Coxsackie Virus: Facts You Need to Know

Coxsackie virus, also called hand, foot, and, mouth disease (HFMD), is a common illness of infants and children that is characterized by fever, sores in the mouth, and a rash with blisters. Coxsackie virus begins with a mild fever, poor appetite, malaise, and frequently a sore throat.

Other coxsackie virus symptoms include one or both of the following:

• Mouth sores that begin as small red spots usually located on the tongue, gums, and inside of the cheeks. They may blister and become ulcers.
• Skin rash on the palms of the hands or soles of the feet; sometimes appears on the buttocks, elbows, knees, or genital area also.

The good news is coxsackie virus typically isn't serious—it usually resolves in 7 to 10 days without medical treatment. 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.

Coxsackie Virus Symptoms

Loyola Medicine pediatric infectious disease specialist Nadia Qureshi, MD, says many parents confuse the rash with chickenpox. But chickenpox rashes usually start on the trunk of the body and move outward, while coxsackie virus rashes center around the hands, feet, and mouth. The location of the sores and rash usually make 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.

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.

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.

What Causes Coxsackie Virus?

Although it sounds similar to the foot-and-mouth disease cattle, sheep, and swine can get, the two diseases are not related. Coxsackie virus is caused by several different viruses, the most common of which is coxsackievirus A16. Occasionally, other strains of coxsackievirus A or enterovirus 71 cause it. The coxsackieviruses are members of a group of viruses called the enteroviruses, which includes polioviruses, coxsackieviruses, and echoviruses.

Coxsackie virus is moderately contagious. Infection is spread from person to person by direct contact with nose and throat discharges or oral fecal contamination—which might sound like your child ate her own poop. And if she's still in diapers, that could be the case: Babies' hands can sneak into dirty diapers pretty fast and then back into the mouth. Yuck.

But actual transmission is usually a little more subtle. A child (or parent) who forgets to wash up after a bathroom trip can easily put an unwashed hand into his mouth. Children can also pass the virus around while playing together, Dr. Pishko explains. 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 coxsackie virus occur worldwide during any season but are more frequent in summer and early autumn. It is not transmitted to or from pets or other animals.

Coxsackie virus is one of many infections, including the herpes virus, that results in mouth sores. Usually, a physician can distinguish between coxsackie virus and other causes of mouth sores based on the age of the patient, the pattern of symptoms reported by the patient or parent, and the appearance of the rash and sores on examination. A throat swab or stool specimen may be sent to a laboratory to determine which enterovirus caused the illness. Since the testing often takes 2 to 4 weeks to obtain a final answer, physicians usually don't order these tests.

How Long is Coxsackie Contagious?

Coxsackie virus can wreak havoc on your household for about a week. The virus sets up shop in your kid's gut and incubates for 3 to 5 days before it begins living up to its name—distributing 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.

And, yes, although coxsackie virus occurs mainly in children under 5 years old, adults are susceptible to infection. In fact, adults may be infected and contagious yet exhibit no symptoms, thereby unknowlingly exposing others to the virus. Having a coxsackie infection once results in immunity to that specific virus, but a second episode may occur later with a different strain of the enteroviruses.

Coxsackie Virus Treatment and Prevention

No specific treatment is available for this infection though symptomatic treatment is given to provide relief from fever, aches, or pain from the mouth ulcers. 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 make eating and drinking difficult. Any kind of children's pain reducer, such as acetaminophen (Tylenol) or ibuprofen (Advil or Motrin), can help alleviate the discomfort of the mouth ulcers and fever, says Dr. Pishko. Avoid citrus and salt, which can aggravate the sores.

Parents of kids with coxsackie virus 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—dry mouth, extreme thirst, decreased urine output or fewer wet diapers, and lethargy—but it's rare, says Dr. Pishko, for serious dehydration to occur as a result of coxsackie virus.

Preventive measures include frequent hand washing (especially after diaper changes), disinfection of contaminated surfaces by household cleaners, and washing soiled articles of clothing. 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.