From the Guidelines
Coxsackie virus infections should be managed with supportive treatment, focusing on symptom relief, as they are self-limiting viral illnesses with no specific antiviral therapy available, according to the European Society of Cardiology guidelines 1.
General Management
The primary approach to managing Coxsackie virus infections involves relieving symptoms while the body fights the infection. This can include:
- Over-the-counter medications like acetaminophen (Tylenol) at 325-650 mg every 4-6 hours (not exceeding 3000 mg daily for adults) or ibuprofen (Advil, Motrin) at 200-400 mg every 6-8 hours with food for pain and fever management.
- Staying well-hydrated, aiming for at least 8-10 glasses of water daily, especially if fever or mouth sores are present.
- For mouth sores, salt water rinses (1/2 teaspoon salt in 8 ounces warm water) or over-the-counter oral pain relievers like benzocaine gels can provide relief.
Specific Considerations
In cases of viral pericarditis, which can be caused by Coxsackie virus, the diagnosis is not possible without evaluating pericardial effusion and/or pericardial/epicardial tissue, preferably by PCR or in-situ hybridisation 1. Treatment of viral pericarditis, including that caused by Coxsackie B, may involve specific antiviral therapies under investigation, such as Interferon alpha or beta 2,5 Mio. IU/m2 surface area s.c. 3 per week 1.
Monitoring and Follow-Up
Most Coxsackie infections resolve within 7-10 days. However, if symptoms are severe, persist beyond two weeks, or include complications like chest pain, difficulty breathing, or severe headache, medical attention should be sought immediately as rare complications can occur. The immune system's ability to develop antibodies against the virus is key to recovery, making supportive care the mainstay of treatment for Coxsackie virus infections 1.
From the Research
Coxsackie Treatment Options
- The treatment options for viral myocarditis caused by coxsackievirus B include immunosuppressive agents, intravenous immunoglobulin (IVIG), antiviral agents, and natural products 2.
- Immunosuppressive agents, such as azathioprine, prednisone, and cyclosporine, may be used to treat myocarditis, as one of the mechanisms thought to contribute to myocarditis is autoimmune destruction 2.
- IVIG may also be used to treat viral myocarditis, as it suppresses the immune response and may replace antibodies, enhance viral clearance, neutralize pathogens, and enhance clearance of inflammatory cytokines that contribute to myocytes destruction 2.
- Antiviral agents, such as interferons, pleconaril, and acyclovir, may be used to target the causative organism and halt the cascade of myocyte destruction 2.
Pleconaril as a Treatment Option
- Pleconaril has been shown to be effective in treating severe Coxsackie virus B infection in preterm newborns, with all four infants in one study recovering without adverse effects 3.
- Pleconaril has also been used to treat a case of severe enteroviral infection of the CNS, with remarkable improvement noticed after treatment 4.
- Pleconaril has been suggested as a potential treatment for enteroviral infections, including Coxsackie virus B, and may be included in diagnostic procedures 4.
Soluble Coxsackie- and Adenovirus Receptor (sCAR-Fc)
- sCAR-Fc has been shown to have high antiviral activity against laboratory and clinical strains of Coxsackie-B-virus, with an inhibition of viral replication up to 3 orders of magnitude (99.9%) at a concentration of 2.5 μg/ml 5.
- sCAR-Fc has been found to be highly efficient at neutralizing clinical CVB isolates, with no naturally occurring resistant mutants observed during inhibition experiments 5.
Treatment of Neonatal Coxsackie B Virus Infection
- Neonatal coxsackie B virus infection may be a treatable disease, with pleconaril showing potential as a treatment option 6.
- Early diagnosis and treatment of coxsackie B viral infection in neonates is important, as severity is associated with perinatal transmission and symptoms may develop within 7 days of age 6.