Coxsackie virus: Difference between revisions
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| colspan="1" style="text-align:center; background:DarkGray" | | | colspan="1" style="text-align:center; background:DarkGray" | | ||
'''Coxsackie Virus''' | |||
|- bgcolor="LightGrey" | |- bgcolor="LightGrey" | ||
! | ! | ||
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==Overview== | ==Overview== | ||
Coxsackie ([[virus]]) is a cytolytic virus of the [[ | Coxsackie ([[virus]]) is a cytolytic virus of the [[picornaviridae]] family, an [[enterovirus]] (a group containing the [[poliovirus]]es, coxsackieviruses, and [[echovirus]]es). There are 61 non-polio enteroviruses that can cause disease in humans, of which 23 are [[coxsackie A virus]]es (6 are [[Coxsackie B]] viruses). [[Enterovirus]] are the second most common viral infectious agents in humans (after the [[rhinovirus]]es) | ||
==Classification== | ==Classification== | ||
[[Coxsackie viruses]] consist of [[ | [[Coxsackie viruses]] consist of [[coxsackie A virus]] and [[coxsackie B virus]]. [[Coxsackie B virus]] has 6 serotypes, one of the significant serotypes is called [[coxsackie B4 virus]]. {{familytree/start}} | ||
{{familytree | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | |A01= '''Coxsackie Virus'''}} | {{familytree | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | |A01= '''Coxsackie Virus'''}} | ||
{{familytree | | | | |,|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|.| }} | {{familytree | | | | |,|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|.| }} | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
[[Coxsackie A virus]] and [[ | [[Coxsackie A virus]] and [[coxsackie B virus]] can cause multiple diseases in humans. The wide array of diseases caused by [[coxsackie viruses]] can be differentiated from one another easily on the basis of involvement of the organs systems, clinical presentation and diagnostic techniques. | ||
<small> | <small> | ||
{| class="wikitable" | {| class="wikitable" | ||
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|[[Hand foot and mouth disease]] | |[[Hand foot and mouth disease]] | ||
| | | | ||
*Fever | *[[Fever]] | ||
*Headache | *[[Headache]] | ||
*Loss of appetite | *Loss of [[appetite]] | ||
*Maculopapular or vesicular rash with very small blisters on | *Maculopapular or [[vesicular rash]] with very small blisters on [[hand]]s, [[feet]], and diaper area; may be tender or painful if pressed | ||
*Sore throat* | *[[Sore throat]] | ||
Ulcers in the throat (including | *[[Ulcers]] in the [[throat]] (including [[tonsil]]s), [[mouth]], and [[tongue]] | ||
| | | | ||
*Throat and lesion swabs | *Throat and lesion swabs | ||
*[[Tzanck test]] | *[[Tzanck test]] | ||
| | | [[File:Hand foot mouth disease-1.jpg|Hand foot and mouth disease|400px]] | ||
|- | |- | ||
|[[Acute hemorrhagic conjunctivitis]] | |[[Acute hemorrhagic conjunctivitis]] | ||
| | | | ||
*Rapidly progressive | *Rapidly progressive | ||
Line 99: | Line 99: | ||
*Positive conjunctival scraping for [[polymerase chain reaction|polymerase chain reaction (PCR)]] | *Positive conjunctival scraping for [[polymerase chain reaction|polymerase chain reaction (PCR)]] | ||
*Positive viral culture of corneal epithelial cells for [[HSV]] | *Positive viral culture of corneal epithelial cells for [[HSV]] | ||
|[[File:Pink eye.jpg|Viral conjunctivitis|400px]] | |[[File:Pink eye-1.jpg|Viral conjunctivitis|400px]] | ||
|- | |- | ||
|[[Herpangina]] | |[[Herpangina]] | ||
| | | | ||
*Sudden fever | *Sudden [[fever]] | ||
*[[Sore throat]] and [[dysphagia]]- May occur up to 24 hours before the appearance of the | *[[Sore throat]] and [[dysphagia]]- May occur up to 24 hours before the appearance of the xanthem | ||
* | *[[Vomiting]] | ||
*Abdominal pain | *[[Abdominal pain]] | ||
*[[Myalgia]] | *[[Myalgia]] | ||
*Headache | *[[Headache]] | ||
*Pharyngeal lesions | *[[Pharyngeal]] lesions | ||
| | | | ||
*Primarily clinical | *Primarily clinical | ||
*Pharyngeal viral | *[[Pharyngeal]] viral [[culture]]s may be helpful | ||
