Coxsackieviruses Treatment & Management

Updated: Dec 06, 2019
  • Author: Martha L Muller, MD, MPH; Chief Editor: Michael Stuart Bronze, MD  more...
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Treatment

Medical Care

Medical care is generally supportive and can be offered on an outpatient basis. More severe symptoms may require inpatient admission for further workup and intervention.

Aseptic meningitis

Treatment is mainly supportive.

Pleconaril, an enteroviral capsid-stabilizing drug, appeared to reduce symptoms in a randomized double-blind study (N = 33), [7] but has not been licensed by the Food and Drug Administration (FDA).

Not all patients require hospitalization, but consider admission for patients with changes in mental status or neurologic deficits.

Myopericarditis

IVIG has been of anecdotal benefit, but no randomized trials have been conducted. A large prospective trial of prednisone with cyclosporine or azathioprine showed no difference compared to supportive treatment alone. [8] Recent experiments have shown that carvedilol, a nonselective beta-blocker, attenuates myocardial lesions and decreases myocardial virus replication in a murine model. However, this intervention has not been evaluated in humans. [9]

Epidemic pleurodynia

Analgesics, narcotics, and heating pads are the mainstays of therapy. All patients recover completely within 1 week.

Acute hemorrhagic conjunctivitis (AHC)

Treatment is symptomatic, and no antimicrobial agent is necessary in the absence of bacterial superinfection.

Immunodeficiency

Both IVIG and pleconaril have been used in immunocompromised patients with enteroviral infections (neonates and B-cell immunodeficient) with varying success.

In vitro studies have suggested that arbidol may have potential as a future antiviral agent with activity against coxsackievirus, but no trials in humans have yet been performed. [10]

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Surgical Care

No surgical intervention is necessary unless patients develop complications such as meningitis and/or encephalitis with increased intracranial pressure, which requires ventriculostomy, or heart failure, which requires valve repair or cardiac transplant.

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Consultations

Consultations play an important role in patients with complex presentations.

A neurologist may help to evaluate patients who present with abnormal neurologic symptoms or to manage rare complications associated with meningitis.

A neurosurgeon may be needed to assist with obtaining brain biopsies or placing a ventriculostomy tube because of increased intracranial pressure.

A cardiologist helps with diagnosis and management of arrhythmia, heart failure, and heart block associated with myocarditis.

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Diet

Diet is as tolerated.

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Activity

Bedrest is indicated for some patients.

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Prevention

Currently, no routine vaccinations are available for prevention.

Minimize respiratory contact with the infected patient if possible.

To prevent further transmission, strict handwashing should be encouraged.

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Further Outpatient Care

No outpatient care, other than usual follow-up care, is required for patients with mild symptoms.

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Further Inpatient Care

Severe aseptic meningitis and/or encephalitis, seizures, myopericarditis, and heart failure require admission for workup and treatment. Antibiotics may be used until bacterial meningitis is ruled out. Supportive inpatient or intensive care may be necessary for severe cases.

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Inpatient & Outpatient Medications

Inpatient medications indicated are based on the patient's presentation at admission (eg, phenytoin for seizure prophylaxis and/or suppression in patients with aseptic meningitis/encephalitis, digoxin in patients with heart failure).

Antipyretics (eg, acetaminophen) for fever and NSAIDs for pain should be adequate in patients with mild symptoms who do not require hospital admission.

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Transfer

Transfer to a tertiary facility may be necessary for specialized consultations or surgeries.

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