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  1. Coxsackievirus Shandong university school of medicine Class 2 Grade 2002 clinical medicine for seven years

  2. Kayla Nicole Clingerman of Woollum, KY was tragically taken from us at the age of 6 from Viral Meningitis. October 13, 1997 - October 11, 2004

  3. This is a picture of Seven month old Olivia Grace Hamilton at Cayuga Lake in 2004. Viral Meningitis. tragically took her life.

  4. Introduction • Late summer or early fall…It’s not yet cold or flu season, but your child is sick. Consider coxsackievirus. • It’s often the culprit when parents leave a doctor’s appointment without knowing what disease their child has.

  5. History • 1947 Coxsackievirus was first identified • 1957 associated with "hand, foot and mouth" disease and first documented • 1988 epidemics occurred • 1994 the largest epidemic in Britain Most of the 952 cases were children aged one to four

  6. Definition • Coxsackieviruses, a family of enteroviruses. These viruses share in common that they infect the human intestines (and stool), but they can cause symptoms throughout the body.

  7. spherical,20-30nm. Icosahedral symmetry, non-enveloped. Capsid:VP1-VP4 +ssRNA.

  8. Capsid:VP1-VP4 VP1 is associated with absorption of virus VP4 locates in the capsid Once VP1 bound to receptor on the target cell,then VP4 is released,+ssRNA enter the cell. +ssRNA:infectious.

  9. Pathogenic mechanism • To cell • CV are characterized by their ability to cause CPE in tissue culture and by their capacity to initiate acute disease by inducing apoptosis within targeted organs in vivo. So,these viruses are considered highly cytolytic. • CV can establish persistence in susceptible cells, indicating that a regulatory mechanism may exist to shut off viral protein synthesis and replication under certain situations. The persistence of coxsackieviral RNA is of particular medical interest due to its association with chronic human diseases.

  10. Basically, the virus confuses the body's defence system. First, the body detects the presence of an enemy using its antigen recognition system. The virus, meanwhile, may mimic the protein structure of the heart muscle, and sometimes, may even interact and alter the antigenic configuration there. Second, the body's defence system reads the signals wrongly. It deploys killer white cells to attack the enemy. The white cells do two things. One, it fires virus-seeking missiles called antibodies to neutralise Coxsackie B and removes it. Two, the white cells also attack the wrong target: the heart. the white cells attack one of its own life support systems. • To defence system

  11. Immunity • sIgA is very important to resist absorption and replication of virus in alimentery tract. • Neutralizing Ab in serum can prevent the diffusion of virus,which can last for several years,even all the life. • Inapparant infectors also get firm immunity.

  12. Incubation • The incubation period (the time between infection and the onset of symptoms) for most coxsackie virus infections is about 2 to 10 days

  13. symptoms • Hand-foot-and-mouth disease mainly affecting young children • Rash. • Nonspecific fever, headache • Herpangina. • Respiratory Infection. • Gastrointestinal Infection.

  14. Hand-foot-and-mouth disease

  15. rash • conjunctivitis • Herpangina

  16. Meningitis • Viral myocarditis

  17. Duration • The duration usually varies, depending on the specific type. • Coxsackie fever often asymptoms, a child's temperature may return to normal within 24 hours, although the average fever lasts 3 to 4 days. In pleurodynia, fever and muscle pain usually last 1 to 2 days, and in herpangina, symptoms generally last 3 to 6 days.

  18. Diagnose • Diagnosis is made based on the history and physical exam • Lab tests are available test stool or fluids from the back of the throat • Serum test for specific Ab • PCR for viral nucleic acid

  19. Susceptible group • Most common in young people. • Adults can be infected, but this is much less common • Most infections occur in the summer or early fall, with a peak from August to October in the northern hemisphere.

  20. Transmission • Coxsackieviruses are present both in the stool and in the respiratory secretions • Fecal-oral transmission • Droplet transmission • Contact transmission

  21. Prevention • There is no vaccine to prevent coxsackie virus infection • Hand washing is the best prevention,especially after toileting and before eating—can help reduce their spread

  22. Treatment • Antibiotics do not help with coxsackievirus infections • Plenty of fluids is useful • Acetaminophen (such as Tylenol) may be given to relieve any minor aches and pains • Most children with a simple coxsackie infection recover completely after a fewdays at home.

  23. Last year, a drug called acyclovir, an anti-viral chemical normally used to treat herpes simplex,made a surprising success in treating patients with Coxsackie A16. The study was not conclusive. It speculated that in these patients, something else was at work: these are the interferons, which are chemical messages sent from cell to cell like warnings to uninfected cells to defend themselves. .

  24. life was like a box a chocolates, never know what you're gonna get ! thank you