* Approximately 1 week after infection, type-specific [[antibodies]] appear in the blood | * Approximately 1 week after infection, type-specific [[antibodies]] appear in the blood | ||
| [[File:Herpangina .jpg|Herpangina|400px]] | | [[File:Herpangina 2.jpg|Herpangina|400px]] | ||
|- | |- | ||
|[[Aseptic meningitis|Aseptic Meningitis]] | |[[Aseptic meningitis|Aseptic Meningitis]] | ||
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*[[Nuchal rigidity]] | *[[Nuchal rigidity]] | ||
*[[Fever]] | *[[Fever]] | ||
*Altered mental status | *[[Altered mental status]] | ||
| | | | ||
*Clinical | *Clinical | ||
*[[Lumbar puncture]] CSF analysis | *[[Lumbar puncture]] [[CSF]] analysis | ||
*CT rarely | *[[CT]] rarely | ||
| | | | ||
|- | |- | ||
Line 138: | Line 138: | ||
*[[Breathlessness]] | *[[Breathlessness]] | ||
| | | | ||
*Clinical | |||
*[[EKG]] | *[[EKG]] | ||
*Cardiac | *[[Cardiac biomarkers]] | ||
**[[Creatine kinase]] | **[[Creatine kinase]] | ||
**[[Cardiac troponin]]-I (cTnI) | **[[Cardiac troponin]]-I (cTnI) | ||
**Serum [[LDH]] , serum [[myoglobin]] and [[SGOT]] ([[AST]]) | **Serum [[LDH]] , serum [[myoglobin]] and [[SGOT]] ([[AST]]) | ||
*[[Echocardiography]] and [[Percardiocentesis]] | *[[Echocardiography]] and [[Percardiocentesis]] | ||
| [[File:Pericarditis | | [[File:Pericarditis-1.jpg|Pericarditis|400x600px]] | ||
|- | |- | ||
|[[Myocarditis]] | |[[Myocarditis]] | ||
| | | | ||
* [[Chest pain]] often described as stabbing, pleuritic or sharp in character | |||
* Swelling of the feet | |||
* [[Breathlessness]] | |||
* [[Dyspnea on exertion]] | |||
* [[Orthopnea]] | |||
* [[Palpitation]]s | |||
* [[Syncope]] in setting of high grade [[AV block]] | |||
* [[Fever]] (especially when infectious, e.g. in [[rheumatic fever]]) | |||
* [[Joint pains]] | |||
* [[Fatigue]] | |||
* [[Cyanosis]] | |||
| | | | ||
| | *Clinical | ||
*Markers of Myonecrosis | |||
**[[Creatine kinase]] (CK-MB) | |||
**[[troponin|Cardiac troponin]] I (cTnI) or T (cTnT) are elevated more frequently than CK-MB (34-53% versus 2-6 %) as reported in two series.<ref name="pmid8994432">{{cite journal| author=Smith SC, Ladenson JH, Mason JW, Jaffe AS| title=Elevations of cardiac troponin I associated with myocarditis. Experimental and clinical correlates. | journal=Circulation | year= 1997 | volume= 95 | issue= 1 | pages= 163-8 | pmid=8994432 | doi= | pmc= | url= }} </ref> | |||
**[[Lactate dehydrogenase]] (LDH) | |||
**[[Alanine transaminase]] (ALT) | |||
**[[Aspartate transaminase]] (AST) | |||
| [[File:File:Acute Rheumatic Myocarditis-1.jpg|Viral myocarditis|400px]] | |||
|- | |- | ||
|[[Pericardial effusion]] | |[[Pericardial effusion]] | ||
| | | | ||
*[[Chest pain]] | |||
*[[Dyspnea]] | |||
*Nonspecific chest discomfort | |||
| | | | ||
| | *Clinical | ||
* Thoracic [[X-ray]] showing the presence of an enlarged cardiac silhouette with clear lungs | |||
*[[CT scan]] | |||
| [[File:Pericardial_effusion-1.jpg|Pericardial effusion|400px]] | |||
|- | |- | ||
|[[Pleurodynia]] | |[[Pleurodynia]] | ||
| | | | ||
*[[Fever]] | |||
*[[Headache]] | |||
*Attacks of severe pain in the lower chest, often on one side | |||
*[[Pleuritic pain]] with the slightest movement of the [[rib cage]] | |||
*[[Dyspnea]] | |||
*Very few have classic muscle pain in the chest and upper abdomen | |||
*May be accompanied by a panic attack | |||
| | | | ||
*Clinical | |||
*[[CXR]] | |||
| | | | ||
|- | |- | ||
|[[Hepatitis]] | |[[Hepatitis]] | ||
| | | | ||
* [[Abdominal pain]] or distention | |||
* [[Gynecomastia]] | |||
* Dark urine and pale or [[clay-colored stools]] | |||
* [[Fatigue]] | |||
* [[Fever]], usually low-grade | |||
* General [[itching]] | |||
* [[Jaundice]] (yellowing of the skin or eyes) | |||
* [[Loss of appetite]] | |||
* [[Nausea]] and [[vomiting]] | |||
* [[Weight loss]] | |||
| | | | ||
* [[Liver function tests]] | |||
| | | | ||
|- | |- | ||
|[[Sjogren's syndrome]] | |[[Sjogren's syndrome]] | ||
| | | | ||
*Dry eyes | |||
*Dry mouth | |||
*[[Xerosis]] | |||
*[[Raynaud phenomenon]] and [[vasculitis]] | |||
