Four Seasons Pediatrics

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Coxsackie Virus

Hand, foot, and mouth disease (Coxsackie Virus) is caused by one of several types of viruses. Coxsackie viruses are a part of a family of viruses known as enterovirus. This family includes polioviruses. In fact, Coxsackie virus was discovered by a scientist named Gilbert Dalldorf in the late 1940s who was searching for a cure for polio. This virus he discovered was named after Coxsackie, New York, where the scientist had obtained some specimens in his research.

Hand, foot, and mouth disease is usually characterized by tiny blisters on the inside of the mouth and the palms of the hands, fingers, and soles of the feet. It is commonly caused by coxsackievirus A16 (an enterovirus), and less often by other types of viruses.

Anyone can get hand, foot, and mouth disease. Virtually every child has coxsackie virus at some point.

Young children are primarily affected, but it may be seen in adults. Most cases occur in the summer and early fall. Outbreaks may occur among groups of children especially in child care centers or nursery schools. Symptoms usually appear 3 to 5 days after exposure.

Hand, foot, and mouth disease is usually spread through person-to-person contact. People can spread the disease when they are shedding the virus in their feces. It is also spread by the respiratory tract from mouth or respiratory secretions (such as from saliva on hands or toys). The virus has also been found in the fluid from the skin blisters. The infection is spread most easily during the acute phase/stage of illness when people are feeling ill and have a fever, but the virus can be spread for several weeks after the onset of infection.

The symptoms are much like a common cold with a rash. The rash appears as blisters or ulcers in the mouth, on the inner cheeks, gums, sides of the tongue, and as bumps or blisters on the hands, feet, and sometimes other parts of the skin such as the buttocks. The skin rash may last for 7 to 10 days.

There is no specific treatmentfor the virus that causes hand, foot, and mouth disease. Cold drinks and or freeze pops help sooth the area. Another option is to make a mixture of 1 part antacid (like mylanta) with 1 part benadryl liquid (generic is diphenhydramine). Mix these into a paper cup. Then swab the inside of the mouth and tongue with the mixture. Older children may swish the mixture in the mouth and then spit out. It is ok if some is swallowed.

Help prevent and control the spread of hand, foot, and mouth disease by:

>Washing hands well, especially after going to the bathroom, changing diapers and/or handling diapers or other stool-soiled material.

>Covering the mouth and nose when coughing or sneezing.

>Washing toys and other surfaces that have saliva on them.

>Excluding children from child care or school settings if there is a fever, or ulcers in the mouth and the child is drooling.

Call us if your child shows signs of dehydration (e.g. not urinating 3 times in 24 hours), or the mouth and tongue are dry with very little drinking. You should also call if the initial fever goes away and returns (after 48 hours).

Dr. Miller Comment: Coxsackie virus (named for Coxsackie, NY) is a right of passage in childhood. Almost all children have it at least once or more. There are many different strains and infection only produces antibodies for the strain that your child is exposed to. Coxsackie virus can show itself in many forms. Hand, Foot and Mouth is one common form. In older children and adolescents the infection can result in irritation along the breast bone (where the ribs connect). This is known is costochondritis. It can be very painful, but usually responds to heat and ibuprofen.

Coxsackie virus is treated symptomatically, and while it can make parents worry (due to the occasional high fever), and can lead to dehydration due to throat pain, it almost always resolves on its own without serious concerns.

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