Coxsackie virus is a member of the Enterovirus family of viruses, named after the town of Coxsackie in New York, where the virus was first identified in 1948. Although acute Coxsackie infection is common and typically self-limiting, chronic Coxsackie infection, while less prevalent, can pose significant health challenges. This article delves into the intricate dynamics of chronic Coxsackie infection, including its pathology, clinical manifestations, diagnosis, and treatment options.


Coxsackie viruses are divided into two types, Coxsackie A and B, both of which have several serotypes. Coxsackie B is more commonly associated with chronic infections, potentially leading to conditions like myocarditis, dilated cardiomyopathy, or chronic fatigue syndrome.

The virus primarily infects the epithelial cells in the respiratory and gastrointestinal tracts. However, in chronic conditions, the virus can escape the primary site of infection and infiltrate other tissues, notably the heart, pancreas, and central nervous system. Despite the immune system’s efforts to neutralize the virus, chronic Coxsackie infection persists, often due to viral genome integration into the host cell or the virus’s ability to resist or evade the immune response.

Clinical Manifestations

Chronic Coxsackie infection may present a variety of symptoms, depending upon the affected tissues and the individual’s immune response. The most common manifestations include:

  1. Chronic Myocarditis and Dilated Cardiomyopathy: Persistent Coxsackie B infection can lead to inflammation of the heart muscles and a resultant decrease in cardiac function over time. Symptoms may include fatigue, shortness of breath, and palpitations.
  2. Chronic Fatigue Syndrome (CFS): A subset of individuals with CFS have been found to harbor chronic Coxsackie infection. Symptoms include severe and persistent fatigue, joint and muscle pain, and cognitive difficulties.
  3. Type 1 Diabetes: Studies have suggested a correlation between Coxsackie B infection and the onset of Type 1 Diabetes, with the virus potentially triggering an autoimmune response against pancreatic islet cells.


Diagnosing chronic Coxsackie infection can be challenging due to the nonspecific nature of symptoms and the lack of definitive diagnostic markers. Serological tests, assessing antibodies against the virus, are common but can fail to distinguish between past and ongoing infection.

PCR-based methods detecting viral RNA in blood, tissues, or cerebrospinal fluid offer higher specificity. Recently, the advent of high-throughput sequencing techniques has provided additional tools for detecting persistent infection, although these techniques are still largely restricted to research settings.

Treatment and Management

There is currently no specific antiviral therapy approved for Coxsackie virus. Management of chronic Coxsackie infection, therefore, centers on symptom alleviation and supportive care.

For chronic myocarditis and dilated cardiomyopathy, treatment typically involves medications to improve cardiac function, including ACE inhibitors, beta-blockers, and diuretics. In severe cases, devices such as ventricular assist devices or procedures like heart transplantation may be necessary.

Chronic fatigue syndrome management includes cognitive-behavioral therapy, graded exercise therapy, and symptom-specific pharmacological interventions. For Type 1 diabetes, insulin therapy is essential.

Experimental antiviral drugs like pleconaril and vaccines against Coxsackie B viruses are under investigation but have not yet been approved for general use.


Chronic Coxsackie infection, while not as common as its acute counterpart, can have severe health implications. As our understanding of the virus continues to evolve, it is hoped that new diagnostic methods and therapeutic strategies can be developed to more effectively manage and treat this condition. Further research into the virus’s pathophysiology, coupled with advancements in medical technology, holds the key to unraveling the mysteries of chronic Coxsackie infection.