*Joint and muscle abnormalities | |||
*[[Interstitial lung disease]] | |||
*Gastrointestinal manifestations | |||
*[[CNS]] involvement | |||
| | | | ||
| | *Clinical | ||
*[[Autoantibodies]] | |||
**Anti-Ro/SSA and anti-La/SSB antibodies | |||
**[[Anti-centromere antibodies]] | |||
| [[File:Sjogren's syndrome-1.jpg|Sjogren's syndrome|400px]] | |||
|}</small> | |}</small> | ||
{{viruses}} | {{viruses}} | ||
[[ | Coxsackie virus oral lesions must be differentiated from other mouth lesions such as oral candidiasis and aphthous ulcer | ||
=== Oral Involvement<small><small> === | |||
Oral lesions of coxackie virus infection must be differentiated from other diseases causing oral lesions such as leukoplakia and herpes simplex virus infection. | |||
{| class="wikitable" | |||
!Disease | |||
!Presentation | |||
!Risk Factors | |||
!Diagnosis | |||
!Affected Organ Systems | |||
!Important features | |||
!Picture | |||
|- | |||
! colspan="3" |Diseases predominantly affecting the oral cavity | |||
! | |||
! | |||
! | |||
! | |||
|- | |||
|[[Oral candidiasis|Oral Candidiasis]] | |||
| | |||
* [[Dysphagia]] or [[odynophagia]] | |||
* White patches on the mouth and tongue | |||
| | |||
*[[Newborn]] babies | |||
*Denture users | |||
*Poorly controlled [[diabetes]] | |||
*As a side effect of medication, most commonly having taken [[antibiotic]]s. Inhaled [[corticosteroids]] for the treatment of lung conditions (e.g, [[asthma]] or [[COPD]]) may also result in oral candidiasis which may be reduced by regularly rinsing the mouth with water after taking the medication. | |||
*People with poor [[nutrition]], specifically [[vitamin A]], [[Iron deficiency anemia|iron]] and [[Folate deficiency|folate deficiencies]]. | |||
*People with an [[immune deficiency]] (e.g. as a result of [[AIDS]]/[[HIV]] or [[chemotherapy]] treatment). | |||
*Women undergoing hormonal changes, like [[pregnancy]] or those on [[birth control pills]]. | |||
*[[Organ transplantation]] patients | |||
| | |||
* Clinical diagnosis | |||
* Confirmatory tests rarely needed | |||
|'''Localized candidiasis''' | |||
* [[Oral candidiasis|Oral]] and [[Esophageal candidiasis|esophageal candidasis]] | |||
* [[Candida vulvovaginitis]] | |||
* [[Chronic mucocutaneous candidiasis]] | |||
'''Invasive candidasis''' | |||
* [[Candidiasis|Candidaemia]] | |||
* [[Endocarditis|Candida endocarditis]] | |||
* [[Osteoarthritis|Candida osteoarticular disease]] | |||
| | |||
* [[Osteoarthritis|Oral candidiaisis is]] a benign self limiting disease unless accompanied by [[immunosuppression]]. | |||
|[[File:Human tongue infected with oral candidiasis--By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg|thumb|Tongue infected with oral candidiasis - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg|400x400px]] | |||
|- | |||
|[[Herpes simplex|Herpes simplex oral lesions]] | |||
| | |||
* [[Fever]] | |||
* [[Sore throat]] | |||
* Painful [[ulcer]]s | |||
| | |||
* Stress | |||
* Recent [[URTI]] | |||
* Female sex | |||
| | |||
* Physical examination | |||
* [[Viral culture]] | |||
* [[Tzanck smear]] | |||
| | |||
* Orofacial Infection | |||
* [[Herpes simplex anogenital infection|Anogenital Infection]] | |||
* [[Herpes simplex ocular infection|Ocular Infection]] | |||
* [[Herpes simplex encephalitis|Herpes Encephalitis]] | |||
* [[Herpes simplex neonatorum|Neonatal Herpes]] | |||
* [[Herpetic whitlow|Herpetic Whitlow]] | |||
* [[Herpes gladiatorum|Herpes Gladiatorum]] | |||
| | |||
* The symptoms of primary [[HSV]] infection generally resolve within two weeks | |||
|[[File:Herpesinfection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg|thumb|Oral herpes simplex infection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg|400x400px]] | |||
|- | |||
|[[Aphthous ulcer|Aphthous ulcers]] | |||
| | |||
* Painful, red spot or bump that develops into an open [[ulcer]] | |||
| | |||
* Being a female | |||
* Between the ages of 10-40 | |||
* Family history of [[Aphthous ulcer|aphthous ulcers]] | |||
| | |||
* Physical examination | |||
* Diagnosis of exclusion | |||
