Bornholm disease overview
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Arooj Naz
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Overview
Bornholm disease or epidemic pleurodynia or epidemic myalgia[1] is a disease caused by the Coxsackie B virus or other viruses[2]. The lining around the lungs is called the pleura. Pleurodynia is a general term for pain from this lining, pain in the chest or upper abdomen when the patient breathes. Epidemic pleurodynia is an infection caused by one of several viruses. This type of infection can cause a similar type of pain as the pain that comes from the lining around the lungs. However, in epidemic pleurodynia, the pain comes from the muscles in the chest that join ribs together. Up until 1949, the underlying cause of the disease was undetermined.
Historical Perspective
Bornholm disease is named after the Danish island Bornholm where early cases occurred. Some notable outbreaks include those that occurred in Ohio (1936), Oxford (1951), Toronto (1958), and Singapore (1974). It is interesting to note that although the epidemics occurred individual of one another and were disperesed over time and geographical location, the disease pattern and seasonal factors were found to be similar in many cases.
Pathophysiology
Bornholm disease is a disease caused by one of the group B coxsackie viruses and is less often caused by a group A coxsackie virus or an echovirus, causing pain in the muscles of the chest that join ribs together.
Causes
Bornholm disease is often due to either the Coxsackie virus or echovirus. The most prevalent strains include Coxsackievirus B, especially B3 and B4, and Coxsackievirus A, including types 4, 6, 9 and 10. Echovirus types 1, 6, 8, 9 and 19 have also been implicated in some cases. Generally, Coxsackievirus B virus is more prevalent in regards to respiratory complaints compared to Coxsackievirus A strains. The clinical spectrum varies depending on age groups for the Coxsackievirus A and B strains of the virus. Although severe progression of the disease is rare, it has been associated in particular with the Coxsackievirus B3 virus.
Differential Diagnosis
Bornholm Disease has been referred to by various different names, some of which include Devil's Grip, epidemic pleurodynia and epidemic myalgia, to name a few. Apart from the plethora of names presenting possible difficulty in its recognition, it is often a diagnosis that is not part of the initial differential diagnosis' when a patient presents with chest pain. Because of the possibility of life-threatening conditions presenting with similar pain, it often requires extensive workup to exclude other diseases in medical settings. Conditions that should be rules out include Acute Coronary syndromes (ACS), Aortic dissection/ Ruptured aortic aneurysm, Pulmonary embolism, Tension pneumothorax, Pneumonia, Pleurisy/ Pleuritis, Acute appendicitis, Pancreatitis, Cholecystitis, Costochondritis, and Guillain-Barré Syndrome.
Epidemiology and Demographics
Up to 90% of epidemics occur in the summer and early fall. The illness most commonly strikes people younger than age 30, although older people also may be affected. According to the CDC, strains of the Coxsackie B4 virus were responsible for 1.9% of all enterovirus infections combined, which was equivalent to at least 54 cases in the United States alone. Bornholm disease is seemingly responsible for 20%-40% of all non-cardiac chest pain. Various paediatric studies done at the Chang Gung Memorial Hospital spanning from 2004-2012 found that of a total of 386 cases studied, 158 were due to the Coxsackie A4 virus, 145 were attributable to the Coxsackie B3 virus and only 83 were found to have been due to the Coxsackie B4 virus.
Natural History, Complications and Prognosis
Patients experience sudden chest pain that is often described as a sharp, cutting or knife-like sensation as well as a fever that often lasts about 4 to 7 day. Recovery is gradual and may take up-to 10 days with relapses being a common finding but the disease is rarely fatal. Complications are unlikely, but affect children more commonly. These include acute viral meningitis, orchitis, hepatic necrosisand coagulopathy, Pericarditis and disseminated intravascular coagulopathy, amongst others. The prognosis is generally very good, requiring symptomatic treatment for pain and bed rest. In cases including orchitis, suspensory bandages may prove useful.
Treatment
Treatment includes the administration of nonsteroidal anti-inflammatory agents or the application of heat to the affected muscles.[3] In healthy people, pleurodynia is a harmless infection that goes away on its own within a few days. To treat the muscle pain, your doctor probably will recommend over-the-counter pain relievers. If necessary narcotic pain medication can be used. Aspirin should not be given to children with pleurodynia because of the risk of Reye's syndrome, a serious reaction causing brain and liver injury in children who take aspirin during certain viral illnesses.
Primary Prevention
The viruses that cause epidemic pleurodynia can spread very easily among young children, who tend to put toys or fingers into their mouth. The disease is most likely to spread in day care centers. The best way to prevent infection is to wash hands thoroughly, especially before meals or after changing a diaper or using the bathroom. There is no vaccine to prevent pleurodynia.
References
- ↑ HOPKINS JH (1950). "Bornholm disease". Br Med J. 1 (4664): 1230–2. PMC 2038054. PMID 15420445. Unknown parameter
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- ↑ http://www.intelihealth.com/IH/ihtPrint/WSIHW000/9339/24698.html?hide=t&k=basePrint#when