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Symptoms and Signs of Coxsackievirus Infection

Doctor's Notes on Coxsackievirus Infection

Coxsackie viruses are enteroviruses; there are numerous serotypes. Signs and symptoms vary; many infections may not cause any symptoms while other infections may cause the common cold, and reddish rash, sore throat or diarrhea. Less common but more severe signs and symptoms include meningitis (a stiff neck, chest pain and febrile), upper respiratory tract infections that may include cough, weakness and fatigue. Toward the end of some infections, a sunburn – like rash may occur.

The virus may also cause hand-foot-mouth disease (commonly seen in children) and cause characteristic red spots and blisters on the soles of the feet, the palms and/or inside the mouth. In some children, the tender blisters occur only inside the mouth with fever and sore throat (herpangina). Other Coxsackie viruses may cause conjunctivitis with swollen eyelids and red hemorrhages in the whites of the eye.

Rarely, some viral types may cause paralysis and/or weakness that is usually not permanent. Other rare signs and symptoms are pleurodynia (sharp chest pain and possibly abdominal pain), myopericarditis (shortness of breath, chest pain, leg swelling and fatigue), severe infections of the newborn (child becomes listless and/or unresponsive) and orchitis in young boys (inflammation and swelling of one or both testicles with severe pain).

The cause of the above symptoms and signs is infection with Coxsackie viruses.

Medical Author:
Medically Reviewed on 3/11/2019

Coxsackievirus Infection Symptoms


Pleurodynia is an inflammation of the muscles in the chest. It causes a sudden onset of sharp chest pain which gets worse when taking a deep breath. Pain may also be present in the abdomen. The pain comes and goes in waves or spasms. Pleurodynia generally resolves on its own in about five days, although it may recur over the next few weeks.


A very serious problem caused by coxsackievirus is an infection of the heart and lining of the heart (myopericarditis). Fortunately, this complication is quite rare. Myopericarditis symptoms may vary from mild to severe. Severe cases may result in heart failure, heart attack or death. Myopericarditis is more common in young, active adults. Symptoms include shortness of breath, chest pain, fatigue, and leg swelling. The injury to the heart may be transient or permanent.

Severe Infection of the Newborn

Newborns may acquire the virus from infected adults or children. Outbreaks of group B coxsackievirus infections have occurred in nurseries. Infection may be transmitted during pregnancy at the time of delivery as the infant comes into contact with the mother's secretions. Some infected babies will have a mild illness, but infants are at higher risk to have severe disease than older children. Severely affected infants become listless or unresponsive and may have myopericarditis/heart failure, pneumonia, or an inflamed liver (hepatitis) or liver failure. Diarrhea may cause dehydration in infants and may be severe enough to be life-threatening or fatal.

Coxsackievirus in People With Impaired Immune Systems

People born with defects in the immune system and those who are taking immunosuppressive medicines (for example, after bone marrow transplants) are susceptible to more severe and prolonged infection with coxsackievirus.

Other Syndromes

Coxsackievirus may infect the testicles of young boys (orchitis) causing inflammation and swelling similar to mumps. The virus may also cause a syndrome that is similar to mononucleosis with an enlarged spleen and sore throat.

Most coxsackievirus infections are mild and may not even cause symptoms. The virus is one cause of the common cold or a generalized mildly erythematous (red) rash, especially seen in the summer months. It may also cause diarrhea or a sore throat that is similar to strep throat.

There are some more severe syndromes caused by the virus, but these are less common. They include meningitis (an infection of the linings of the spinal cord and brain), encephalitis (inflammation of the brain), pleurodynia (chest pain), and myopericarditis (inflammation of the heart). Infection of newborns may be particularly severe. These syndromes are described below.

Respiratory Illness

It is common for the coxsackievirus to cause a febrile upper respiratory tract infection with sore throat and/or a runny nose. Some patients have a cough resembling bronchitis. Less commonly, coxsackievirus may cause pneumonia.