| | |||
* Oral cavity | |||
| | |||
* Self-limiting , [[Pain]] decreases in 7 to 10 days, with complete healing in 1 to 3 weeks | |||
|[[File:Afta foto - By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358.jpg|thumb|Apthous ulcer on the lower surface of the tongue - By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358|400x400px]] | |||
|- | |||
|[[Squamous cell carcinoma]] | |||
| | |||
*Non healing [[ulcer]], [[nodule]], indurated plaque or mass | |||
*May involve [[skin]], [[lips]], inside the [[mouth]], [[throat]] or [[esophagus]] | |||
| | |||
* Chronic sun or [[Ultraviolet|UV exposure]] | |||
* Fair [[skin]] | |||
* [[Elderly]] age (>45 yrs) | |||
* [[Male sex]] | |||
* [[Smoking]] | |||
| | |||
*[[Physical exam]] | |||
*[[Biopsy]] | |||
| | |||
*[[Oral Cavity]] | |||
**Floor of [[mouth]] | |||
**Lateral [[tongue]] | |||
*[[Throat]] | |||
*[[Esophagus]] | |||
| | |||
*[[Malignant]] | |||
*Can spread to [[TMJ]] | |||
*Some times associated with [[leukoplakia]] | |||
|[[File:PLoS oral cancer.png|thumb|400x400px| |Squamous cell carcinoma - By Luca Pastore, Maria Luisa Fiorella, Raffaele Fiorella, Lorenzo Lo Muzio - http://www.plosmedicine.org/article/showImageLarge.action?uri=info%3Adoi%2F10.1371%2Fjournal.pmed.0050212.g001, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=15252632]] | |||
|- | |||
|[[Leukoplakia]] | |||
| | |||
*White leathery spots on the [[mucous membranes]] of the [[tongue]] and inside of the [[mouth]] | |||
*Lateral borders of [[tongue]] | |||
| | |||
*Atypical [[Tobacco]] use | |||
*Chronic [[irritation]] | |||
*[[Immunodeficiency]] | |||
*[[Bloodroot]] ([[Sanguinarine|sanguinaria]]) | |||
| | |||
*[[Physical exam]] | |||
*Diagnosis of exclusion | |||
*[[Biopsy]] | |||
| | |||
*[[Vulva|Vulvar]] lesions occur independent of oral lesions | |||
| | |||
*Associated with [[HIV]] | |||
*Persistant white spots | |||
*[[Benign]] but can progress to [[carcinoma]] after almost 10 years | |||
*Oral proliferative [[Leukoplakia|verrucous leukoplakia]] is an aggressive sub type with multiple lesions and higher conversion to [[warts]] or [[carcinoma]]<ref>{{Cite journal | |||
| author = [[Ann M. Gillenwater]], [[Nadarajah Vigneswaran]], [[Hanadi Fatani]], [[Pierre Saintigny]] & [[Adel K. El-Naggar]] | |||
| title = Proliferative verrucous leukoplakia (PVL): a review of an elusive pathologic entity! | |||
| journal = [[Advances in anatomic pathology]] | |||
| volume = 20 | |||
| issue = 6 | |||
| pages = 416–423 | |||
| year = 2013 | |||
| month = November | |||
| doi = 10.1097/PAP.0b013e3182a92df1 | |||
| pmid = 24113312 | |||
}}</ref> | |||
|[[File:Oral hairy leukoplakia (EBV, in HIV)a.jpg|thumb|400x300px|Leukoplakia - By Aitor III - Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=9873087]] | |||
|- | |||
|[[Melanoma]] | |||
| | |||
*A lesion with [[ABCD]] | |||
**[[Asymmetry]] | |||
**Border irregularity | |||
**Color variation | |||
**[[Diamete]]r changes | |||
*[[Bleeding]] from the lesion | |||
| | |||
*[[Ultraviolet|UV radiations]] | |||
*[[Genetic predisposition]] | |||
*[[Old age]] | |||
*[[Male gender]] | |||
*Family or personal history of [[melanoma]] | |||
*Multiple benign or atypical [[Nevus|nevi]] | |||
| | |||
*[[ABCD]] characteristics | |||
*[[Bleeding]] or [[ulceration]] may show [[malignancy]] | |||
*Serum [[LDH]] may be elevated in case of [[malignancy]] | |||
*[[Biopsy]] | |||
| | |||
*Can [[metastasize]] | |||
*All [[UV radiation]] or sun exposed areas can be effected independently | |||
*1-2 to hundreds of [[granules]] | |||
| | |||
*[[Neural crest cell]] derivative | |||
*Development begins with disruption of [[nevus]] growth control | |||
*Progression involves [[MAPK/ERK pathway]] | |||
*[[RAS|N-RAS]] or [[BRAF]] [[oncogene]] also involved | |||
|[[File:Palate malign melanoma 01.jpg|thumb|400x400px|Oral melanoma - By Emmanouil K Symvoulakis, Dionysios E Kyrmizakis, Emmanouil I Drivas, Anastassios V Koutsopoulos, Stylianos G Malandrakis, Charalambos E Skoulakis and John G Bizakis - Symvoulakis et al. Head & Face Medicine 2006 2:7 doi:10.1186/1746-160X-2-7 (Open Access), [1], CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=9839811]] | |||
