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Infectious Disease And Microbiology – Epidemic Pleurodynia (Bornholm Disease)
Epidemic pleurodynia is an acute febrile illness characterized by the sudden onset of severe chest or abdominal pain accompanied by muscle spasms. It is also known as epidemic myalgia or Bornholm disease, named after a Danish island where outbreaks were first described, and is sometimes referred to as “devil’s grip” due to the intensity of pain.
This condition typically occurs in outbreaks, often affecting multiple members of the same household or community either simultaneously or over several days. It is most commonly caused by enteroviruses, particularly coxsackievirus group B, though coxsackievirus A and echoviruses can also be responsible. The disease is more prevalent during late summer and early autumn, coinciding with peak enteroviral transmission. Close contact in settings such as sports fields, locker rooms, or shared drinking containers facilitates person-to-person spread. Children tend to experience milder illness than adults, though infections can also occur in neonates. Intense physical exertion during the incubation period may lead to more severe symptoms.
Prevention focuses on limiting transmission through good hygiene practices. Avoiding shared oral contact, using individual drinking containers, and preventing contamination of shared items such as ice chests are important measures. Education of students, athletes, and staff in group settings can help reduce outbreaks.
The pathophysiology is thought to involve direct viral invasion of skeletal muscles of the thoracic and abdominal wall, leading to inflammation and pain. The most common etiologic agent is coxsackievirus B, although several echoviruses and coxsackievirus A strains have also been implicated.
Clinically, the illness begins abruptly without a prodrome, with fever and severe, intermittent spasms of pleuritic chest or upper abdominal pain. Fever typically rises quickly to 38–39.5°C and subsides as the pain resolves. The pain is sharp, stabbing, and often described as knifelike, lasting 15–30 minutes per episode and associated with sweating and rapid breathing. In adults, chest pain predominates, while children more commonly present with abdominal pain, sometimes mimicking acute surgical conditions. Muscle tenderness is usually present, and a pleural rub may occasionally be heard. The illness generally lasts 4–6 days, although duration may vary.
On physical examination, pain can typically be reproduced by palpation of the affected muscles, and in some cases, localized swelling may be noted. Laboratory findings are usually nonspecific, with a normal white blood cell count. Virologic confirmation can be achieved by isolating the virus from throat swabs or stool samples, or by demonstrating rising antibody titers. Chest imaging is typically normal, although small pleural effusions may rarely be seen.
The differential diagnosis is broad and includes pneumonia, pulmonary embolism, myocardial ischemia, pulmonary infarction, herpes zoster, and causes of acute abdominal pain such as appendicitis or renal colic. Because of its dramatic presentation, careful evaluation is needed to exclude these more serious conditions.
Treatment is primarily supportive. Nonsteroidal anti-inflammatory drugs are the mainstay for pain relief, and application of heat to the affected muscles can provide additional comfort. In severe cases, opiate analgesics may be required. General supportive care is usually sufficient, and no specific antiviral therapy is indicated.
The prognosis is excellent. The illness is self-limited, typically resolving within 4–7 days, and is rarely fatal. Recurrences can occur but are uncommon. Complications are rare but may include aseptic meningitis or orchitis in a small percentage of cases, while pericarditis and pneumonia are even less frequently observed.
Epidemic pleurodynia is an acute febrile illness characterized by the sudden onset of severe chest or abdominal pain accompanied by muscle spasms. It is also known as epidemic myalgia or Bornholm disease, named after a Danish island where outbreaks were first described, and is sometimes referred to as “devil’s grip” due to the intensity of pain.
This condition typically occurs in outbreaks, often affecting multiple members of the same household or community either simultaneously or over several days. It is most commonly caused by enteroviruses, particularly coxsackievirus group B, though coxsackievirus A and echoviruses can also be responsible. The disease is more prevalent during late summer and early autumn, coinciding with peak enteroviral transmission. Close contact in settings such as sports fields, locker rooms, or shared drinking containers facilitates person-to-person spread. Children tend to experience milder illness than adults, though infections can also occur in neonates. Intense physical exertion during the incubation period may lead to more severe symptoms.
Prevention focuses on limiting transmission through good hygiene practices. Avoiding shared oral contact, using individual drinking containers, and preventing contamination of shared items such as ice chests are important measures. Education of students, athletes, and staff in group settings can help reduce outbreaks.
The pathophysiology is thought to involve direct viral invasion of skeletal muscles of the thoracic and abdominal wall, leading to inflammation and pain. The most common etiologic agent is coxsackievirus B, although several echoviruses and coxsackievirus A strains have also been implicated.
Clinically, the illness begins abruptly without a prodrome, with fever and severe, intermittent spasms of pleuritic chest or upper abdominal pain. Fever typically rises quickly to 38–39.5°C and subsides as the pain resolves. The pain is sharp, stabbing, and often described as knifelike, lasting 15–30 minutes per episode and associated with sweating and rapid breathing. In adults, chest pain predominates, while children more commonly present with abdominal pain, sometimes mimicking acute surgical conditions. Muscle tenderness is usually present, and a pleural rub may occasionally be heard. The illness generally lasts 4–6 days, although duration may vary.
On physical examination, pain can typically be reproduced by palpation of the affected muscles, and in some cases, localized swelling may be noted. Laboratory findings are usually nonspecific, with a normal white blood cell count. Virologic confirmation can be achieved by isolating the virus from throat swabs or stool samples, or by demonstrating rising antibody titers. Chest imaging is typically normal, although small pleural effusions may rarely be seen.
The differential diagnosis is broad and includes pneumonia, pulmonary embolism, myocardial ischemia, pulmonary infarction, herpes zoster, and causes of acute abdominal pain such as appendicitis or renal colic. Because of its dramatic presentation, careful evaluation is needed to exclude these more serious conditions.
Treatment is primarily supportive. Nonsteroidal anti-inflammatory drugs are the mainstay for pain relief, and application of heat to the affected muscles can provide additional comfort. In severe cases, opiate analgesics may be required. General supportive care is usually sufficient, and no specific antiviral therapy is indicated.
The prognosis is excellent. The illness is self-limited, typically resolving within 4–7 days, and is rarely fatal. Recurrences can occur but are uncommon. Complications are rare but may include aseptic meningitis or orchitis in a small percentage of cases, while pericarditis and pneumonia are even less frequently observed.
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