From the Guidelines
Coxsackie virus infections, which cause Coxsachyli rash, are typically self-limiting and resolve on their own within 7-10 days, with treatment primarily focused on supportive care to alleviate symptoms. The rash associated with Coxsackie virus infections, commonly known as hand, foot, and mouth disease, appears as small red spots that may blister, typically on hands, feet, mouth, and sometimes buttocks or genitals 1. For symptom relief, acetaminophen or ibuprofen can be used for fever and discomfort, following appropriate dosing guidelines based on age and weight. It is essential to keep the rash area clean and dry, avoid irritating soaps, and apply calamine lotion to help with itching if present. Staying hydrated is crucial, especially if sores in the mouth make drinking difficult, and cold liquids, popsicles, and soft foods can help with oral discomfort. Practicing good hygiene, including frequent handwashing, is vital to prevent spreading the virus to others, as it's highly contagious through respiratory droplets and contact with blister fluid 1. If symptoms worsen significantly, persist beyond 10 days, or if dehydration occurs, seeking medical attention promptly is recommended.
Some key considerations in managing Coxsackie virus infections include:
- Recognizing the potential for severe disease, including meningoencephalitis, myelitis, paralysis, myocarditis, sepsis-like syndrome, respiratory disease, and acute hepatitis, especially in certain high-risk groups or with specific virus types like EV-A71 and EV-D68 1.
- Understanding that enteroviruses are a common cause of self-limiting febrile illnesses in infants and young children but can occasionally cause severe disease 1.
- Being aware of the importance of diagnosing enterovirus infections to identify the virus type involved, especially in patients with severe clinical presentations and for investigating outbreaks 1.
Given the potential severity of some enterovirus infections and the importance of accurate diagnosis for guiding treatment and public health responses, it is crucial to follow recommended diagnostic approaches, such as those outlined for different clinical presentations, including the use of vesicle fluid, respiratory samples, and stool for diagnosing hand, foot, and mouth disease 1.
From the Research
Coxsachyli Rash Characteristics
- The Coxsachyli rash is a characteristic feature of hand-foot-and-mouth disease, caused primarily by Coxsackie A16 and enterovirus 71 2.
- The rash typically presents as painful papules and blisters over the extremities and genitalia, accompanied by an enanthem involving ulceration of the mouth, palate, and pharynx 2.
- However, recent outbreaks of Coxsackie A6 infection have been associated with more severe and atypical cutaneous features, including vesicobullous and erosive eruptions, extensive cutaneous involvement, and periorificial lesions 2, 3.
Clinical Presentations
- Hand-foot-and-mouth disease can present with variable clinical features, including macular, maculopapular, or vesicular rashes on the hands and feet, as well as oral enanthema 4.
- Atypical presentations of the disease, caused by Coxsackie virus A6, have been reported in adults and are characterized by high fever, vesiculobullous eruptions, and more severe skin manifestations 5, 3.
- Infants with eczema may be predisposed to severe disease, and adults can also be affected, likely due to fecal-oral transmission in a household setting 2, 3.
Histologic Features
- Biopsy specimens from adult patients with atypical hand-foot-and-mouth disease caused by Coxsackievirus A6 show distinctive changes in the epidermis and adnexal structures, including spongiosis, neutrophilic exocytosis, and massive keratinocyte necrosis 6.
- The inflammatory infiltrate is made of T cells with a cytotoxic profile, with numerous granulysin-positive cells, similar to those observed in severe drug-induced eruption with necrosis of keratinocytes 6.