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30/7/2015

CoxsackievirusesTreatment&Management:MedicalCare,SurgicalCare,Consultations

CoxsackievirusesTreatment&Management
Author:MarthaLMuller,MDChiefEditor:MichaelStuartBronze,MDmore...
Updated:Oct23,2014

MedicalCare
Medicalcareisgenerallysupportiveandcanbeofferedonanoutpatientbasis.Moreseveresymptomsmayrequire
inpatientadmissionforfurtherworkupandintervention.

Asepticmeningitis
Treatmentismainlysupportive.
Pleconaril,anenteroviralcapsidstabilizingdrug,appearedtoreducesymptomsinarandomizeddoubleblindstudy
(N=33), [7]buthasnotbeenlicensedbytheFoodandDrugAdministration(FDA).
Notallpatientsrequirehospitalization,butconsideradmissionforpatientswithchangesinmentalstatusor
neurologicdeficits.

Myopericarditis
IVIGhasbeenofanecdotalbenefit,butnorandomizedtrialshavebeenconducted.Alargeprospectivetrialof
prednisonewithcyclosporineorazathioprineshowednodifferencecomparedtosupportivetreatmentalone. [8]
Recentexperimentshaveshownthatcarvedilol,anonselectivebetablocker,attenuatesmyocardiallesionsand
decreasesmyocardialvirusreplicationinamurinemodel.However,thisinterventionhasnotbeenevaluatedin
humans. [9]

Epidemicpleurodynia
Analgesics,narcotics,andheatingpadsarethemainstaysoftherapy.Allpatientsrecovercompletelywithin1week.

Acutehemorrhagicconjunctivitis(AHC)
Treatmentissymptomatic,andnoantimicrobialagentisnecessaryintheabsenceofbacterialsuperinfection.

Immunodeficiency
BothIVIGandpleconarilhavebeenusedinimmunocompromisedpatientswithenteroviralinfections(neonatesand
Bcellimmunodeficient)withvaryingsuccess.
Invitrostudieshavesuggestedthatarbidolmayhavepotentialasafutureantiviralagentwithactivityagainst
coxsackievirus,butnotrialsinhumanshaveyetbeenperformed. [10]

SurgicalCare
Nosurgicalinterventionisnecessaryunlesspatientsdevelopcomplicationssuchasmeningitisand/orencephalitis
withincreasedintracranialpressure,whichrequiresventriculostomy,orheartfailure,whichrequiresvalverepairor
cardiactransplant.

Consultations
Consultationsplayanimportantroleinpatientswithcomplexpresentations.
Aneurologistmayhelptoevaluatepatientswhopresentwithabnormalneurologicsymptomsortomanagerare
complicationsassociatedwithmeningitis.
Aneurosurgeonmaybeneededtoassistwithobtainingbrainbiopsiesorplacingaventriculostomytubebecauseof
increasedintracranialpressure.
Acardiologisthelpswithdiagnosisandmanagementofarrhythmia,heartfailure,andheartblockassociatedwith
myocarditis.

Diet
Dietisastolerated.

Activity
Bedrestisindicatedforsomepatients.

ContributorInformationandDisclosures
Author
MarthaLMuller,MDAssociateProfessorofPediatrics,DivisionofInfectiousDiseases,UniversityofNew
MexicoSchoolofMedicine
Disclosure:Nothingtodisclose.
SpecialtyEditorBoard
FranciscoTalavera,PharmD,PhDAdjunctAssistantProfessor,UniversityofNebraskaMedicalCenterCollege
ofPharmacyEditorinChief,MedscapeDrugReference
Disclosure:ReceivedsalaryfromMedscapeforemployment.

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30/7/2015

CoxsackievirusesTreatment&Management:MedicalCare,SurgicalCare,Consultations

JohnWKing,MDProfessorofMedicine,Chief,SectionofInfectiousDiseases,Director,ViralTherapeutics
ClinicsforHepatitis,LouisianaStateUniversityHealthSciencesCenterConsultantinInfectiousDiseases,
OvertonBrooksVeteransAffairsMedicalCenter
JohnWKing,MDisamemberofthefollowingmedicalsocieties:AmericanAssociationfortheAdvancementof
Science,AmericanCollegeofPhysicians,AmericanFederationforMedicalResearch,Associationof
SubspecialtyProfessors,AmericanSocietyforMicrobiology,InfectiousDiseasesSocietyofAmerica,SigmaXi
Disclosure:ReceivedhonorariafromMedScapeforother.
ChiefEditor
MichaelStuartBronze,MDDavidRossBoydProfessorandChairman,DepartmentofMedicine,StewartG
WolfEndowedChairinInternalMedicine,DepartmentofMedicine,UniversityofOklahomaHealthScience
CenterMasteroftheAmericanCollegeofPhysiciansFellow,InfectiousDiseasesSocietyofAmerica
MichaelStuartBronze,MDisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,American
MedicalAssociation,OklahomaStateMedicalAssociation,SouthernSocietyforClinicalInvestigation,
AssociationofProfessorsofMedicine,AmericanCollegeofPhysicians,InfectiousDiseasesSocietyofAmerica
Disclosure:Nothingtodisclose.
AdditionalContributors
MariaDMileno,MDAssociateProfessorofMedicine,DivisionofInfectiousDiseases,TheWarrenAlpert
MedicalSchoolofBrownUniversity
MariaDMileno,MDisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,AmericanCollegeof
Physicians,AmericanSocietyofTropicalMedicineandHygiene,InfectiousDiseasesSocietyofAmerica,
InternationalSocietyofTravelMedicine,SigmaXi
Disclosure:Nothingtodisclose.
Acknowledgements
MashiulHChowdhury,MDAssistantProfessor,DepartmentofMedicine,DivisionofInfectiousDisease,
ProgramDirector,InfectiousDiseaseFellowship,Director,TravelHealthCenter,DrexelUniversityCollegeof
Medicine
Disclosure:Nothingtodisclose.
NhatMDoan,MDFellow,DepartmentofInternalMedicine,DivisionofInfectiousDiseases,Washington
HospitalCenter
Disclosure:Nothingtodisclose.
ParulKaushik,MD,MPHFellow,DepartmentofMedicine,DivisionofInfectiousDisease,DrexelUniversity
CollegeofMedicine
Disclosure:Nothingtodisclose.
MichaelRajnik,MDAssociateProfessor,DepartmentofPediatrics,ProgramDirector,PediatricInfectious
DiseaseFellowshipProgram,UniformedServicesUniversityoftheHealthSciences
MichaelRajnikisamemberofthefollowingmedicalsocieties:AmericanAcademyofPediatrics,ArmedForces
InfectiousDiseaseSociety,InfectiousDiseasesSocietyofAmerica,andPediatricInfectiousDiseasesSociety.
Disclosure:Nothingtodisclose.

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