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Learn More About The 7 Most Common Sore Throat Ailments

Coxsackie Virus

Coxsackie Virus (Hand-Foot-Mouth Disease)

Coxsackie pharyngitis causes sore throat, and may be accompanied by high fevers, rash, vomiting, and diarrhea. Hand-Foot-Mouth Disease causes mouth and throat pain, fever and small tender lesions on the palms of the hands and the soles of the feet.


Figure 1-2. Shows the vesicles and redness on the anterior pillars of the soft palate.

Figure 2.

Figure 3. The same vesicles and redness on the anterior pillars of the soft palate and also on the posterior pharngeal wall (back of throat).

Find links to the other common sore throat ailments in our Sore Throat Guide at the bottom of the page.

Normal Throat 

Coxsackie Virus

A Normal Throat is pink rather than fire-engine red, and has no sores or ulcers. Size of tonsils will vary, but the tonsils will not be a very different color from the surrounding throat tissue.

Coxsackie Virus often has small blisters on the anterior pillars of the tonsil (a.), the pharynx (b.), and the soft palate (c.). The tonsils may look almost normal (d.).

Coxsackie virus infections cause a number of different clinical patterns in children. Several patterns may cause sore throat, and they include Coxsackie pharyngitis (Herpangina) and Hand-Foot-Mouth Disease. Both of these disease patterns occur mostly in younger children, and mostly in warm weather months.

The coxsackie virus is spread by fecal-oral transmission. The virus is shed in the stools of infected children. Inadequate hand washing by children or caregivers who change diapers increases the transmission of the virus. The virus then gains entry into the next patient by oral ingestion into the gastrointestinal tract. Swimming pools have been thought to be a significant factor in spread of this virus. The saliva and blister fluid may also transmit illness.


Coxsackie pharyngitis (Herpangina) causes small vesicles on the anterior pillars of the tonsils and soft palate that may break open and become shallow sores. Hand-Foot-Mouth Syndrome has the same vesicles on the pillars and soft palate, as well as the buccal mucosa (soft tissue on the inside of the cheeks) and the tongue, but also has the small vesicles on the palms and soles.


The most common complication of the Coxsackie throat and mouth infections may be dehydration in infants and children who will not drink due to pain. The high fevers may also cause febrile seizures in infants and toddlers.


No specific treatment exists. Supportive treatment involves both systemic pain and fever control (Acetaminophen or Ibuprofen). Topical pain relief by gargling with equal parts of Maalox and Diphenhydramine (Benadryl) may be beneficial in some patients. Adequate hydration may at times require IV fluids. Topical viscous Xylocaine should be avoided in young children due to toxicity from absorption.