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Coxsackie viral infection in Child
Other Resources UpToDate PubMed

Coxsackie viral infection in Child

Contributors: Peter Joo MD, Neil Mendoza MD, Michael W. Winter MD
Other Resources UpToDate PubMed


The coxsackieviruses are members of the genus Enterovirus and are responsible for a variety of clinical diseases in humans. The most common clinical presentation is an undifferentiated febrile illness.

All age groups are affected, but neonatal infection with these viruses may progress to severe organ dysfunction and death. Additionally, immunosuppressed patients may develop severe and fatal infections of the central nervous system. Transmission occurs via fecal-oral or respiratory secretions. Peak outbreaks occur during the summer and spring months.

Coxsackieviruses can cause an upper respiratory infection. The illness may resemble the common cold. Differentiation between an infection caused by this virus and other similar viruses is not usually possible on clinical grounds alone. Acute hemorrhagic conjunctivitis has been reported with infection with a certain viral serotype.

Coxsackieviruses are frequently associated with rashes. The rash is usually not specific enough to allow a clinical diagnosis. One exception is hand-foot-and-mouth disease, which can be caused by certain coxsackievirus serotypes, most commonly A16. This disease is most prevalent in children younger than 10 years. Patients have sore throat and fever. Vesicles are present in the oral cavity. Vesicular and papular lesions are also seen on the extensor surfaces of the hands and feet.

Herpangina is another clinical syndrome that has been associated with the coxsackieviruses. Patients frequently have fever, sore throat, and headache. This is followed over the course of hours to days by an eruption on the soft palate, uvula, and tonsils. The eruption begins as macules that progress to papules and then to vesicles.

Coxsackieviruses can result in a variety of neurological manifestations, including acute viral meningitis. Patients present acutely or subacutely with headache. Fever, chills, and meningismus may or may not be present. Patients may have concomitant pharyngitis. Encephalitis due to coxsackieviruses has also been reported. Symptoms may be mild or severe and be associated with seizures or coma. There has been an association made between a serotype of coxsackievirus and acute flaccid paralysis, with symptoms similar to poliomyelitis.

Coxsackieviruses can cause pleurodynia (an acute infection of skeletal muscle). Patients have fever and sharp pain in the chest and upper abdomen. Certain serotypes can also cause myopericarditis and dilated cardiomyopathy.

Most cases of coxsackievirus infection are benign and self-limited, with resolution of fevers within 2-4 days and resolution of rashes within 3-10 days.


B97.11 – Coxsackievirus as the cause of diseases classified elsewhere

186658007 – Coxsackie virus disease

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Differential Diagnosis & Pitfalls

Although most cases of coxsackieviruses are self-limiting conditions that resemble other viral infections, fatal cases have been reported, particularly with central nervous system involvement or in immunocompromised patients. Therefore, it is important to risk stratify and be aware of any neurological manifestations of disease.

Alternative diagnoses to consider:
  • Aphthous stomatitisOrofacial herpes simplex virus, inflammatory bowel disease (Crohn disease, Ulcerative colitis), Behçet syndrome
  • Arthropod bite or sting – fleas, bedbugs, etc
  • Dermatophyte infections (see, eg, Tinea cruris, Tinea faciei)
  • Allergic contact dermatitis
  • Varicella
  • Herpes simplex gingivostomatitis (see Orofacial herpes simplex virus)
  • Erythema multiforme
  • Eczema herpeticum

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Last Reviewed:01/31/2019
Last Updated:09/04/2023
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Coxsackie viral infection in Child
A medical illustration showing key findings of Coxsackie viral infection (Severe Coxsackievirus A6 HFMD) : Fever, Headache, Vomiting, Oral ulcers, Oral petechiae, Skin erosion, Myalgia, Pharyngitis, Vesicles
Copyright © 2024 VisualDx®. All rights reserved.