Coxsackievirus is a member of the Picornaviridae family of viruses which is a subtype of Enterovirus. In cooler climates, outbreaks of coxsackievirus often occur in the summer and fall, though they can cause infections year-round in tropical parts of the world. The most well-known coxsackie disease is hand-foot and-mouth disease (HFMD), a common childhood illness which affects mostly children aged 5 or under and it is often from infection by coxsackie A16 or A6.
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Coxsackieviruses spread from person to person, usually on unwashed hands of surfaces contaminated by feces. In most cases, coxsackieviruses cause mild flu-like symptoms and go away without treatment. But in some cases, and especially in infants, infections can lead to more serious diseases such viral meningitis, encephalitis and myocarditis. There are two groups of coxsackie viruses, coxsackie A which tends to cause more severe disease, and coxsackie B. In total, there are 24 different serotypes of the virus and each serotype has distinct proteins on its viral surface and causes different disease conditions. Examples for coxsackie A include HFMD (coxsackie A16 or A6), acute haemorrhagic conjunctivitis (coxsackie A24), herpangina, and aseptic meningitis (both coxsackie A and B viruses). Coxsackievirus A7 can also cause polio-like permanent paralysis. There are six types of coxsackie B (B1-B6) and they tend to infect the heart, pleura, pancreas, and liver, causing pleurodynia, myocarditis, pericarditis, and hepatitis. Specifically, coxsackie B2 and B5 viruses have been implicated in HFMD as well as respiratory infection and the B4 strain of coxsackievirus has been discovered to be a possible cause of diabetes mellitus type 1. Both group A and group B coxsackie viruses can cause nonspecific febrile illnesses, rashes, upper respiratory tract disease, and aseptic meningitis.
Neutralization tests are generally the best serological assays available for coxsackieviruses however, they are labor intensive and take at least 3 days before the results are available. Alterative assays include antibody titers which are compared in paired sera, the first sample collected within 5 days of the onset of symptoms and the second some days later – a significant rise in titer is evidence for a recent infection. More recently, IgM capture assays have become available for various coxsackie A, B, and echovirus serotypes. However, cross-reactivity between the IgM responses to different enteroviruses, including hepatitis A, often occurs. In addition, the IgM response usually lasts 8 – 12 weeks but may persist longer in some patients, indicating a persistent infection. However, 10% of normal adults will also give a positive result, perhaps having experienced a recent enterovirus infection. The older the patient, the more likely such heterotypic responses will take place.
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