Coxsackie virus

• Brief prodrome with Fever, malaise, upper respiratory infection, lymphadenopathy
• Common:
  • Herpangina: painful oral vesicles with erythematous base which then ulcerate
    • Vesicles located in anterior oral cavity (most common on tongue and buccal mucosa)
  • Hand-foot-and-mouth disease: herpangina + red papules that become gray vesicles on hands and/or feet
• Less common:
  • Parotitis
  • Orchitis
  • Acute pericarditis
  • Myocarditis
  • Meningitis, encephalitis
  • Some children get a desquamation of the nails around 2 weeks afterwards (self resolves)

• Clinical diagnosis, based on history and physical examination
  • If unsure, see Pediatric Fever

• No specific therapy for most; self-limited
• NSAIDS and cool liquids for pain
• Encourage good hand hygiene to prevent spread
• Some recommend Magic Mouthwash/oral lidocaine if not tolerating PO intake, although evidence suggests no better than placebo[1]

In infants, do NOT use oral lidocaine due to risk of lidocaine toxicity and FDA black box warning[2][3]

• Discharge with close outpatient followup to ensure adequate PO intake.

• Pediatric fever
• Hand-foot-and-mouth disease
• Herpangina
• Enteroviral Infections
• Pediatric Rashes