|- | |||
|[[Fordyce spots]] | |||
| | |||
*Rice-like [[granules]] or [[spots]] | |||
*Small, [[painless]], [[raised]], [[pale]], red or white | |||
*1 to 3 mm in [[diameter]] | |||
| | |||
*Greasy skin types | |||
*Some [[Rheumatic|rheumatic disorders]] | |||
*[[Hereditary nonpolyposis colorectal cancer]] | |||
**Lower [[gingiva]] (gums) | |||
**[[Vestibular system|Vestibular mucosa]] | |||
| | |||
*[[Physical exam]] | |||
*Small [[keratin]]-filled [[pseudocysts]] | |||
*May be seen on [[incidental]] [[mucosal]] [[biopsy]] | |||
**[[Biopsy]] not done for them primarily | |||
| | |||
*[[Oral cavity]] | |||
**[[Vermillion border|Vermilion border]] of the lips | |||
**[[Oral mucosa]] of the upper lip | |||
*[[Buccal mucosa]] in the commissural region often bilaterally | |||
*[[Genitals]] | |||
| | |||
*[[Benign neoplasms]] with [[sebaceous]] features | |||
*Visible [[sebaceous glands]] | |||
*No surrounding [[mucosal]] change | |||
*Several adjacent [[glands]] may coalesce into a larger cauliflower-like cluster | |||
|[[File:Fospot.jpg|thumb|400x400px|Fordyce spots - Por Perene - Obra do próprio, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=19772899]] | |||
|- | |||
|[[Burning mouth syndrome]] | |||
| | |||
*Burning or [[tingling]] on the [[lips]], [[tongue]], or entire [[mouth]] | |||
| | |||
*[[Nutritional deficiencies]] | |||
*Chronic [[anxiety]] or [[depression]] | |||
*[[Diabetes type 2]] | |||
*[[Menopause]] | |||
*[[Oral thrush]] or [[dry mouth]], or damaged [[nerves]] transmitting taste | |||
*[[Female gender ]] | |||
*[[Menopause]] | |||
| | |||
*[[Presentation]] | |||
*[[Physical exam]] | |||
| | |||
*[[Oral cavity]] | |||
| | |||
*Pain typically is low in the morning and builds up over the day | |||
*Low dosages of [[benzodiazepines]], [[tricyclic antidepressants]] or [[anticonvulsants]] may be effective | |||
| | |||
|- | |||
|[[Torus palatinus]] | |||
| | |||
*Bony growth on midline of the [[hard palate]] | |||
*[[Nodular]] mass covered with normal [[mucosa]] | |||
| | |||
*[[Genetic predisposition]] | |||
**[[Autosomal dominant]] | |||
| | |||
*[[Physical exam]] | |||
*Types | |||
**[[Torus palatinus|Flat tori]] | |||
**[[Torus palatinus|Spindle tori]] | |||
**[[Torus palatinus|Nodular tori]] | |||
**[[Torus palatinus|Lobular tori]] | |||
| | |||
*[[Hard palate]] | |||
| | |||
*More common in [[Asian]] and Inuit populations | |||
*Twice more common in [[females]] | |||
*Repeated [[trauma]] can cause [[bleeding]] | |||
*[[Surgery]] may be required in symptomatic | |||
|[[File:06-06-06palataltoria.jpg|thumb|Torus palatinus|400x400px|Torus palatinus - By Photo taken by dozenist, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=846591]] | |||
|- | |||
| colspan="4" |'''Diseases involving oral cavity and other organ systems''' | |||
| | |||
| | |||
| | |||
|- | |||
|[[Behçet's disease|Behcet's disease]] | |||
| | |||
*Painful [[mouth sores]] | |||
*[[Acne]] like skin lesions | |||
*Headache, [[fever]], poor [[balance]], [[disorientation]] | |||
*[[Abdominal pain]], [[diarrhea]] or [[bleeding]] | |||
*[[Uveitis]] | |||
*Joint [[swelling]] and joint [[pain]] | |||
*Genital [[sores]] wit [[pain]] and [[scaring]] | |||
*[[Aneurysms]] | |||
| | |||
*Over active [[immune system]] | |||
| | |||
*[[Physical examination]] | |||
| | |||
*[[Mouth]] | |||
*[[Genitals]] | |||
*[[GIT]] | |||
*[[Eye]] | |||
*[[Joints]] | |||
*[[Skin]] | |||
*[[Vascular system]] | |||
*[[Brain]] | |||
| | |||
*[[Outbreaks]] of exaggerated [[inflammation]] | |||
*Affects smaller [[blood vessels]] | |||
|[[File:Behcets disease.jpg|thumb|400x400px|Behcet's disease - By Ahmet Altiner MD, Rajni Mandal MD - http://dermatology.cdlib.org/1611/articles/18_2009-10-20/2.jpg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=17863021]] | |||
|- | |||
|[[Crohn's disease]] | |||
| | |||
*Chronic, episodic [[diarrhea]] or [[constipation]] | |||
*[[Abdominal pain]] | |||