Some people with coxsackievirus have a rash. In many, this is a nonspecific generalized red rash or clusters of fine red spots. The rash may not appear until the infection has started to get better. Although it may resemble a light sunburn, the rash does not peel. The rash itself is not contagious.

The virus may also cause small, tender blisters and red spots on the palms, soles of the feet, and inside the mouth. In the mouth, sores occur on the tongue, gums, and cheek. This condition is known as hand-foot-mouth disease (HFMD) and is caused by group A coxsackievirus. HFMD is most common in children under 10 years of age. HFMD usually causes a sore throat, fever, and the characteristic blister rash described above. It is mild and resolves on its own. While the blister fluid is a theoretical source of transmission of the virus, the large majority of those infected develop HFMD from contact with respiratory droplets or stool exposure.

Coxsackievirus also may cause a syndrome called herpangina in children. Herpangina presents with fever, sore throat, and small, tender blisters inside the mouth. It is more common in summer and is usually found among children 3-10 years of age. It may be confused with strep throat at first until test results for strep come back negative.

Eye Infection: Conjunctivitis

Acute hemorrhagic conjunctivitis (AHC) presents with swollen eyelids and red hemorrhages in the whites of the eye. Usually, the infection spreads to the other eye as well. Affected people may feel like there is something in their eye or complain of burning pain. AHC may be caused by coxsackievirus, although it is more commonly caused by a related virus. Symptoms usually resolve in about a week.


Coxsackieviruses, especially those from group B, may cause viral meningitis (inflammation of the linings of the spinal cord and brain). Viral meningitis is also known as "aseptic meningitis" because routine cultures of the spinal fluid show no bacterial growth. This is because routine culture methods test for bacteria and not for viruses. Patients with aseptic meningitis complain of a headache and fever with mild neck stiffness. A rash may be present. In children, symptoms may be less specific, including change in personality or becoming lethargic. Febrile seizures may occur in children. Seizures are less common in adults, although adults may complain of fatigue that lasts for weeks after the meningitis resolves.

Less commonly, coxsackievirus may cause inflammation of the brain tissue (meningoencephalitis), as well. People with meningoencephalitis usually have fever and are lethargic or confused. Meningoencephalitis is more common in small children.

Weakness and Paralysis

Another rare symptom is weakness in an arm or leg or even partial paralysis. The symptoms are similar to, but milder than, those caused by poliomyelitis. Paralysis or weakness may follow a bout of AHC or may occur on its own. Weakness and paralysis caused by coxsackievirus usually are not permanent.

Coxsackievirus Infection Causes

  • Coxsackieviruses are part of a viral genus called Enterovirus
  • They are divided into two groups:
    • Group A coxsackievirus
    • Group B coxsackievirus
  • Each group is further divided into several serotypes.
  • The virus is not destroyed by the acid in the stomach, and it can live on surfaces for several hours.

Viral Infection Types, Treatment, and Prevention Slideshow

Viral Infection Types, Treatment, and Prevention Slideshow

Viruses are small particles of genetic material (either DNA or RNA) that are surrounded by a protein coat. Some viruses also have a fatty "envelope" covering. They are incapable of reproducing on their own. Viruses depend on the organisms they infect (hosts) for their very survival. Viruses get a bad rap, but they also perform many important functions for humans, plants, animals, and the environment. For example, some viruses protect the host against other infections. Viruses also participate in the process of evolution by transferring genes among different species. In biomedical research, scientists use viruses to insert new genes into cells.

When most people hear the word "virus," they think of disease-causing (pathogenic) viruses such as the common cold, influenza, chickenpox, human immunodeficiency virus (HIV), and others. Viruses can affect many areas in the body, including the reproductive, respiratory, and gastrointestinal systems. They can also affect the liver, brain, and skin. Research reveals that that viruses are implicated in many cancers as well.


Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.