Why would EPA lie in 1989, and today, by claiming  Coxackieviruses cause no disease?

8.    Coxsackieviruses -----------------------------------

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 them
23 are Coxsackie A viruses (6 are Coxsackie B viruses). Enterovirus are the second most common viral infectious
agents in humans (after the rhinoviruses)

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 haemorrhagic conjunctivitis (A24 specifically), herpangina, and aseptic meningitis (both
Coxsackie A and B viruses). Coxsackie B viruses also cause infectious myocarditis, infectious pericarditis, and

Enterovirus 71 (EV71) is a common cause of
hand, foot, and mouth disease and sometimes causes severe
neurologic complications, mainly in children. We report a case of adult-onset encephalitis caused by intrafamilial
transmission of a subgenogroup C4 strain of EV71. This case elucidates the risk for EV71 encephalitis even in adults.

In children, enterovirus 71 (EV71) is a common cause of hand, foot, and mouth disease (HFMD), and most patients
recover within 4–6 days. However, severe neurologic complications, such as acute encephalitis and poliolike paralysis,
develop in some patients with EV71 infection. In the largest and most severe EV71-associated HFMD outbreak
occurring in Taiwan in 1998, 405 children had severe neurologic complications, pulmonary edema, or both; 78 children
died (1). In adults, transmission of EV71 within households is common, but EV71 infection is commonly limited to mild
illness, and neurologic complications are uncommon in adults (2–4). We report a case of acute EV71 encephalitis in a
mother and cases of HFMD in her 3 sons due to intrafamilial transmission of EV71.

minor flu-like illness without jaundice, may lead to profound anorexia, malaise, nausea and vomiting, and, often, fever or
right upper quadrant abdominal pain. Urticaria and arthralgias occasionally occur, urine darkens, followed by jaundice
(the icteric phase), liver is usually enlarged and tender, but the edge of the liver remains soft and smooth. Mild
splenomegaly occurs in 15 to 20% of patients. liver diseases, from a subclinical carrier state to severe or fulminant
acute hepatitis, particularly in the elderly, in whom mortality can reach 10 to 15%. Hepatocellular carcinoma can
ultimately develop in chronic HBV [Hepatitis B] infection, even without being preceded by cirrhosis. chronic hepatitis is
usually asymptomatic or benign but progresses to cirrhosis in 20 to 30% of patients; cirrhosis often takes decades to
appear. Hepatocellular carcinoma can result from HCV [Hepatitis C] -induced cirrhosis.  (Merck)
Myocarditis: an expected health hazard associated with water resources contaminated with Coxsackie viruses type B
Authors: Ma Ali a; Tmk Abdel-Dayem b
Affiliations:    a Environmental Virology Laboratory, Department of Water Pollution Researches National Research
Centre 12311 Dokki, Cairo Egypt.
b Department of Cardiology, Faculty of Medicine Ain Shams University Cairo Egypt.

DOI: 10.1080/0960312031000122415
Publication Frequency: 6 issues per year
Published in:  International Journal of Environmental Health Research, Volume 13, Issue 3 September 2003 , pages 261
- 270

Enteroviruses, especially Coxsackie B viruses (CBVs), are responsible for approximately 50% of cases of viral
myocarditis. In the present study, serum samples (160) were collected from acute myocarditis patients at different age
groups and 104 samples of the same age groups as a control. Cholesterol, LDH, CPK, and GOT were measured for all
serum samples (264). Also, to study the source of virus transmission, 72 water and 72 wastewater samples were
collected from water and wastewater treatment plants at intakes and outlets. Water and wastewater samples were
concentrated by filtration through Zeta-plus filter cartridges and reconcentrated by the PEG-6000 precipitation method.
Serum, water, and wastewater samples were inoculated in BGM cells for three successive passages. RT - PCR with
enterovirus primers was carried out directly for serum samples and for 1st and 3rd cell culture passages. The positive
samples were used for neutralization assay using anti-CBV sera pool to determine the CBV followed by neutralization
with separate antisera. The results showed that 50 (31.25%) serum samples from acute myocarditis patients and two
(1.4%) samples from the controls were positive for enterovirus RT - PCR. For water and wastewater samples
enteroviruses were present in 63.8% and 8.3% for intake and outlet of water treatment plants and, 66.6% and 47.2% for
intake and outlet of wastewater treatment plants, respectively. The level of CBV serotypes was varied where CBV3 was
dominant for all age groups of myocarditis patients and CBV2 and CBV5 were also detected while CBV2 was the main
CBV in water samples and CBV2, 3 and 5 were detected in wastewater samples. The integration of cell culture-PCR
reduces the time required for virus detection and enhances the sensitivity of the test.  
Keywords: Myocarditis; Myocardial Infarction; Water; Wastewater; Coxsackie B Viruses