Coxsackie virus rash

Introduction to Coxsackie Virus Coxsackieviruseruption is caused by Coxsackie virus (CV), which was named after the outbreak of polio in Coxac Village, USA in 1948. Coxsackie virus is divided into groups A and B, group A. It mainly causes skeletal muscle damage in newborn rats; group B can cause central nervous system and visceral damage. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: contact spread Complications: meningitis pneumonia

Coxsackie virus rash

(1) Causes of the disease

Coxsackie virus eruption is caused by Coxsackie virus (CV).

(two) pathogenesis

Coxsackie virus eruption is caused by Coxsackie virus (CV), which was named in 1948 by the outbreak of polio in the village of Coxac, and the Coxsackie virus is divided into groups A and B. Group A mainly causes skeletal muscle damage in newborn rats; Group B can cause damage to the central nervous system and viscera, and the common damages associated with skin diseases are as follows.

1. Coxsack group A virus rash

(1) Coxsack A9.

(2) Coxsack A4.

2. Coxsack Group B virus rash COX B1, 3, 5 more common.

(1) Coxsack B1.

(2) Coxsack B3.

(3) Coxsack B5.

Coxsackie virus rash prevention

Due to the excessive serotype of enterovirus (nearly 70 types), it is not possible to make an effective and feasible vaccine, and the preventive measures are far less effective than polio.

Coxsackie rash complications Complications meningitis pneumonia

Meningitis and pneumonia can sometimes occur.

Coxsackie virus rash symptoms Common symptoms Herpes rash rash diarrhea pleural effusion chest pain sputum hepatosplenomegaly local lymphadenopathy

Coxsackie virus eruption is caused by Coxsackie virus (COX), which was named in 1948 by the outbreak of polio in the village of Coxac, and the Coxsackie virus is divided into groups A and B. Group A mainly causes skeletal muscle damage in newborn rats; Group B can cause damage to the central nervous system and viscera, and the common damages associated with skin diseases are as follows.

Coxsack Group A virus rash

(1) Coxsackie A9: It is the most easily isolated type of COX virus, which is often prevalent in summer, causing erythema, maculopapular rash, wheal, blisters, cyanosis, etc., which originate in the face and neck and gradually spread to the trunk. Limbs, palmar, skin lesions about 1 to 2 weeks subsided, may be associated with herpetic angina, local lymphadenopathy, may have short-term fever, sometimes meningitis, pneumonia, patient's throat secretions, cerebrospinal fluid, feces The virus can be isolated from the blood.

(2) Coxsackie A4: There are fever, anorexia, salivation, pharyngitis, rhinitis and other prodromal symptoms. In the face, neck and body (except the buttocks), there are measles-like rashes or scarlet-like erythema, which disappears within 1 to 4 days. It has been reported that there are 5 to 10 mm diameter pale yellow opaque blister, which disappears in 1 to 2 weeks.

2. Coxsackie B group virus rash, COX B1, 3, 5 more common.

(1) Coxsack B1: A variety of rashes occur during fever, including rubella-like, pityriasis-like rashes, vesiculars such as hand-foot-mouth disease and herpetic angina, which are common in children.

(2) Coxsackie B3: rash, blisters and ecchymoses with fever, headache, diarrhea, myalgia, hepatosplenomegaly, often in summer, only seen in children.

(3) Coxsackie B5: mainly causes encephalitis, myocarditis, pericarditis, peritonitis, hepatitis, orchitis, herpetic angina, occasional rash, hot rash after rash, mostly maculopapular rash, from face expansion To the trunk and limbs, the palmar sputum is not tired, and the rash disappears without leaving traces. It is more common in infants under 18 months. The virus can be isolated from the throat secretions and cerebrospinal fluid.

Coxsackie virus rash check

1. Peripheral blood picture The total number of white blood cells is normal or slightly increased.

2. Virus isolation is the main method of diagnosis, with the advantages of saving, fast and accurate, while avoiding the serotypes encountered by serological methods.

The positive rate of virus isolation from feces is the highest. It can still be positive within 10 days after onset. Virus can be isolated from blood within 36 hours before onset and fever. Patients with respiratory infection can isolate virus from throat swab or sputum, cerebrospinal fluid. The positive rate of isolated virus is low, but the diagnosis is of great significance. Other specimens including pleural effusion, pericardial effusion, urine, muscle biopsy tissue and autopsy nerve tissue can be sent for examination. Fecal specimens can be stored at 4 °C for many days. Other specimens should be kept below -7 °C.

The isolation of viruses from the feces and respiratory tract is only of reference, as it may be a co-infection, and the isolation of viruses from blood, cerebrospinal fluid and pericardial effusion is diagnostic, so specimens should be collected from multiple sources to increase The reliability of the results.

