What is Group B Coxsackie Virus?
Coxsackievirus Group B is a type of virus that belongs to the Picornaviridae family and the Enterovirus genus. Enterovirus, or EV, is a type of virus with a single RNA strand and is named so because it spreads through the gastrointestinal route, or our digestive system. Before being categorised as EV A-D, these viruses were grouped based on their effects on humans and lab animals into four groups: polioviruses, coxsackie A viruses, coxsackie B viruses, and echoviruses. The strains of enterovirus that can cause disease in us humans are enterovirus A-D and rhinovirus A-C.
Coxsackieviruses are a type of virus that do not have an envelope and contain a single RNA strand. Group A coxsackieviruses have been noted to cause a condition known as flaccid paralysis, which occurs due to widespread muscle inflammation. On the other hand, Group B coxsackieviruses have been found to lead to a condition called spastic paralysis due to the damage of nerve tissues and specific muscle injuries. There are at least 23 types (1-22, 24) of Group A and six types (1-6) of Group B coxsackieviruses recognised: CV-B1, CV-B2, CV-B3, CV-B4, CV-B5, and CV-B6. Group B coxsackieviruses can infect the heart, the lining of the lungs, the pancreas and the liver causing conditions such as pleurodynia (chest or abdominal pain), myocarditis (inflammation of the heart), pericarditis (inflammation the protective covering of the heart), and hepatitis (inflammation of the liver). It also can cause a widespread disease in newborn babies. This article will mainly focus on the coxsackievirus Group B.
What Causes Group B Coxsackie Virus?
The Coxsackie group B virus can lead to several health problems as follows:
* It often begins with ‘viral prodrome’ that includes symptoms like fever, feeling excessively tired (fatigue), discomfort (malaise), muscle pain (myalgia), upset stomach (nausea), vomiting, diarrhea, and abdominal pain.
* Another symptom is ‘exanthema’ which means a rash or skin eruption on the skin.
* It can lead to ‘aseptic meningitis’, a condition where the protective membranes covering the brain and spinal cord become inflamed, but is not caused by bacteria.
* This virus can also cause ‘encephalitis’ which is the inflammation of the brain.
* Pleurodynia is another symptom caused by this virus, characterized by severe, sharp chest or abdominal pains that come and go and can be severe.
* ‘Myopericarditis’, an inflammation of the heart muscle (myo) and the outer layer of the heart (pericardium).
* This virus can also lead to pancreatitis, an inflammation of the pancreas, which results in the destruction of the cells that produce insulin (beta cells), leading to type one diabetes.
Risk Factors and Frequency for Group B Coxsackie Virus
Coxsackie group B virus affects everyone equally and can be found all around the world. It’s most common in the warm summer months. It’s important to know that trends for this virus aren’t studied based on its types, but based on the diseases it causes. For example, for 2 to 3 years, the coxsackie B1 virus was the most common type. Meanwhile, infections from coxsackie B4 virus were more deadly than other types.
The age of the infected person can affect how serious the diseases are. Kids and adults usually have a milder illness, with less chance of serious problems than newborns. There are 21 viruses that can cause heart disease and the coxsackie B virus is the one mostly responsible for viral heart inflammation, particularly in newborns and young children.
- The coxsackie group B virus affects both males and females and can be found anywhere in the world.
- Most infections occur during the warm summer months.
- The type of illness you get can depend on the specific type of coxsackie virus.
- Kids and adults usually have milder illnesses than newborns.
- The virus can cause viral meningitis, mostly in infants and kids under five.
- It can also cause encephalitis, a type of brain inflammation, in any age group but mostly children and young adults.
- It is most often the cause of pleurodynia, a type of chest pain, in adults.
- Out of the 21 viruses that can cause heart disease, coxsackie B virus is the major cause, especially in newborns and younger children.
Signs and Symptoms of Group B Coxsackie Virus
Getting infected with Coxsackie B viruses can lead to a variety of symptoms, such as headaches, fevers, sore throats, upset stomach, extreme tiredness, chest pain, and muscle pain. How severe the infection is can depend on the person’s age, immune health, as well as which organs the virus attacks. After catching the virus, symptoms usually appear after a certain period – this ‘incubation period’ differs depending on the type of sickness. The virus spreads the most in the first two weeks of infection.
Specific diseases caused by this virus can lead to additional symptoms:
- Exanthema shows up as skin rashes with redness around them. They first appear on the face and neck before spreading to the trunk and the legs and arms within 24 hours. The rash does not appear on the palms and soles. This disease can also come with small, red or purple spots on the skin, and swollen glands in the neck.
- Aseptic meningitis symptoms include fever and irritability in babies, and fever, headache, stiff neck, nausea, and vomiting in kids or adults.
- Encephalitis can make people confused or cause seizures. The disease can range from being mild to fatal.
