Coxsackie B
Summary
Coxsackie B viruses are non-enveloped, positive-sense single-stranded RNA enteroviruses of the family Picornaviridae. They are the leading viral cause of myocarditis and pericarditis and also cause pleurodynia (Bornholm disease) and aseptic meningitis.
Detail
Transmission is faecal-oral with summer and early autumn peaks. The characteristic syndromes divide usefully between the two coxsackie groups: group B causes myocarditis, dilated cardiomyopathy, pericarditis, pleurodynia with severe paroxysmal chest and abdominal pain from intercostal muscle involvement, and, in neonates, a devastating systemic illness with myocarditis and hepatitis; group A causes herpangina, with painful posterior oropharyngeal vesicles and ulcers, and hand-foot-and-mouth disease, most often serotype A16. Both groups cause aseptic meningitis, and enteroviruses collectively are the commonest cause of it, with a CSF picture of lymphocytic pleocytosis, normal glucose, and mildly raised protein. Coxsackie B has also been implicated as an environmental trigger for type 1 diabetes mellitus through molecular mimicry with pancreatic beta-cell antigens. Diagnosis is by CSF or throat PCR. There is no specific antiviral therapy; management is supportive, with particular caution about NSAIDs in acute myocarditis.
Sources
- Levinson Medical Microbiology and Immunology
- First Aid for the USMLE Step 1
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