*[[Vomiting]] | |||
*[[Weight loss]] or [[weight gain]] | |||
| | |||
*[[Smoking]] | |||
*[[Whites]] and [[European]] [[Jews]] | |||
*[[Hormonal contraception]] | |||
*Diets high in microparticles, sweet, fatty or refined foods | |||
*Industrialized country | |||
| | |||
*Typical [[history]] and [[symptoms]] | |||
*[[Skip lesions]] on [[biopsy]] | |||
*[[Anti saccharomyces cerevisiae antibodies|Anti-Saccharomyces cerevisiae antibodies (ASCA)]] | |||
*[[Anti-neutrophil cytoplasmic antibodies]] ([[ANCA]]) | |||
| | |||
*[[Eyes]] | |||
*[[Joints]] | |||
*[[Skin]] | |||
| | |||
*May lead to | |||
**[[Obstruction]]s | |||
**[[Abscess]]es | |||
**Free [[perforation]] | |||
**[[Hemorrhage]] | |||
| | |||
|- | |||
|[[Agranulocytosis]] | |||
| | |||
*[[Fever]] or [[chills]] | |||
*Frequent [[infections]] | |||
*Unusual [[redness]], [[pain]], or [[swelling]] around a wound | |||
*Mouth [[ulcers]] | |||
*[[Abdominal pain]] | |||
*[[Burning sensation when urinating]] | |||
*[[Sore throat]] | |||
| | |||
*[[Medications]]<ref name="PMID17142169">{{cite journal |author=Andrès E, Zimmer J, Affenberger S, Federici L, Alt M, Maloisel F. |title=Idiosyncratic drug-induced agranulocytosis: Update of an old disorder. |journal=Eur J Intern Med. |volume=17|issue=8 |pages=529-35 |year=2006|pmid 17142169|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed/17142169}}</ref> | |||
*[[List of chemotherapeutic agents#Cytotoxic Chemotherapy|Cytotoxic chemotherapy]] | |||
*[[Hematological malignancy|Hematologic malignancies]] | |||
*[[Autoimmune disorders]] | |||
| | |||
*[[Neutropenia]] <100 cells per micro litre | |||
*[[Eosinopenia]] | |||
*[[Basopenia]] | |||
| | |||
*[[Oral cavity]] | |||
*[[Skin]] | |||
*[[GIT]] | |||
*[[Urinary system]] | |||
*[[Conjunctiva]] | |||
| | |||
*[[Immunocompromised|Immunocompromization]] | |||
*Types | |||
**[[Drug-induced]] | |||
**[[Malignant]] | |||
**[[Autoimmune]] | |||
| | |||
|- | |||
|[[Syphilis]]<ref> title="By Internet Archive Book Images [No restrictions], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File:A_manual_of_syphilis_and_the_venereal_diseases%2C_(1900)_(14595882378).jpg"</ref> | |||
| | |||
*[[Chancre]] | |||
*Regional [[lymphadenopathy]] | |||
| | |||
*[[Multiple sexual partners]] | |||
*Illicit [[drug use]] | |||
*[[Unprotected sex]] | |||
*[[Homosexual men|Men who have sex with men]] | |||
*Residence in highly prevalent areas | |||
*[[Human Immunodeficiency Virus (HIV)|HIV]] infection | |||
*Presence of other [[STI]]s | |||
*Previous history of [[Sexually transmitted disease|STIs]] | |||
*[[Intravenous drug use]] | |||
| | |||
*[[Darkfield microscope|Darkfield microscopy]] | |||
*Non [[Treponema|treponemal]] tests like [[VDRL]] and [[RPR test]]) | |||
*[[Treponema|Treponemal]] tests[[FTA-ABS|FTA-ABS tests]], (TP-PA) assay, [[Enzyme linked immunosorbent assay (ELISA)|enzyme immunoassays]], and [[Chemiluminescence|chemiluminescence immunoassays]]) | |||
| | |||
*[[Oral cavity]] | |||
*[[Penis]] | |||
*[[Cervix]] | |||
*[[Labia]] | |||
*[[Anal canal]] | |||
*[[Rectum ]] | |||
*[[CNS]] | |||
*[[Cardiovascular|CVS]] | |||
| | |||
*[[Primary syphilis]] | |||
**[[Chancre]] | |||
*[[Secondary syphilis]] | |||
**[[Condyloma latum|Condylomata lata]] | |||
*[[Latent syphilis]] | |||
**[[Asymptomatic]] | |||
*[[Tertiary syphilis]] | |||
**[[Gumma|Gummas]] | |||
**[[Neurosyphilis]] | |||
|[[File:Hutchinson teeth congenital syphilis PHIL 2385.rsh.jpg|thumb|400x400px|oral syphilis - By CDC/Susan Lindsley - http://phil.cdc.gov/phil_images/20021114/34/PHIL_2385_lores.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=2134349]] | |||
|- | |||
|[[Coxsackie virus]] | |||
| | |||
*[[Fever]] | |||
*[[Sores]] in the [[mouth]] | |||
*[[Rash]] with [[blisters]] | |||
*[[Aches]] | |||
| | |||
*[[Pregnancy]] | |||
*[[immunodeficiency]] | |||
| | |||
*[[History]] and [[Physical exam]] | |||
*[[Swabbing|Throat swabs]] | |||
*Swabs from the lesion | |||
*[[Tzanck test]] | |||
| | |||
*[[Oral cavity]] | |||
*[[Skin]] | |||
| | |||
*Symptomatic treatment | |||
