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A Journal on Internal Medicine and Pharmacology

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Gazzetta Medica Italiana Archivio per le Scienze Mediche 2003 October;162(5):127-8

language: Italian

Coxackievirus B hepatitis. A clinical case

Pellicanò S. 1, Calzone R. 2, Bertuccio A. 2, Rizza R. 2, Rombolà F. 2, Del Giudice A. C. 2, Bertuccio S. N. 2

1 Ospedale «S. Giovanni di Dio», Crotone;
2 U.O. Malattie Infettive, Ospedale Civile «G. Iazzolino», Vibo Valentia


A case of hepatitis due to Coxsackievirus is described. The symptomatology caused by this virus is extremely polymorphic such as: vesicular pharyngitis, Bornholm’s disease, myocarditis, meningitis, meningoencephalitis and rarely eanthema, hand foot and mouth disease, respiratory syndromes, acute benign pericarditis, orchitis and hepatitis. The virus is eliminated with faeces and nosepharyngeal secretion. Transmission in man may be direct (oral way) or indirect with vehicle (foods, water) or with vectors (insects, flies, mosquitoes). Early infancy is especially interested since Coxsackievirus B hepatitis may be fatal, characterized by fulminant form (a premature neonate with severe Coxsackie BI hepatitis developed disseminated intravascular coagulation and didn’t respond to conventional treatment). The pathophysiology of chronic hepatitis in rabbits infected with Coxsackie B5 was investigated. No hepatocyte autoantibodies were detected and there was no elevation of intrahepatic cytokine levels compared to uninfected controls. Thus, CVB5 causes a chronic hepatitis in rabbits with virus limited to hepatocyte cytoplasm and no evidence of autoimmunity. Hepatitis was produced by Coxsackievirus B4, an agent highly infectious to man, in 3 of 9 experimentally infected monkeys. Viral antigen was found in the liver cells of a monkey and a virus particle in the kidney. These observations and previous studies strongly suggest that the Cosackievirus can exist in the liver and other tissues in a dormient or slow viral state. Stress is laid on the rarity of the clinical picture.

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