- Pleurodynia, also called Bornholm disease, causes chest pain that becomes worse when breathing, leading to confusion with heart attack. The pain can last anywhere from two days to two weeks, along with other symptoms such as fever, stomach pain, and tender muscles of the trunk and limbs.
- Myopericarditis leads to inflammation of the heart, causing symptoms like shortness of breath, chest pain, and an irregular heartbeat. The sickness can last from a few hours up to several months. In severe cases, it can lead to heart failure or cardiac arrest.
- Pancreatitis shows up with belly pain, nausea, vomiting, and an increase in the pancreatic enzymes amylase and lipase. A severe pancreatitis case due to Coxsackie group B can lead to the destruction of insulin-making cells in the pancreas, resulting in type one diabetes mellitus.
Testing for Group B Coxsackie Virus
If you have an enterovirus infection, your doctor will likely know just by looking at your symptoms, as this type of infection usually gets better on its own. However, in more serious cases, like heart inflammation, brain inflammation, and newborn infections, your doctor might need to identify the specific virus causing trouble.
The identification of the virus can also be helpful during large-scale outbreaks of the virus to understand how the infection is spreading. The main tests used to confirm enterovirus infection are RT-PCR, viral cultures, or serological tests. The most common test used is the RT-PCR test. This test can find enterovirus RNA, which is the genetic material of the virus, in samples from your nose and throat, your urine, your blood, and the fluid that surrounds your brain and spinal cord.
Though RT-PCR is a quick and efficient test, it doesn’t identify the specific subtype of the virus. Viral cultures, on the other hand, can identify the subtype, but these tests take longer and are not as accurate. Serological tests are used when doctors suspect a particular subtype of the virus and are much less common. Other tests your doctor may conduct include:
- Blood tests (CBC, Comprehensive metabolic profile)
- Erythrocyte sedimentation rate (a test that measures inflammation in your body)
- Chest X-ray
- Abdominal CT scan (a detailed scan of your abdomen)
- Head CT scan (a detailed scan of your head)
- Lumbar puncture (a procedure to collect and examine the fluid surrounding your brain and spinal cord)
- Lactic acid test (a test to measure the level of lactic acid, a chemical produced by your body, in your blood)
- Procalcitonin test (a test that can help diagnose bacterial infections)
Treatment Options for Group B Coxsackie Virus
The virus eventually resolves on its own and there’s no specific remedy. If you have symptoms, the right course is to manage and ease them. For example, if you’re dealing with complications that affect the nervous system, you may need medication to control seizures or to help manage delirium (a state of severe confusion).
When it comes to issues affecting the heart, like myocarditis (an inflammation of the heart muscle), initial supportive measures include providing extra oxygen and giving fluids to help balance your body’s water and electrolyte levels. Additionally, treatment may be needed for heart failure and irregular heartbeats.
What else can Group B Coxsackie Virus be?
It’s important to remember that many viral infections can have similar symptoms. Particular viruses that mimic Coxsackie Group B are important to remember as they may require specific treatments or have serious complications. These include:
- Human immunodeficiency virus (HIV)
- Hepatitis B and C, which can lead to liver cancer
- JCV, which causes a disease that affects multiple areas of the brain
- Measles, which can lead to a rare brain disorder
- Herpes simplex virus, which can cause inflammation of the brain
- Rabies, which can also cause inflammation of the brain
- Poliomyelitis
- Epstein Barr virus, which can cause an enlarged spleen and possibly a ruptured spleen
- Cytomegalovirus
What to expect with Group B Coxsackie Virus
Infections often resolve on their own. Most of the time, people make a complete recovery with only a few exceptions. For instance, aseptic meningitis caused by an Enterovirus generally has a good outcome, but some patients might feel generally unwell and tired for a few weeks. Also, babies and children who get aseptic meningitis may face mild intellectual challenges. Additionally, heart conditions known as myocardial syndromes can sometimes lead to unfavorable outcomes.
Possible Complications When Diagnosed with Group B Coxsackie Virus
Complications can occur when infections affect the central nervous system, which may lead to aseptic meningitis and encephalitis. The heart can also be targeted, resulting in viral myopericarditis and severe heart failure.
Common Complications:
- Aseptic meningitis (inflammation of the protective membranes covering the brain and spinal cord)
- Encephalitis (inflammation of the brain)
- Viral myopericarditis (inflammation of the heart muscles and outer covering)
- Fulminant heart failure (sudden and severe heart failure)
Preventing Group B Coxsackie Virus
As there is currently no treatment or vaccine available for the Coxsackie B virus, doctors and nurses stress the importance of preventing the spread of the infection. This can be done through proper hand washing and keeping our surroundings clean. For pregnant women, exposure to this virus can lead to serious health problems in their newborn baby. Therefore, it is advisable for expecting mothers to steer clear of anyone who is believed to have this infection.