|[[File:Hand foot mouth disease 07a.jpg|thumb|400x400px|Coxsackie virus stomatitis - Adapted from Dermatology Atlas.<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref>]] | |||
|- | |||
|[[Chickenpox|Chicken pox]] | |||
| | |||
*[[Conjunctival]] symptoms | |||
*[[Catarrhal]] symptoms | |||
*Characteristic [[spots]] on the trunk appearing in two or three waves | |||
*[[Itching]] | |||
| | |||
*[[Pregnancy]] | |||
*[[Premature infants]] born to susceptible mothers | |||
*All [[infants]] born at less than 28 weeks [[gestation]] or who weigh =1000 grams | |||
*[[Immunocompromised]] | |||
| | |||
*[[History]] and [[physical exam]] | |||
*[[PCR]] to detect [[VZV]] in [[skin lesions]] ([[vesicles]], [[scabs]], [[Maculopapular|maculopapular lesions]]) | |||
| | |||
*[[Oral cavity]] | |||
*[[Skin]] | |||
| | |||
*[[Sodium bicarbonate]] in baths or [[antihistamines]] for [[itching]] | |||
*[[Paracetamol]] ([[acetaminophen]]) for [[fever]] | |||
*[[Prednisolone]] is [[contraindicated]] | |||
|[[File:Herpangina2016.jpg|thumb|400x400px|Chickenpox - By James Heilman, MD - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=52872565]] | |||
|- | |||
|[[Measles]] | |||
| | |||
*[[Fever]] | |||
*[[Rash]] | |||
*[[Cough]] | |||
*[[Coryza]] (runny nose) | |||
*[[Conjunctivitis]] (pink eye) | |||
*[[Malaise]] | |||
*[[Koplick spots]] in mouth | |||
| | |||
*Unvaccinated individuals<ref name="pmid11135778">{{cite journal| author=Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE| title=Individual and community risks of measles and pertussis associated with personal exemptions to immunization. | journal=JAMA | year= 2000 | volume= 284 | issue= 24 | pages= 3145-50 | pmid=11135778 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11135778 }} </ref><ref name="pmid9009400">{{cite journal| author=Ratnam S, West R, Gadag V, Williams B, Oates E| title=Immunity against measles in school-aged children: implications for measles revaccination strategies. | journal=Can J Public Health | year= 1996 | volume= 87 | issue= 6 | pages= 407-10 | pmid=9009400 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9009400 }} </ref> | |||
*Crowded and/or unsanitary conditions | |||
*Traveling to less developed and developing countries | |||
*Immunocompromized | |||
*Winter and [[spring]] seasons | |||
*Born after 1956 and never fully vaccinated | |||
*Health care workers | |||
| | |||
*[[History]] and [[examination]] | |||
*[[PCR]] for [[Measles]]-specific [[IgM|IgM antibody]] | |||
*[[PCR]] for [[Measles]] [[RNA]] | |||
| | |||
*[[Oral cavity]] | |||
*[[Skin]] | |||
*[[Respiratory tract]] | |||
*[[Eyes]] | |||
*[[Throat]] | |||
| | |||
*Caused by [[Morbillivirus]] | |||
*Primary site of infection is the [[respiratory epithelium]] of the [[nasopharynx]] | |||
*Transmitted in [[respiratory secretions]], via [[aerosol droplets]] containing [[Virus|virus particles]] | |||
|[[File:Koplik spots, measles 6111 lores.jpg|thumb|400x400px|Koplick spots (Measles) - By CDC - http://phil.cdc.gov/PHIL_Images/20040908/4f54ee8f0e5f49f58aaa30c1bc6413ba/6111_lores.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=824483]] | |||
|} | |||
[[Category:Emergency medicine]] | |||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Otolaryngology]] | |||
[[Category:Dermatology]] | |||
[[Category:Cardiology]] | |||
[[Category:Ophthalmology]] | |||
[[Category:Pulmonology]] |
Latest revision as of 21:09, 29 July 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]
Coxsackie Virus |
Overview
Coxsackie (virus) is a cytolytic virus of the picornaviridae family, an enterovirus (a group containing the polioviruses, coxsackieviruses, and echoviruses). There are 61 non-polio enteroviruses that can cause disease in humans, of which 23 are coxsackie A viruses (6 are Coxsackie B viruses). Enterovirus are the second most common viral infectious agents in humans (after the rhinoviruses)
Classification
Coxsackie viruses consist of coxsackie A virus and coxsackie B virus. Coxsackie B virus has 6 serotypes, one of the significant serotypes is called coxsackie B4 virus.
