Coxsackie A virus
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# 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).

# Historical Perspective
The coxsackie viruses were discovered in 1948-49 by Gilbert Dalldorf, a scientist working at the New York State Department of Health in Albany, New York. 
Dr. Dalldorf, in collaboration with Grace Sickles, had been searching for a cure for the dreaded disease polio. Earlier, Dalldorf had worked on monkeys suggesting that fluid collected from a non-polio virus preparation could protect against the crippling effects of polio. Using newborn mice as a vehicle, Dalldorf attempted to isolate such protective viruses from the feces of polio patients. In carrying out these experiments, he discovered viruses that often mimicked mild or nonparalytic polio. The virus family he discovered was eventually given the name coxsackie, for the town of Coxsackie, New York, a small town on the Hudson River where Dalldorf had obtained the first fecal specimens.
The Coxsackie viruses subsequently were found to cause a variety of infections, including epidemic pleurodynia (Bornholm disease), and were subdivided into groups A and B based on their pathology in newborn mice. (Coxsackie A virus causes paralysis and death of the mice, with extensive skeletal muscle necrosis; Coxsackie B causes less severe infection in the mice, but with damage to more organ systems, such as heart, brain, liver, pancreas, and skeletal muscles.)
The use of suckling mice was not Dalldorf's idea, but was brought to his attention in a paper written by Danish scientists Orskov and Andersen in 1947, who were using such mice to study a mouse virus. The discovery of the Coxsackie viruses stimulated many virologists to use this system and ultimately resulted in the isolation of a large number of so-called enteric viruses from the gastrointestinal tract that were unrelated to poliovirus, and some of which were oncogenic (cancer-causing).
The discovery of the Coxsackie viruses yielded further evidence that viruses can sometimes interfere with each other's growth and replication within a host animal.  Other researchers found that this interference can be mediated by a substance produced by the host animal, a protein now known as interferon.  Interferon has since become prominent in the treatment of a variety of cancers and infectious diseases.
Lately, in the media, there have been many cases of children dying in third world countries from Hand Foot and Mouth disease. Even in the US there have been cases of children dying from this.
Selected papers:
- 1948 An unidentified, filtrable agent isolated from the feces of children with paralysis. Science 108:61-62.
- 1949 A virus recovered from the feces of "poliomyelitis" patients pathogenic for suckling mice. J. Exp. Med. 89:567-82.  With G. M. Sickles. Serologic differences among strains of the Coxsackie group of viruses. Proc. Soc. Exp. Biol. Med. 72:30-31.  The Coxsackie group of viruses. Science 110:594.
- 1951 With R. Gifford. Clinical and epidemiologic observations of Coxsackie virus infection. N. Engl. J. Med. 244:868-73.  The sparing effect of Coxsackie virus infection on experimental poliomyelitis. J. Exp. Med. 94:65-71.
- 1952 With R. Gifford. Adaptation of group B Coxsackie virus to adult mouse pancreas. J. Exp. Med. 96:491-97.
- 1954 With R. Gifford. Susceptibility of gravid mice to Coxsackie virus infection. J. Exp. Med. 99:21-27.
- 1955 With R. Gifford. The recognition of mouse ectromelia. Proc. Soc. Exp. Biol. Med. 88:290-92.  With R. Albrecht. Chronologic association of poliomyelitis and Coxsackie virus infections. Proc. Natl. Acad. Sci. USA 41:978-82.
- 1956 With S. Kelly. Antigenic potency of poliovirus vaccines. Am. J. Hyg. 64:243-58.
- 1957 The neuropathogenicity of group A Coxsackie viruses. J. Exp. Med. 106:69-76.

# Diseases
The most well known Coxsackie A disease is hand, foot and mouth disease (unrelated to foot and mouth disease), a common childhood illness, often produced by Coxsackie A16. In most cases infection is asymptomatic or causes only mild symptoms. In others, infection produces short-lived (7-10 days) fever and painful blisters in the mouth (a condition known as herpangina), on the palms and fingers of the hand, or on the soles of the feet. There can also be blisters in the throat, or on or above the tonsils. Adults can also be affected. The rash, which can appear several days after high temperature and painful sore throat, can be itchy and painful, especially on the hands/fingers and bottom of feet.
Other diseases include acute hemorrhagic conjunctivitis (A24 specifically), herpangina, and aseptic meningitis (both Coxsackie A and B viruses).
Coxsackie B viruses also cause infectious myocarditis, infectious pericarditis, and pleurodynia.

# Differentiating Coxsackie A virus disease from other diseases
Different rash-like conditions can be confused with Coxsackie A virus and are thus included in its differential diagnosis. The various conditions that should be differentiated from Coxsackie A virus include:

# Treatment
Treatment is dependent on the disease process initiated by the virus.

# Related Chapters
- Bornholm disease
- Coxsackie B
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