Clinical and Epidemiological Features of Coxsackie Group B Virus Infections

Abstract

Since the report of their discovery in 1948 thirty distinct serotypes of Coxsackie viruses have been described. The group A Coxsackie viruses have been causally related to the syndromes of herpangina and aseptic meningitis. The group B viruses, six in number, have been found to cause epidemics of pleurodynia and aseptic meningitis and encephalomyocarditis of infants. In addition, many reports have implicated the group B Coxsackie viruses in some cases of acute benign pericarditis, myocarditis, polio-like infection and orchitis. In order to provide some assistance in clinical diagnosis the experience gained in the study of 180 laboratory confirmed cases of Coxsackie group B virus infections has been reviewed. The significant epidemiologic features of these cases were the summer-fall distribution and the predominace of a single serotype in a given year. In this series the following clinical syndromes were observed: aseptic meningitis (64%), pleurodynia (21%), abdominal distress (4%), mouth lesions (3%), myocarditis (4%), pericarditis (3%), myalgia (4%). Exanthema, orchitis and nonspecific febrile illness were each diagnosed in less than 2% of patients. Age appeared to play a determining role in the type of clinical syndrome produced by the group B Coxsackie viruses. Five infants with myocarditis went on to a fatal conclusion, but the two adult patients with myocardial involvement had mild courses. Five patients with pericarditis were all adult males. Although abdominal pain occurred most often in children under 10 years of age, pleurodynia was diagnosed infrequently in this age group. Clinical diagnosis of group B Coxsackie infection can be made with a high degree of success in the following circumstances: (1) epidemics of pleurodynia; (2) aseptic meningitis, orchitis, pericarditis, exanthem, abdominal pain, etc., occurring in patients exposed to a person with pleurodynia; (3) neonatal myocarditis. In temperate climates Coxsackie B infections are rare except during the summer and fall months.