Harvard Health Publications

Epidemic Pleurodynia

What Is It?

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 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

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.

Diagnosis

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

Symptoms of 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.

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.

Treatment

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.

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 pleurodynia. However, about 5% of patients 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.

External resources

American Academy of Pediatrics (AAP) 141 Northwest Point Blvd. Elk Grove Village, IL 60007-1098 Phone: (847) 434-4000 Fax: (847) 434-8000 http://www.aap.org/

Centers for Disease Control and Prevention (CDC) 1600 Clifton Rd., NE Atlanta, GA 30333 Phone: (404) 639-3534 Toll-Free: (800) 311-3435 http://www.cdc.gov/

National Center for Infectious Diseases Office of Health Communication Centers for Disease Control and Prevention Mailstop C-14 1600 Clifton Rd., NE Atlanta, GA 30333 Toll-Free: (888) 232-3228 http://www.cdc.gov/ncidod/

National Institute of Allergy and Infectious Diseases (NIAID) Building 31, Room 7A-50 31 Center Drive MSC 2520 Bethesda, MD 20892-2520 Phone: (301) 496-5717 http://www.niaid.nih.gov/

National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse 1 AMS Circle Bethesda, MD 20892-3675 Phone: (301) 495-4484 Toll-Free: (877) 226-4267 Fax: (301) 718-6366 TTY: (301) 565-2966 http://www.niams.nih.gov/

National Foundation for Infectious Diseases 4733 Bethesda Ave., Suite 750 Bethesda, MD 20814 Phone: (301) 656-0003 Fax: (301) 907-0878 http://www.nfid.org/


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