What are the other Names for this Condition? (Also known as/Synonyms)

• Enterovirus B Infection
• Group B Coxsackievirus Infection
• Non-Polio Enterovirus Infection

What is Coxsackie B Virus Infection? (Definition/Background Information)

• Coxsackie B Virus Infection is a viral infection that causes a wide variety of clinical syndromes ranging from mild upper respiratory tract illness to severe life-threatening infections of the heart and brain. Young children are more at risk for this infection
• It is a common infection worldwide that usually occurs during warm summer months. Coxsackie B Virus Infection is caused by a group of RNA viruses belonging to the genus Enterovirus of the Picornaviridae family of viruses
• The virus is shed in the feces (stool) and airway secretions (sputum or mucus from the nose) of infected individuals. It spreads to other individuals in a variety of ways such as:
  • Fecal-orally - through ingestion of food or water contaminated with feces
  • By breathing in infected air droplets
  • Or through contaminated hands, objects, or surfaces
• Coxsackie B Virus Infections are a common cause of respiratory illnesses. In most cases, it causes no symptoms or mild flu-like symptoms within a few days of exposure. It primarily involves the lining of the airways and the gastrointestinal (GI) system
• From there, the virus spreads through blood to different body organs to cause a wide variety of illnesses, including meningoencephalitis (Infection of the brain and its membranes), myocarditis/pericarditis (Infection of the heart muscle and its sac), hepatitis (swelling of the liver), and pancreatitis leading to type 1 diabetes mellitus
• The diagnostic test of choice for Coxsackie B Virus Infection is polymerase chain reaction (PCR) test, which helps detect the genetic material present in the virus. Presently, there are no antiviral treatments available; therefore, only symptomatic treatment is administered
• In general, Coxsackie B Virus Infection is a self-limited illness in most individuals, who are known to recover completely in a few days in the absence of any medical treatment. When required, symptomatic treatment may be provided
• In a majority of cases, the prognosis of individuals with Coxsackie B Virus Infection leading to meningoencephalitis is generally excellent; very few cases develop further complications. However, those with myocarditis may require heart transplant in some cases, and the outcomes may be poor
• Currently, there are no approved vaccines available to prevent Coxsackie B Virus Infections. General sanitation measures including hand hygiene are helpful in preventing the spread of this infection

Who gets Coxsackie B Virus Infection? (Age and Sex Distribution)

• Coxsackie B Virus Infection is widespread worldwide and usually occurs during the warmer months
• It affects all age groups, although young children are more at risk
• Males and females are affected equally, and there is no gender predilection noted
• All racial and ethnic groups are at risk and no predilection is observed

What are the Risk Factors for Coxsackie B Virus Infection? (Predisposing Factors)

The risk factors for Coxsackie B Virus Infection include:

• Newborns, infants, and young children are at a higher risk for infection
• Individuals with chronic illnesses and those who have weakened immune systems
• Individuals on chronic steroidal therapy and immunosuppressive therapy
• Group settings such as hospitals, schools, childcare centers, summer camps, etc.

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Coxsackie B Virus Infection? (Etiology)

Coxsackie B Virus Infection is caused by a group of viruses belonging to the genus Enterovirus of the Picornaviridae family of viruses. These are RNA viruses, which means that they have ribonucleic acid (RNA) as their genetic material.

The virus is shed in the feces (stool) and respiratory secretions (such as sputum or nasal mucus/discharge) of infected individuals. It can be transmitted to others in a variety of ways such as through:

• Oral-fecal route: Through ingestion of food or water contaminated with feces of an infected individual; from fecal contaminated hands or objects to the mouth
• Respiratory route: By breathing in the infected air droplets which are created when an infected individual coughs or sneezes; touching one’s mouth, nose, or eyes with unwashed contaminated hands
• From infected mother to babies during pregnancy, labor, or just after childbirth

What are the Signs and Symptoms of Coxsackie B Virus Infection?

Coxsackie B Virus Infection is a common cause of respiratory illnesses. In most cases (90%), it causes no symptoms or only mild flu-like respiratory illness within 3-5 days of exposure. The symptoms are non-specific and go away without any treatment. These may include:

• Fever
• Headache
• Malaise (feeling uneasy and sick)
• Cough, sneezing, and runny nose
• Sore throat
• Skin rash
• Joint and muscle pain
• Stomach upset
• Reduced hunger
• Nausea/vomiting

Occasionally, the lower airways and lungs become infected, especially in very young children, causing more serious illnesses such as bronchiolitis or pneumonia.

