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Coxsackieviruses are divided into group A and group B viruses based on early observations of their pathogenicity in neonatal mice. [1] Group A coxsackieviruses were noted to cause a flaccid paralysis (which was caused by generalized myositis) while group B coxsackieviruses were noted to cause a spastic paralysis (due to focal muscle injury and degeneration of neuronal tissue).
Echovirus 9 (also known as E-9, E.C.H.O. 9, and formerly Coxsackie A23 or A23 virus) [1] is a serotype of echovirus. When first discovered, it was labelled as a coxsackie A virus, A23. It was later discovered that A23 was an echovirus antigenically identical to the already-known echovirus 9. [2] Echovirus 9 is the most common enterovirus type. [3]
Coxsackie B infections usually do not cause serious disease, although for newborns in the first 1–2 weeks of life, Coxsackie B infections can easily be fatal. [2] The pancreas is a frequent target, which can cause pancreatitis. [2] Coxsackie B3 (CB3) infections are the most common enterovirus cause of myocarditis and sudden cardiac death. [8]
Coxsackie A virus is a subgroup of enterovirus A, which are small, non-enveloped, positive-sense, single-stranded RNA viruses. Its protective, icosahedral capsid has an external portion that contains sixty copies of viral proteins (VP1,-2,-3) and an internal portion surrounding the RNA genome containing sixty copies of VP4 viral proteins.
Coxsackievirus B4 is one of the six serotypes found in Group B and is a positive sense, single-stranded, non-enveloped RNA virus. Its genome is linear and is 7,293 nucleotides in length with both a 5’ and 3’ untranslated region and encodes its own 3’ poly-A tail.
The increased susceptibility of dystrophin deficient heart to coxsackievirus-induced dilated cardiomyopathy is attributed to more efficient release of the virus from infected cells resulting an increase in viral-mediated cytopathic effects. [4] Viral-induced dilated cardiomyopathy can be characterized using different methods.
CAR is a receptor for both Coxsackie B virus and adenovirus 2 and 5, which are structurally distinct. [22] In patients with myocarditis or dilated cardiomyopathy, elevated Coxsackie B2 viral nucleic acids have been detected in myocardial biopsy samples. [23]
sCAR-Fc (Soluble Receptor Analogue) is an experimental prophylactic treatment against coxsackievirus B3 (CVB) infections. Coxsackievirus B3 can cause cardiac damage, eventually resulting in a weakened and enlarged heart that is termed dilated cardiomyopathy. [1]