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Herpangina, also called mouth blisters, is a painful mouth infection caused by coxsackieviruses. Usually, herpangina is produced by one particular strain of coxsackie virus A (and the term "herpangina virus" refers to coxsackievirus A), [ 1 ] but it can also be caused by coxsackievirus B or echoviruses . [ 2 ]
Hand, foot, and mouth disease (HFMD) is a common infection caused by a group of enteroviruses. [10] It typically begins with a fever and feeling generally unwell. [10] This is followed a day or two later by flat discolored spots or bumps that may blister, on the hands, feet and mouth and occasionally buttocks and groin.
In general, group A coxsackieviruses tend to infect the skin and mucous membranes, causing herpangina; acute hemorrhagic conjunctivitis; and hand, foot, and mouth disease. [2] Both group A and group B coxsackieviruses can cause nonspecific febrile illnesses, rashes, upper respiratory tract disease, and aseptic meningitis.
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]
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Common symptoms can include myocarditis, meningoencephalitis, and hepatitis. Other less severe symptoms can include pneumonia, Gastrointestinal symptoms, pancreatitis, and seizures. Patients with Coxsackie B4 virus have seemed to have herpangina, tonsillitis, and pharyngitis. [6] CB4 virus has caused transplacental infections in mice.
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.
Historically, poliomyelitis was the most significant disease caused by an enterovirus, namely poliovirus. There are 81 non-polio and 3 polio enteroviruses that can cause disease in humans. Of the 81 non-polio types, there are 22 Coxsackie A viruses, 6 Coxsackie B viruses, 28 echoviruses, and 25 other enteroviruses. [3]