Bornholm disease

Alternative names

Pleurodynia, epidemic myalgia

Definition

Bornholm disease is primarily a disease of muscle, specifically the chest (inter-costal) muscles. By extension, the outer lining (pleura) of the lungs may be affected. The illness causes chest pain and fever.

Causes

The infection is caused by any of the coxsackie B viruses. Some of the coxsackie A and the echoviruses have also been associated with Bornholm disease.

The coxsackie and echoviruses belong to the enterovirus family. Enteroviruses can spread by being inhaled or swallowed.

Who gets it and who is at risk?

This is usually an epidemic disease, affecting children in crèches and schools, and adults in situations where they interact with a lot of people.

Most epidemics of Bornholm disease occur in summer and autumn.

It is unusual over the age of 30.

There are no specific risk factors.

Symptoms and signs

There is an incubation period of around four days. This is followed by the sudden onset of pain and fever. Sometimes the pain is preceded by mild symptoms such as headache, feeling unwell and sore throat.

The pain is typically located in the chest or upper part of the abdomen. It is a muscular pain and varies in intensity. The pain can sometimes occur in other parts of the body.

The pain is often very severe and is associated with profuse sweating.

The pain is spasmodic, lasting for intervals of 15 to 30 minutes. During spasms, the patient’s breathing may be fast and shallow. Children may breathe with grunting noises, suggesting pneumonia. Coughing, sneezing or deep breathing make the pain worse.

In older children and adults, the pain is described as stabbing or knifelike. It may be mistaken for a "heart attack", an ulcer, a broken rib, early shingles or other very painful conditions.

When the pain is felt in the abdomen it is often cramp-like and can be mistaken for colic in a younger child. The child may double over and refuse to walk or move. If the pain is severe and associated with sweating, pale skin and rigidity of the tummy muscles, then it can suggest a surgical cause such as appendicitis.

Usually the pain is on only one side of the chest and or abdomen, but sometimes there is pain in muscles of the neck and limbs as well. The pain usually lasts two to four days but may return a second time after one or two days.

Patients may have several recurrent episodes over a few weeks, but this is rare.

Most children have other signs of infection with enteroviruses, such as vomiting, nausea and loss of appetite. They may also have a headache and sore throat.

Diagnosis

The diagnosis is usually made when the doctor talks to and examines the patient. The doctor may find the affected muscles to be tender to the touch.

The history is obtained from the parent of an affected child. He will want to know if you have been in contact with someone with similar symptoms.

Laboratory investigations are seldom helpful, nor are x-rays of the chest.

Treatment

As is the case with many viral illnesses, there is no specific treatment.

Painkillers and drugs to reduce fever may be used when necessary. Temporary use of a narcotic analgesic such as pethidine may be required.

A hot water bottle over the painful area may help.

Outcome

Complications are rare; these are caused by spread of the virus to other organs.

Meningitis occasionally occurs. Adult males may experience an inflammation of the testes. The heart may be affected, with inflammation of the heart muscle or the sac surrounding the heart (the pericardium).

When to call your doctor

When any member of your household starts to experience the symptoms described above, particularly if you have heard that the infection is going around school or work. It is important to exclude other more serious causes of chest and abdominal pain.

Reviewed by Dr Eftyhia Vardas, University of the Witwatersrand