What is Coxsackie Virus: Symptoms, Treatment Methods and Prevention

The symptoms of this disease are similar to those of most seasonal illnesses, making diagnosis difficult. However, there is one main sign by which you can unmistakably identify the Coxsackievirus in children: this is the “hand-foot-tongue” symptom. This symptom is characterized by a rash of watery blisters, most often localized in the mouth and between the fingers and toes.

Coxsackievirus is an enterovirus disease, transmitted by tactile, airborne, and fecal-oral routes (through unwashed hands, fruits, and vegetables). The virus is most typically caught in children’s groups.

In fact, Coxsackie is a group of 30 active enteroviruses that multiply in the gastrointestinal tract. The incubation period usually lasts 7–10 days.

Maya Ruselevich, an allergist, pediatrician, and pulmonologist, tells more about the symptoms and treatment.

Maya Ruselevich

allergist, pediatrician, pulmonologist

• Founder of the medical clinic B_Health
• Candidate of Medical Sciences
• 19 years of experience

What are the ways of the Coxsackievirus transmission? How can the risk of infection be reduced?

The Coxsackievirus (a common cause of hand-foot-and-mouth syndrome and herpangina) is transmitted by droplet (through coughing/sneezing), fecal-oral, contact—through saliva, discharge from mouth ulcers or fluid from blisters, and indirectly—through contaminated objects and surfaces.

What to do to reduce the risk of infection: wash your hands thoroughly (especially after using the toilet, before eating, after contact with a rash), avoid close contact with sick people, regularly disinfect toys and surfaces, do not allow shared use of dishes and napkins, keep your child at home until a fever or active ulcers prevent him from contact.

What are the typical symptoms of Coxsackie virus infection?

Fever may be present, but it is not always a symptom. However, there is a general weakness, refusal to eat, and sometimes a sore throat or painful swallowing. After 1–2 days, small blisters or ulcers may appear in the mouth, followed by a rash on the hands and feet, and sometimes on the buttocks.

If the child refuses to drink and eat, becomes excessively lethargic, or has difficulty breathing, these are alarming signs.

Where is the typical rash of Coxsackievirus localized, and what does it look like?

Typical localization – palms, soles, sometimes buttocks, and also the mouth (back of mouth, palate, tongue, lips).

Rash—small papules or vesicles (bubbles) often not swollen, sometimes painful, may look different in different phototypes (red spots, white/transparent bubbles).

How to treat Coxsackievirus?

There is no specific antiviral treatment for the standard forms (e.g., HFMD from Coxsackie A virus); treatment is symptomatic and supportive (fluid replacement, pain and fever control, topical agents for painful mouth ulcers).

Complications (meningitis, myocarditis, severe dehydration) are treated according to the specifics in the hospital in infectious or intensive care units.

What can help relieve the child’s condition at home?

• give enough fluids, in small portions, cool drinks or cool purees to relieve pain in the mouth;
• painkillers/fever reducers as needed (paracetamol or ibuprofen according to age and weight);
• soft food, avoid spicy/salty/sour foods that irritate the ulcers;
• topical painkillers/mouthwashes—only as prescribed by the child’s pediatrician/dentist;
• humidification and rest.

Do not give antibiotics without signs of bacterial infection!

How often do adults get sick?

We can’t say that adults get sick less often than children. The Coxsackie virus can also cause severe symptoms in adults. Therefore, it cannot be ignored!

When is it necessary to consult a doctor, and when is hospitalization indicated?

Seek urgent care if: unwillingness to drink/symptoms of dehydration (little urination, dry mucous membranes), high fever (especially if it is prolonged), convulsions, very severe drowsiness/irritability, respiratory failure, cyanosis, fainting, or sudden deterioration of well-being.

Hospitalization is required if complications are suspected (meningitis/encephalitis, myocarditis, severe dehydration, severe neurological symptoms)—this is the doctor’s decision in the context of assessing the condition.

Since the rash bothers the child, scratching can lead to infection and, in turn, a secondary infection requiring antibiotics.

Typical mistakes parents make when treating children. Advice on how to act correctly and not panic

The most common mistakes are:

• self-prescribing antibiotics for viral infections;
• force-feeding a child when it hurts to swallow (this only worsens the condition);
• underestimating dehydration in infants.

What can I advise instead:

• monitor the amount of urination and activity of the child—these are simple markers of hydration;
• if necessary, give an antipyretic according to age/weight;
• if there is pain in the mouth, offer cold drinks/ice cream or jelly, small portions of food;
• if there is any anxiety, contact a pediatrician or therapist (for adults)—a short consultation is better than a delayed complication.

How long does it take to recover fully?

In most cases, full recovery occurs within 7–10 days. Without complications, the symptoms gradually resolve, but the virus may persist in feces for longer, so increased vigilance in hygiene is required for several weeks.

What to do if a sick person appears in a kindergarten group or school class?

• notify the parents of the group and the administration of the institution;
• strengthen hygiene measures: washing hands, disinfecting toys and surfaces, ventilating the room more often;
• temporarily stay home or leave children with fever, sore mouth, or active blisters at home until they feel better (local recommendations for exclusion from kindergarten vary; usually, the child can return after the fever disappears, and the condition significantly improves);
• in the event of an outbreak, follow the instructions of the local health department or pediatrician/therapist.