Bornholm disease (patient information)

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Overview
Bornholm disease or epidemic pleurodynia or epidemic myalgia is a disease caused by the Coxsackie B virus or other viruses. It is named after the Danish island Bornholm where early cases occurred. The lining around your lungs is called the pleura. Pleurodynia is a general term for pain from this lining, pain in the chest or upper abdomen when you breathe. 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. Epidemic pleurodynia also is called Bornholm disease, Sylvest's disease, devil's grip and epidemic benign dry pleurisy. It usually is caused by one of the group B coxsackieviruses and is less often caused by a group A coxsackievirus or an echovirus. Group B coxsackieviruses are transmitted from person to person by fecal-oral contamination or direct mouth to mouth contact. Other people become infected with the virus if they touch contaminated items then put their fingers in their mouth before washing them properly. Contaminated items can include soiled diapers, shared toys and toilets. Epidemic pleurodynia is contagious and occurs in clusters, meaning many people in an area get it around the same time. 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.

What are the symptoms of Bornholm disease?
Symptoms may include fever and headache, but the distinguishing characteristic of this disease is attacks of severe pain in the lower chest, often on one side. The slightest movement of the rib cage causes a sharp increase of pain, which makes it very difficult to breathe, and an attack is therefore quite a frightening experience, although it generally passes off before any actual harm occurs. The attacks are unpredictable and strike "out of the blue" with a feeling like an iron grip around the rib cage. The colloquial names for the disease, such as 'The Devil's grip' (see also "other names" below) reflect this symptom.

Once inside the body, the coxsackieviruses multiply in the throat and intestines then spread into the bloodstream. At this point, the body's immune defenses often can limit the infection and prevent the person from developing symptoms. If the immune defenses are less successful, the person develops a fever or other symptoms, such as headache, nausea and vomiting, and sore throat. Only a few infected people develop the classic muscle pain in the chest and upper abdomen that gives the disease its name. In these people, the coxsackievirus infection has settled in the muscles of the chest and upper abdomen, causing inflammation there. The chest pain usually feels worse with deep breathing, called pleuritic pain. It can be a severe, stabbing pain or it can be a milder cramping in the side. Usually, only one side of the chest or abdomen is affected, although occasionally the pain can include muscles of the neck or arms. The pain usually comes in waves that last 15 to 30 minutes, although some people report having pain episodes that last for several hours. The pain can be so severe that you have trouble breathing, sweat a lot and become anxious.

When to seek urgent medical care?
Call your doctor immediately if you or someone in your family develops severe chest pain.

Treatment options
Treatment includes the administration of nonsteroidal anti-inflammatory agents or the application of heat to the affected muscles. 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, your doctor may prescribe narcotic pain medication. 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.

Where to find medical care for Bornholm disease
Directions to Hospitals Treating Bornholm disease

Prevention of Bornholm Disease
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.

What to expect (Outlook/Prognosis)
The illness lasts about a week and is rarely fatal. Relapses during the weeks following the initial episode are a characteristic feature of this disease. Almost all generally healthy individuals recover completely from pleurodynia. However, about 5% of people develop acute viral meningitis as a complication of the coxsackievirus infection, and about 5% of adult males develop orchitis. Less common complications include hepatitis, pericarditis and myocarditis.