What is Pleurodynia? | Symptoms, Causes, Treatment, Epidemiology, Diagnosis

What is Pleurodynia?

Pleurodynia is viral infection that affects the humans. It was first discovered in Iceland and Norway in the 19th Century. It causes mild flu like symptoms to severe systemic illness such as swelling of heart and pancreas. Pleurodynia causes severe morbidity to young people than older people and spreads rapidly during summer month. The viral infection is known to transmit to humans through poor sanitation and poor hand hygiene.(1, 2)

Pleurodynia is also known as epidemic myositis, Bornholm disease, devil’s grip, epidemic myalgia or epidemic Pleurodynia. It is a viral infection caused by Coxsackie virus B.(3)

Symptoms of Pleurodynia

The symptoms of Pleurodynia range from mild flu like symptoms to severe systemic infections. Some of the most prominent symptoms of pleurodynia are:

  • Pain as a Symptom of Pleurodynia: The pain is sudden in onset and occurs periodically. It is felt in the upper part of the abdomen followed by pleuritic pain and soreness in the extremities. The pain is described as ‘stabbing’, ‘knifelike’ or ‘catching’ type of pain. It is said to aggravate during coughing, yawning, while turning sides in bed, deep breathing etc. As the pain gets worsened, the patients find it difficult to lie flat on the back.
  • Fever: The fever ranges between 101° to 104° F. Rigor chills was also observed with fever.
  • Headache as a Sign of Pleurodynia: The patients may feel moderate to severe headache, specifically felt in frontal region. Headache is an important clinical sign for the diagnosis of meningitis or encephalitis (inflammation of the brain and spinal cord).
  • Respiratory Symptoms of Pleurodynia: The patients may develop cough which is ‘dry’ and productive for some.

Gastrointestinal Symptoms of Pleurodynia:

Others Symptoms of Pleurodynia:

  • Tenderness in the chest around the ribs
  • Lymphadenopathy ( tenderness of one or more nodes)
  • Stiffness in the neck
  • Severe Chest pain, abdominal pain, headache are the important features for the diagnosis of Pleurodynia.(2, 3)

Causes of Pleurodynia

Pleurodynia is caused by Coxsackie virus B. Coxsackie virus is small virus of 10 to 20 milli microns. Coxsackie virus B spreads to humans through faecal-oral route. The infection spreads due to poor hand hygiene, when the persons comes in close contact with the infected person, or poor sanitation. There are two groups of Coxsackie virus, Group A and Group B. Coxsackie virus B causes severe systemic illness such as Pericarditis ( inflammation of the layer surrounding the heart) or Myocarditis (inflammation in the heart muscles) especially in infants. The virus also causes Encephalomyelitis (inflammation of brain and spinal cord), pancreatitis (inflammation of pancreas), and hepatitis (inflammation of the liver).(2)

Epidemiology of Pleurodynia

Pleurodynia was first discovered in Norway in the year 1872. The first case was seen in the place called Bamble in Norway hence the disease was named as ‘Bamble disease’. The case was later recorded in 1930 in Denmark and in Washington DC during 1960.The cause of Pleurodynia was established in 1949 and it was found to be due to Coxsackie B virus. The virus transmits from human to human through faecal-oral route. The disease was also noted to spread rapidly during summer months. The virus outbreak was occasionally seen in other parts of the world.(1, 4)

Diagnosis of Pleurodynia

Pleurodynia can be diagnosed through the following tests:

Laboratory Tests to Diagnose Pleurodynia:

  • Stool Test: Stool specimen test is done by the first week of the onset of the infection. It is a highly dependent test for the virus detection as the prevalence is high compared to other tests.
  • Serology Tests to Diagnose Pleurodynia: It is a test used for the detection of the virus. The serological tests identify the presence of the antibodies created due to the virus.
  • Swab Tests: Throat and rectal swab test is done to detect the presence of the virus. Throat swab test detects the respiratory tract involvement. Rectal swab test detects the gastrointestinal illness.
  • Blood Tests: Erythrocyte sedimentation rate, White blood cell count, creatinine, C – reactive protein is checked.
  • Cerebrospinal Fluid Analysis to Diagnose Pleurodynia: It is a test to diagnose conditions affecting the brain and spinal cord. It is done to detect the Coxsackie B virus presence.

Other Investigations to Diagnose Pleurodynia:

  • Electrocardiogram (ECG): It is done to check the electrical activity of the heart, to rule out any heart involvement in the disease. The test is used to analyse the changes in the ST wave.
  • Chest x-ray: It is a diagnostic test to check the heart, lungs, airways and bones. The chest x-ray is done to find out any abnormality, lung effusions etc.
  • CT Scan to Diagnose Pleurodynia: It is an imaging test done to check the soft tissues, any abnormality in the heart and gastro-oesophageal abnormality (3, 5).

Treatment for Pleurodynia

Pleurodynia is treated with non steroidal anti-inflammatory medications, antibiotics such as penicillin, streptomycin and intravenous fluids.(3, 5)

Conclusion

It needs to be noted well that one must take all precautions to prevent the infection. Pleurodynia, being a viral infection, can also turn out to be very serious. Maintaining proper sanitation and hand hygiene is of utmost importance.

References:

  1. Alfred s. Lazarus, Ph. D. (1952, Jan). An Outbreak of Epidemic Pleurodynia, with special reference to the Laboratory Diagnosis of Coxsackie Virus Infections. American Journal of Public Health. Vol 42
  2. Charles M., Carpenter. M. D. (1952, August). Coxsackie Viruses: A Review of Pathologic, Epidemiologic, Diagnostic and Etiologic Observations. California Medicine. Vol. 77. No. 2
  3. John J. Finn Jr., M. D. (1949). Epidemic Pleurodynia: Clinical and Etiologic Studies based on one hundred and fourteen cases. Archives of Internal Medicine.
  4. Masja Leendertsea (2013). Pleurodynia caused by an echovirus 1 brought back from the tropics. Journal of Clinical Virology. 58: 490– 493.
  5. Amos Lal (2018). Unusual cause of Chest Pain, Bornholm Disease, a forgotten entity; case report and review of literature. Respiratory Medicine Case Reports. 25: 270–273.

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