Coxsackieviruses are the most common viruses that cause hand, foot, and mouth disease (HFMD), a common illness in infants and children. The good news is that while coxsackievirus is very contagious, the infection typically isn't serious in children, and it usually resolves in seven to 10 days without medical treatment.
According to the Centers for Disease Control and Prevention (CDC), coxsackievirus spread is most common during the summer and fall months. However, the virus is prevalent in the United States and can cause illness any time of year. Read on to learn about the causes, symptoms, and treatment of coxsackievirus infection.
What Causes Coxsackievirus?
Although hand, foot, and mouth disease (HFMD) sounds similar to the foot-and-mouth disease cattle, sheep, and swine can get, the two diseases are not related. Several different viruses cause HFMD, the most common and least severe of which is coxsackievirus A16. Occasionally, other strains of coxsackievirus A or enterovirus 71 can cause the disease.
The coxsackieviruses are members of a group of viruses called the enteroviruses, which includes polioviruses, coxsackieviruses, and echoviruses.
How Does Coxsackievirus Spread?
Coxsackievirus is very contagious. The virus is spread from person to person by direct contact with nose and throat discharges (such as saliva or nasal mucus), fluid from blisters or scabs, or oral-fecal contamination. Oral-fecal contamination, you ask? That sounds like my child ate their own poop. If they're still in diapers, that could be the case—babies' hands can sneak into dirty diapers pretty fast and then back into their mouths. Yuck.
But the actual transmission is usually a little more subtle. A child who forgets to wash up after a trip to the bathroom can easily put an unwashed hand into their mouth. Kids can also pass the virus around while playing together since the virus can survive for a long period of time on surfaces, meaning that daycares and schools are a major source of outbreaks.
Individual cases and outbreaks of coxsackievirus infection occur worldwide during any season but are more frequent in summer and early autumn. The virus is not transmitted to or from pets or other animals.
Coxsackievirus Symptoms
The symptoms of hand, foot, and mouth disease typically appear between three and five days after exposure and last for seven to 10 days.
Symptoms of Coxsackievirus Infection in Kids
According to the CDC, the symptoms of coxsackievirus infection in kids include:
Flu-like symptoms that include fever, sore throat, poor appetite, and low energy or malaisePainful sores in the mouth start out as red spots on the tongue, gums, and inside cheeksNon-itchy skin rashes that appear as flat or slightly raised red spots on palms, soles of feet, arms, legs, buttocks, and sometimes the genitalsRed spots in the mouth and on the body that can turn into blisters
In rare cases, the virus may be associated with aseptic or viral meningitis, resulting in fever, headache, stiff neck, or back pain, which may require hospitalization for a few days.
Loyola Medicine pediatric infectious disease specialist Nadia Qureshi, M.D., says many parents confuse the HFMD rash with chickenpox. But chickenpox rashes usually start on the trunk of the body and move outward, while coxsackievirus rashes center around the hands, feet, and mouth.
Diagnosing Coxsackievirus Infection
The location of the sores and rash with coxsackievirus infection usually makes diagnosis fairly easy, but what shows up when can vary from child to child. “The fever usually starts to go away before the blisters show up, but I've seen the fever coincide with the rashes, too,” says Stephen Pishko, M.D., assistant professor of the general pediatrics division at the University of Tennessee Health Sciences Center and LeBonheur Children's Hospital in Memphis.
Coxsackievirus is one of many viruses, including the herpes virus, that results in mouth sores. Usually, a physician can distinguish between coxsackievirus and other causes of mouth sores based on the age of the patient, the pattern of symptoms, and the appearance of the rash and sores on examination.
However, a throat swab or stool specimen may be sent to a laboratory to determine which enterovirus caused the illness. Since the results from this testing often take two to four weeks—long after symptoms of HFMD usually subside—physicians usually don't order these tests.
Younger kids might not be too keen on a thorough throat examination, but if you can manage it, look for little blisters in the back of the throat, on the tongue, and inside the cheeks. The body rash, also in the form of little blisters, usually makes its debut on your child's palms and soles. "It can go to other places on the body, such as the arms and legs, but for the most part, it does affect the hands and feet," says Dr. Pishko.
The mouth sores, called herpangina, typically appear two to three days later. "Sometimes you don't notice the oral lesions at first," says Dr. Pishko. Instead, parents spot the body rash, which develops about a day later. "And then they might realize their child wasn't eating or drinking well a couple of days before," Dr. Pishko adds.
Different Types of Rashes and How to Treat Them
How Long Is Coxsackievirus Contagious?
