlers, especially in day-care settings, be cleaned with a disinfectant daily, because enteroviruses and other viruses can survive on them for days. Doctors usually advise that an infected child be kept out of day care or school for a few days to avoid spreading the virus to others.

Did You Know?

Coxsackievirus got its name from the town of Coxsackie, New York, the site of the first recognized outbreak of the virus infection in 1948.

See also
Hepatitis, Infectious



U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA 30333. The CDC offers information about coxsackievirus and other enterovirus infections at its website.
Telephone 800-311-3435

Website . KidsHealth is a website created by the medical experts of the Nemours Foundation and is devoted to issues of children's health. It contains articles on a variety of health topics, including coxsackievirus.

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