to surround the genome and proteins, at which point the procapsid attaches to the exterior of the vesicle and encapsidates the genome and proteins. It is at this point that VP0 gets cleaved by a cellular proteinase and the virus finally becomes fully mature and infectious. Since CB4 is a non-enveloped virus, it accomplishes egress through cytolysis, breaking through the plasma membrane in order to move on to infect other cells in the host (Hunt, 2010) Symptoms Coxsackie B 1–4 viruses are typically the most severe and fatal neonatal diseases. Common symptoms can include myocarditis, meningoencephalitis, and hepatitis. Other less severe symptoms can include pneumonia, Gastrointestinal symptoms, pancreatitis, and seizures. Patients with Coxsackie B4 virus have seemed to have herpangina, tonsillitis, and pharyngitis. CB4 virus has caused transplacental infections in mice. Infection in the first couple weeks of gestation has been shown to be harmful for dams as well as the fetus, causing reduced litter sizes, abortion, or stillbirth. Pups that were born from dams infected on days 4 and 17 of gestation had significantly (p < 0.05) greater pancreatic abnormalities leading to symptoms similar to diabetes. Coxsackie B4 virus and type 1 diabetes One theory proposes that type 1 diabetes is a virus-triggered autoimmune response in which the immune system attacks virus-infected cells along with the beta cells in the pancreas, but to date there is no stringent evidence to support this hypothesis in humans. A 2004 systematic review analyzing a possible association between coxsackievirus B infection and type 1 diabetes was inconclusive. A 2011 systematic review and meta-analysis showed an association between enterovirus infections and type 1 diabetes, but in contrast, other studies have shown that rather than triggering an autoimmune process, enterovirus infections, as coxsackievirus B, could protect against onset and development of type 1 diabetes. Transmission to neonates Enteroviruses commonly infect neonates and infants younger than 12 months. Coxsackie b viruses are usually spread to infants through perinatal transmission. However, more severe cases of coxsackie B viruses are spread through transplacental transmission. Common symptoms of neonatal coxsackie B virus infection in children include meningitis and/or encephalitis. Coxsackie B4 virus is able to infect the brain and spinal cord and cause inflammation. Diagnosis Infection due to Coxsackie B viruses can be determined by measuring the amount of neutralizing antibodies in the blood, PCR, and through microscopic detection. It is difficult to diagnose CBV based on the symptoms.