Coxsackievirus can wreak havoc on your household for about a week. The virus sets up shop in your kid's gut and incubates for three to five days before it begins living up to its name—causing sores in the mouth and a rash on your child's hands and feet. The infected person is most contagious during the first week of illness. "Children may return to daycare or school when their fever has broken, and the sores have healed," adds Dr. Qureshi.
Although coxsackievirus infection occurs mainly in children under 5 years old, adults are susceptible. In fact, adults may be infected and contagious yet exhibit no symptoms, unknowingly exposing others to the virus as a result. The potential for asymptomatic infections only makes regular hand-washing even more critical to reducing spread.
Having a coxsackie infection once results in immunity to that specific virus, but a second episode may occur later with a different strain of enterovirus.
Coxsackievirus Treatment
No specific treatment is available for the coxsackievirus infection itself but there are treatments that provide relief from the fever, aches, or pain from the mouth ulcers that can accompany it. The body rash usually does not itch, so the best course of action is just to wait it out. The mouth sores, on the other hand, can be quite painful and can make eating and drinking difficult. Tip: Avoid citrus and salt, which can aggravate the sores.
Any kind of children's over-the-counter pain reducer, such as acetaminophen (Tylenol) or ibuprofen (Advil or Motrin), can help alleviate the discomfort of mouth ulcers and fever, says Dr. Pishko. Be sure to consult a pediatrician before giving your child medication.
Parents and caregivers of kids with coxsackievirus infection often call the doctor with concerns about dehydration since mouth sores can sting and take the fun out of drinking and eating. Definitely keep an eye out for symptoms of dehydration—dry mouth, extreme thirst, decreased urine output or fewer wet diapers, and lethargy—but it's rare for serious dehydration to occur as a result of coxsackievirus, says Dr. Pishko.
How To Prevent Coxsackievirus Infection
Preventive measures include frequent hand-washing (especially after diaper changes), disinfection of contaminated surfaces with household cleaners that can kill germs on contact, and washing soiled articles of clothing. Additionally, keeping your family from being exposed to those who have the virus will help reduce the risk of getting sick yourselves.
But while those preventative measures can be effective at keeping coxsackievirus away from your home and family, what if you have one child with the virus and you want to contain and prevent it from spreading to other family members, including yourself? In this case, the CDC recommends the following tactics:
Wash your hands thoroughly after touching any bodily fluids, including sneezing, coughing, using the bathroom, or touching someone who is sick.Regularly clean and disinfect surfaces to prevent the virus from spreading within your home.Avoid touching your eyes, nose, and mouth, especially if you haven't washed your hands.
Children are often excluded from child-care programs, schools, or other group settings during the first few days of the illness. These measures may reduce the spread of infection, but they will not completely interrupt it.
Things that kill coxsackievirus
To kill coxsackievirus, make sure to wipe down all surfaces, including high-traffic surfaces such as door knobs, touch screens, light switches, toilet seats and flush handles, and faucets with a disinfectant that contains at least 60% alcohol.
Additionally, if you wash your hands thoroughly (at least 20 seconds) and frequently with soap and warm water, you can help prevent the spread of the virus. In instances when you can't wash your hands, look for hand sanitizer with a minimum of 60% alcohol.
Things that don't kill coxsackievirus
There are many popular ideas about how to clean your home to prevent germs from spreading, but unfortunately, not all of them are effective. Here are three commonly used things that won't kill coxsackievirus:
Essential oils: Despite many claims that essential oils can be used to combat bacterial and viral illness, the Food and Drug Administration (FDA) neither regulates nor approves the use of essential oils for preventing illnesses.Surfactants: All-purpose cleaning sprays, or surfactants, do not kill germs and viruses. Instead, they help dissolve and clean away dirt and grime. Even if a surfactant contains lemon, citrus, or essential oils, unless it contains germ-killing ingredients like alcohol, it won't prevent coxsackievirus from spreading.DIY vinegar sprays: Making homemade vinegar-based cleaning sprays is a great way to keep chemicals out of your home, but it won't keep germs out. Vinegar is not regulated or registered as a disinfectant by the Environmental Protection Agency (EPA) since it is limited in its ability to kill germs, including bacteria and viruses.9 Seriously Germy Places—And How to Protect Your Child
Key Takeaways
Coxsackievirus is one of the viruses that cause hand, foot, and mouth disease, a common childhood illness that produces rashes and blisters. Coxsackievirus infection can be prevented by limiting exposure to the virus, good hand-washing habits, and disinfecting high-risk areas like the toilet, door knobs, and other high-traffic surfaces when someone is ill. The illness lasts about a week and is not typically considered dangerous. Talk to a doctor for diagnosis, treatment suggestions, and prevention education.
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