Coxsackie Virus | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Coxsackie A virus | Coxsackie B virus[1] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Common Coxsackie B virus diseases | Coxsackie B4 virus diseases | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
• Hand, foot and mouth disease • Acute hemorrhagic conjunctivitis • Herpangina • Aseptic meningitis | • Pericarditis • Myocarditis • Pericardial effusion • Pleurodynia • Hepatitis • Sjogren's syndorme | • Diabetes mellitus • Acute flaccid myelitis[2] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Differential Diagnosis
Coxsackie A virus and coxsackie B virus can cause multiple diseases in humans. The wide array of diseases caused by coxsackie viruses can be differentiated from one another easily on the basis of involvement of the organs systems, clinical presentation and diagnostic techniques.
Virus Type | Disease | Clinical Features | Diagnosis | Image |
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Coxscakie A virus | Hand foot and mouth disease |
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Acute hemorrhagic conjunctivitis |
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Herpangina |
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Aseptic Meningitis |
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Coxsackie B virus | Pericarditis |
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Myocarditis |
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Viral myocarditis | |
Pericardial effusion |
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Pleurodynia |
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Hepatitis |
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Sjogren's syndrome |
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Template:Baltimore classification Template:Viral diseases
Coxsackie virus oral lesions must be differentiated from other mouth lesions such as oral candidiasis and aphthous ulcer
Oral Involvement
Oral lesions of coxackie virus infection must be differentiated from other diseases causing oral lesions such as leukoplakia and herpes simplex virus infection.
Disease | Presentation | Risk Factors | Diagnosis | Affected Organ Systems | Important features | Picture |
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Diseases predominantly affecting the oral cavity | ||||||
Oral Candidiasis |
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Localized candidiasis
Invasive candidasis |
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Herpes simplex oral lesions |
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Aphthous ulcers |
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Squamous cell carcinoma |
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Leukoplakia |
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Melanoma |
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Fordyce spots |
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Burning mouth syndrome |
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Torus palatinus |
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Diseases involving oral cavity and other organ systems | ||||||
Behcet's disease |
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Crohn's disease |
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Agranulocytosis |
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Syphilis[6] |
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Coxsackie virus |
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Chicken pox |
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Measles |
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- ↑ Fields, Bernard N. (1985). Fields Virology. New York: Raven Press. pp. 739–794. ISBN 0-88167-026-X. Unknown parameter
|coauthors=
ignored (help) - ↑ Cho SM, MacDonald S, Frontera JA (2017). "Coxsackie B3/B4-Related Acute Flaccid Myelitis". Neurocrit Care. doi:10.1007/s12028-017-0377-8. PMID 28324262.
- ↑ Smith SC, Ladenson JH, Mason JW, Jaffe AS (1997). "Elevations of cardiac troponin I associated with myocarditis. Experimental and clinical correlates". Circulation. 95 (1): 163–8. PMID 8994432.
- ↑ Ann M. Gillenwater, Nadarajah Vigneswaran, Hanadi Fatani, Pierre Saintigny & Adel K. El-Naggar (2013). "Proliferative verrucous leukoplakia (PVL): a review of an elusive pathologic entity!". Advances in anatomic pathology. 20 (6): 416–423. doi:10.1097/PAP.0b013e3182a92df1. PMID 24113312. Unknown parameter
|month=
ignored (help) - ↑ Andrès E, Zimmer J, Affenberger S, Federici L, Alt M, Maloisel F. (2006). "Idiosyncratic drug-induced agranulocytosis: Update of an old disorder". Eur J Intern Med. 17 (8): 529–35. Text "pmid 17142169" ignored (help)
- ↑ title="By Internet Archive Book Images [No restrictions], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File:A_manual_of_syphilis_and_the_venereal_diseases%2C_(1900)_(14595882378).jpg"
- ↑ "Dermatology Atlas".
- ↑ Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE (2000). "Individual and community risks of measles and pertussis associated with personal exemptions to immunization". JAMA. 284 (24): 3145–50. PMID 11135778.
- ↑ Ratnam S, West R, Gadag V, Williams B, Oates E (1996). "Immunity against measles in school-aged children: implications for measles revaccination strategies". Can J Public Health. 87 (6): 407–10. PMID 9009400.