The incubation period of Coxsackie virus infection ranges from 2 to 9 days. The clinical manifestations of infection with various Coxsackie viruses are diverse and may present as distinct disease entities.
This disease is caused by certain group A viruses (2, 4, 5, 6, 8, 10). There is an abrupt onset on fever, sore throat, anorexia, dysphagia, vomiting or abdominal pain. The pharynx is usually hyperemic and characteristic discrete vesicles occur on the anterior pillars of the fauces, the palate, uvula, tonsils, or tongue. The illness is self-limited and most frequent in small children.
B. Summer Minor Illnesses
Coxsackie viruses are often isolated patients with acute febrile illnesses of short duration that occur during the summer or fall and are without distinctive features.
C. Pleurodynia (Epidemic Myalgia, Boruholm Disease)
This disease is caused by group B viruses. Fever and Chest pain are usually abrupt in onset but are sometimes preceded by malaise, headache and anorexia. The chest pain may be located on either side or sub-sternally, is intensified by movement, and may last from 2 days to 2 weeks. Abdominal pain occurs in approximately half of cases, and in children this may be the chief complaint. The illness is self-limited, and recovery is complete, although relapses are common.
D. Aseptic Meningitis and Mild Paresis
This syndrome is caused by all types of group B Coxsackie viruses and by Coxsackie viruses A7, A9 and A24. Fever, malaise, headache, nausea and abdominal pain are common early symptoms. Signs of meningeal irritation, stiff neck or back and vomiting may appear 1-2 days later. The disease sometimes progresses to mild muscle weakness suggestive of paralytic poliomyelitis. Patients almost always recover completely from non-poliovirus paresis. Early in aseptic meningitis, the cerebrospinal fluid shows pleocytosis (up to 500 cells / mcL) with up to 50% polymorphonuclear neutrophils.
E. Neonatal Disease
Neonatal disease may be caused by group B Coxsackie viruses with lethargy, feeding difficulty and vomiting with or without fever. In severe cases, myocarditis or pericarditis can occur within the first 8 days of life; it may be preceded by a brief episode of diarrhea and anorexia. Cardiac and respiratory embarrassment are fatal, or the patient may recover completely. The disease may sometimes be acquired transplacentally. Myocarditis has also been caused by some group A Coxsackie Viruses.
A number of the entero viruses have been associated with common colds; among these are Coxsackie viruses A10, A21, A24 and B3.
G. Hand, foot and Mouth disease
This disease has been associated particularly with Coxsackie viruses A16, but A4, A5, A7, A9 and A10 have also been implicated. Virus may be recovered only from the stool and pharyngeal secretions but also from vesicular fluid. The syndrome is characterized by oral and pharyngeal ulcerations and a vesicular rash of the palms and soles that may spread to the arms and legs. Vesicles heal without crusting, which clinically differentiates them from the vesicles of herpes- and pox-viruses. The rare deaths are caused by pneumonia.
Coxsackie viruses of group A and echoviruses have been implicated to a lesser degree. At autopsy, virus infections induce heart disease. The virus may affect the endocardium, pericardium, myocardium, or all three. Acute myocardiopathies have been shown to be caused by Coxsackie viruses A4, A14, B1-B5 and others, and also by echoviruses types 9 and 22 and others. Monkeys infected with Coxsackie virus B4 develop pancarditis, with a pathologic picture strikingly similar to that of rheumatic heart disease. In experimental animals, the severity of acute viral myocardiopathy is greatly increased by vigorous exercise, hydrocortisone, alcohol consumption, pregnancy and under-nutrition and is greater in males than in females. In human illnesses, these factors may similarly increase the severity of the disease.
I. Acute Hemorrhagic Conjunctivitis
Coxsackie virus A24 is one of the agents that can cause this disease
J. Diabetes Mellitus
Serologic studies suggest an association of diabetes of abrupt onset with past infection by Coxsackie virus B4 and perhaps other members of the B group. Experimental studies support the findings in human illnesses; these factors may similarly increase the severity of the disease.
K. Swine Vesicular disease
The agent of this disease is an enterovirus that antigenically is related to Coxsackie virus B5. Furthermore, the swine virus can also infect humans.