Epidemic pleurodynia

What is epidemic pleurodynia?

The lining around your lungs is called the pleura. Pleurodynia is a general term for pain due to (or mimicking) inflammation of the pleura, which causes 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 type of pain similar to 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, or devil's grip. 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 mouths 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.

Symptoms of epidemic pleurodynia

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.

Diagnosing epidemic pleurodynia

Your doctor will ask about your symptoms and will examine you. Your doctor may press on muscles in your chest to see if the pressure triggers a spasm of pain. Often, your doctor can diagnose the problem without any special tests, especially if there is an outbreak of the illness in your area.

If your doctor is not sure of the diagnosis, you may need additional tests. These may include blood tests, x-rays of the chest or abdomen, an electrocardiogram (EKG), and a laboratory examination of body fluids or feces.

Expected duration of epidemic pleurodynia

Symptoms of epidemic pleurodynia usually last about one to two days in children and about two to six days in adults. In some people, the pain and fever can return after they have been gone for a day or two. Very rarely, a person will have the pain and fever come and go over a period of three weeks or longer.

Preventing epidemic pleurodynia

The viruses that cause epidemic pleurodynia can spread very easily among young children, who tend to put toys or fingers into their mouths. 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.

Treating epidemic pleurodynia

In healthy people, epidemic 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. Aspirin should not be given to children with epidemic 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.

When epidemic pleurodynia is severe or develops in a person with an impaired immune system, antiviral drugs or immunoglobulin treatment may be recommended.

When to call a professional

Call your doctor immediately if you or someone in your family develops severe chest pain.

Prognosis

Almost all generally healthy individuals recover completely from epidemic pleurodynia. Uncommon complications of the coxsackievirus infection include viral meningitis, or inflammation of the testis (orchitis), liver (hepatitis), lining of the heart (pericarditis), or heart muscle (myocarditis).

Additional info

American Academy of Pediatrics (AAP)
 https://www.aap.org/

Centers for Disease Control and Prevention (CDC)
 https://www.cdc.gov/

National Institute of Allergy and Infectious Diseases (NIAID)
 https://www.niaid.nih.gov/

National Foundation for Infectious Diseases
 https://www.nfid.org/