Coxsackie A virus can be isolated from the A9 and A16 serotypes by cell culture. The other serotypes need to be inoculated into the mice by various routes (subcutaneous, intraperitoneal, intracerebral, etc.) to isolate the virus. Then, it was confirmed by a specific antiserum as a neutralization test. Recently, RD cells (human rhabdomyosarcoma cells) were used to isolate and culture other group A viruses other than Coxsackie A1, A19, and A22 viruses. Tissue B is the first choice for tissue culture. The common cell strains include monkey kidney, human embryonic kidney and Hela cells. The African green monkey kidney (BGM) cell line and RD cell line are better. After 2 to 5 days, the cytopathic effect is observed. For initial diagnosis, and then using specific antiserum for neutralization test to identify, the whole process takes about 1 to 3 weeks, but as a clinical diagnosis, you do not have to wait for the identification of serotypes.

3. Serological examination Due to the large number of serotypes, it is only applicable in the following cases:

1 The virus has been isolated as a serotype;

2 has been found to have characteristic clinical manifestations such as epidemic chest pain, which clearly indicates when certain antibodies (such as group B viruses) are used to detect antibodies; or when hands, feet, and oral diseases are usually caused by Coxsackie A16 virus;

3 is occurring when a single serotype virus causes epidemics;

4 for sero-epidemiological investigation of a particular serotype.

In the serological test method, the neutralization test is the most specific method for identifying the isolated serotype of the virus, but as an antibody for detecting enterovirus infection, the neutralization test is not sensitive enough, and the operation is complicated and expensive, and the patient is in the course of the disease. Neutralizing antibodies began to appear at 2 weeks, peaked after 2 to 3 weeks, and remained for 3 to 6 years. The specificity of the complement-binding assay was lower, and the rate of heterotypic antibody was higher, but the complement-binding antibody appeared simultaneously with the neutralizing antibody. It can be used as a basis for recent infections for 2 to 3 months. The hemagglutination inhibition test is not useful, because only 1/3 of the enterovirus produces erythropoietin, and even some strains can be produced in the same serotype. The strain does not produce erythrocyte lectin. Recently, it has been reported to detect IgM enterovirus antibody by immunoblotting. The positive rate is 60%, most of which are group specific (22/31), a few are type specific, and have specificity. Neutralizing antibodies and complement-binding antibodies are passively transferred from the mother to the baby through the placenta and breast milk. The local antibodies in the intestine also have protective effects. It has been reported that heat-treating the virus as an antigen and synthesizing the polypeptide The antigen was detected by ELISA for IgG antibody, and the sensitivity (by virus isolation as control) was 0.67 and 0.62, respectively, which was higher than the complement binding test. In 56 cases with negative virus isolation, the IgG-ELISA double serum titer was significant. The rise was 13 and 19, respectively, for clinical diagnosis.

In recent years, it has been reported that the detection of enterovirus RNA in serum by PCR has high sensitivity and specificity, and the positive rate is significantly higher than that of cell culture.

Coxsackie virus rash diagnosis

Diagnostic criteria

In addition to clinical manifestations, cerebrospinal fluid, pericardial fluid, pleural effusion, blister fluid, blood for virus isolation, biopsy specimens, throat swabs, rectal swabs, stools, etc. can be used for cell culture, but digestive tract culture separation The virus can only be used as a diagnostic reference. It can also be isolated and identified by suckling mice. Because of the serotype, there are certain difficulties. In the early stage and the recovery stage, serum neutralization test or complement fixation test is performed respectively, and the titer is more than 4 times or disease. Early detection of specific IgM antibodies is diagnostic.

1. Epidemiological data is popular in summer and autumn, and there are many children, and the incidence of many people in the family has reference significance. The data popular in the region in the near future is especially valuable in diagnosis.

2. Clinical features Some characteristic clinical manifestations, such as oral herpes, chest pain or myalgia, myocarditis, meningitis, special rash, etc. are valuable for assisting diagnosis, the total number of white blood cells is normal, and the bimodal fever also has certain reference significance. When the newborn has any serious episodes of serious epidemics, and sudden neonatal cardiopulmonary dysfunction, the possibility of coxsackie virus infection should be considered. In the summer and autumn, unexplained fever and/or rash may occur, especially when the patient For infants and young children, Coxsackie virus infection should also be suspected.

3. Diagnosis is based on the fact that there are often such viruses in the intestines of healthy people. For example, when the Coxsackie virus is isolated only in the stool or anal swab of the patient, it is not possible to draw conclusions based on this. The following points should be used as the basis for diagnosis. :

(1) The virus is isolated from various body fluids or secretions of the patient such as cerebrospinal fluid, blood, vesicle slurry, pleural effusion, etc., or autopsy organs such as heart, brain, liver, spleen, and the like.

(2) Using double serum for neutralization test (or other serological tests), the antibody titer increased by more than 4 times.

(3) The virus isolation rate in patients is much higher than that in the normal control group of untouched patients.

(4) No other known pathogens can cause such syndromes, but the same virus can be repeatedly separated from the patient's pharyngeal lotion, throat swab, feces, anal swab, etc., and also detected from surrounding contacts. The same virus.

Refer to the clinical manifestations section of this section for differentiation from meningitis and pneumonia.

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