Coxsackie: is it serious?

When your doctor told you that your child has “coxsackie”, most of you will be very worry. Your friends and relatives who get to know this will do whatever they can to avoid contact with your pity child. Perhaps the news about the coxsackie outbreak which took away a few precious lives still lingering in your mind. Is coxsackie infection really so serious? Though it can be serious, but 99.99% of the time, it's NOT.

Coxscakievirus infection is very common, it occurs everyday in tropical country. About 90% of the time, you don't even know that you are actually infected with this virus because it produces only flu-like symptoms and sometimes no symptoms at all. Hundreds of viruses can cause flu-like symptoms (fever, cough, runny nose, sore throat). Doctors are unable to diagnose coxsackievirus infection unless he takes swab from your oral or rectum and send for coxsackievirus test. There is no blisters in the mouth or on the hands or feet whatsoever.

For the rest of 10% of time, coxsackievirus infection will show more specific signs in which we can classify them into a specific disease. Hand-foot-mouth disease, which we are most familiar with, is one of them. It will be more serious if it shows signs of brain (meningitis/encephalitis) or heart involvement. However, involvement of brain & heart is extremely rare, and unlikely to end up in death with prompt treatment.

    Coxsackievirus

So when you hear someone has “coxsackie”, then he/she most probably has hand-foot-mouth disease. Since coxsackievirus is an enterovirus (entero=gut), it is transmitted through fecal-oral route, when the stool of the infected child somehow land in your mouth! Other than this, the oral/nasal secretion and blister fluid also contain the virus . Thus coxsackievirus also can be spread through direct contact with this secretion. For example, when the infected child touch his stool or rub his watery nose, then he touch a toy, then another child touch that toy and put his unwashed hands in his mouth or nose. Besides, the virus can also fly in the air when sneezing or coughing and land in others' nose or mouth.

Coxsakievirus is highly contagious, so it's not uncommon to see small “outbreak” within nursery or kindergarten. Infants are more likely to get it and the risk decreases with age and it's not common in children >10 years old and adult. For hand-foot-mouth disease, the illness usually last 5-7 days, and the child are most contagious for this period of time. So, usually doctors will suggest to avoid contact with the affected child for at least 1 week.

The rash of hand-foot-mouth disease typically start with red dots, which turn into blisters and then later ulcers. It appears on the hands (palm), feet (sole) and mouth (tongue, gum, palate, inner cheek). The rash has a characteristic erythemathous halo (red ring around the blisters). It may last for 5-10 days. Sometimes the blisters only affect the mouth but not the hands or feet (herpangina).

    Blisters/ulcers with typical "red ring" around them

There is no specific treatment for coxsackievirus infection or hand-foot-mouth disease. It can get cured by our own immune system in 7-10 days. Since blisters or ulcers in the mouth can be painful, some infants or small children may have poor feeding which can lead to dehydration (lack of fluids). If this happen, it may warrant hospital admission for intravenous fluid replacement. Medicine usually given are to relieve fever and pain in the mouth.

Coxsackievirus or hand-foot-mouth disease is a mild disease. So, don't be panic.