Other organ-specific diseases: In some cases, along with the non-specific flu-like symptoms, the spread of the virus to various other body regions causes organ-specific diseases. These include:

• Aseptic meningitis: Infection of the membranes that surround the brain and spinal cord
• Encephalitis: Infection of the brain
• Myocarditis/pericarditis: Infection of the heart muscle/sac
• Hepatitis: Swelling of the liver
• Pancreatitis: Swelling of the pancreas
• Pleurodynia: Infection of the muscles of chest and abdomen causing sharp attacks of pain in the chest and abdomen

Aseptic meningitis/encephalitis may present with:

• Fever and chills
• Nausea and vomiting
• Malaise
• Headaches
• Neck pain
• Sensitivity to light
• Upper respiratory symptoms
• Irritability and anorexia
• Seizures
• Lethargy

Myocarditis: Coxsackie B viruses are the most common infectious cause for myocarditis and dilated cardiomyopathy (50%). It predominantly occurs in middle-aged men around 40 years of age. An upper respiratory infection may precede the condition by 7 to 14 days. Manifestations of this heart condition may include difficulty breathing, chest pain, heart failure, etc.

How is Coxsackie B Virus Infection Diagnosed?

The diagnosis of Coxsackie B Virus Infection may involve:

• Complete physical examination and medical history evaluation
• A definitive diagnosis can be made by detecting the virus in different samples depending on the clinical syndrome:
  • Stool or rectal swabs
  • Nasopharyngeal or throat swabs
  • Cerebrospinal fluid (CSF) which flows in the brain and spinal cord
• The tests used in the detection of the virus may include:
  • Polymerase chain reaction (PCR) test: It detects the genetic material of the virus. It is the recommended test as it is highly sensitive and faster compared to other methods
  • Isolation of the virus in cell culture
  • Serology (e.g., ELISA) to detect the antibodies

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Coxsackie B Virus Infection?

Coxsackie B Virus Infection primarily infects the lining of the airways and the digestive tract. From there, the virus spreads through blood to different organs in the body, which can lead to a wide variety of clinical syndromes. Very young children (including newborn babies) and immunocompromised individuals are at higher risk of serious illness and complications.

• Infection can spread from the expectant mother to baby during pregnancy, labor, or just after birth leading to miscarriages, stillbirths, and severe systemic infection (resembling bacterial sepsis)
• Complications of aseptic meningitis and encephalitis may occur in 5-10% of the cases leading to:
  • Seizures
  • Movement disorders
  • Altered mental status
  • Paralysis
  • Coma
• Complications of myopericarditis may include:
  • Pericardial effusion (fluid accumulation in the sac around heart)
  • Arrhythmia (abnormal rhythm of the heart)
  • Valvular dysfunction
  • Dilated cardiomyopathy
  • Heart failure
  • Cardiac arrest
• Pancreatitis (inflammation of the pancreas) complicated by type 1 diabetes mellitus

How is Coxsackie B Virus Infection Treated?

There are no antiviral drugs available against Coxsackie B Virus Infection. Antibiotics are ineffective in treating the infection as it is a viral illness.

• In many cases, it causes a self-limited illness in most people who recover completely in a few days without any medical treatment. Plenty of rest and fluid intake can help in a speedy recovery
• However, severe infections, such as aseptic meningitis, encephalitis, and myocarditis, may require hospitalization and immediate medical attention. Treatment is supportive to relieve symptoms and manage the complications
• Heart transplant may be required in some cases of myocarditis

How can Coxsackie B Virus Infection be Prevented?

There is no vaccine currently available against Coxsackie B Virus Infection. However, the following preventative measures can help avoid or arrest the spread of infection:

• Frequently washing one’s hands thoroughly with soap and water, especially after using the toilet, changing diapers, and before eating or preparing food
• Covering mouth and nose while sneezing or coughing
• Avoiding touching face and eyes with unwashed hands
• Disinfecting the surfaces of objects such as shared toys
• Keeping infected kids out of school or childcare center for a few days
• Avoiding contact with individuals affected by the condition where possible. This also includes avoiding visiting them in hospitals, especially those with weak immune system. This helps decrease the spread of infection within the community
• Following all infection-control procedures in healthcare and other settings
• Use of protective clothing, masks, and gloves, when necessary

What is the Prognosis of Coxsackie B Virus Infection? (Outcomes/Resolutions)

In general, the prognosis of Coxsackie B Virus Infection is excellent in a majority, with 90% of the infections being subclinical (no apparent illness) or causing only a mild, self-resolving flu-like illness.

• However, individuals with severe infections, such as aseptic meningitis, encephalitis, and myocarditis, may require hospitalization and urgent care. Newborn infants and immunocompromised individuals are at a higher risk of developing severe complications
• Although, aseptic meningitis resulting from Coxsackie B Virus Infection has a generally excellent prognosis with complete recovery, although some individuals can experience malaise and fatigue for a couple of weeks. Some infants and children may develop mild mental health complications
• Myocardial syndromes due to infection of heart can sometimes lead to complications with poor outcomes; the condition can even be fatal

Additional and Relevant Useful Information for Coxsackie B Virus Infection:

Coxsackievirus has been named after the town Coxsackie in New York, the hometown of the patient from whom the virus was first isolated.