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Epidemic Pleurodynia

Disease Details

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Description: Epidemic pleurodynia, also known as Bornholm disease, is an acute illness characterized by sudden onset of intense, stabbing chest or abdominal pain caused by a viral infection, usually coxsackieviruses.
Type: Epidemic pleurodynia is an infectious disease, not a genetic one. It is caused by coxsackieviruses, which are part of the enterovirus family. Therefore, it does not have a type of genetic transmission.
Signs And Symptoms: The expected symptoms of Bornholm disease include fever, pleuritic chest pain, or epigastric abdominal pain that is frequently spasmodic. Bornholm associated chest pain is distinguished by attacks of severe pain in the lower chest, often on the right side. In a prior study, the episodes were shown to last five to ten minutes and then subside for thirty minutes. The pain is exacerbated by movement and makes walking and breathing more difficult. Patients have found relief from the pain by lying still for a brief period of time. The slightest movement of the rib cage causes a sharp increase in pain, which makes it difficult to breathe, 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 "other names" below) reflect this symptom. Bornholm disease is a clinical diagnosis that uses the spasmodic pain, fever, and relapses to distinguish the illness from other potential causes of pain such as appendicitis or myocardial infarction. Tachycardia and arrhythmias have been found with Bornholm disease by using an electrocardiogram (ECG). Murmurs, rubs, and pericardial effusions have been detected on physical examination. Maculopapular rashes can also be present with Bornholm disease
Prognosis: Epidemic pleurodynia, also known as Bornholm disease, typically has a good prognosis. The condition is usually self-limiting, with most patients recovering completely within a week or two. Rarely, complications may arise, but they are uncommon. Proper rest, hydration, and pain management can help in recovery.
Onset: Epidemic pleurodynia, also known as Bornholm disease, typically has an abrupt onset. This viral infection, caused primarily by Coxsackie B viruses, often presents with sudden, severe chest or abdominal pain. The pain can be intense and is often exacerbated by deep breathing or movement.
Prevalence: The prevalence of epidemic pleurodynia, also known as Bornholm disease, is not well-defined but it is considered a relatively uncommon condition. It tends to occur in localized outbreaks rather than being widespread. Cases are generally sporadic and can occur worldwide, often linked to enterovirus infections, particularly Coxsackie B virus.
Epidemiology: The most common cause of Bornholm disease, Coxsackie B virus, is shed in large amounts in the feces of infected persons and is spread primarily through the fecal-oral route. Respiratory secretions and oral-oral methods have also shown to be modes of transmission. In previous cases the disease has been spread by sharing drink containers, and has been contracted by laboratory personnel working with the virus.
The pharynx is typically the initial site for entering the body, however the virus will proliferate in lymphatic tissues and use the blood stream to reach the muscles and produce symptoms. Preventative measures to decrease transmission of the virus causing Bornholm disease emphasize hand hygiene. In previous studies of Bornholm disease the majority of the patients affected were children.
Intractability: Epidemic pleurodynia, also known as Bornholm disease, is generally not considered intractable. It is typically a self-limited illness caused by coxsackieviruses, primarily affecting the muscles of the chest and upper abdomen. Symptoms usually resolve within a few days to a couple of weeks, although supportive care may be required to manage pain and discomfort during the acute phase. In most cases, the prognosis is good, and long-term complications are rare.
Disease Severity: Epidemic pleurodynia, also known as Bornholm disease, typically presents with moderate severity. It is characterized by sudden, intense, and sharp chest or abdominal pain, often accompanied by fever and headache. Though distressing, the condition is usually self-limiting, with symptoms resolving within a week to 10 days.
Healthcare Professionals: Disease Ontology ID - DOID:10882
Pathophysiology: Epidemic pleurodynia, also known as Bornholm disease, is caused by Coxsackie B viruses, a subgroup of enteroviruses. The virus primarily affects striated muscles, leading to inflammation and necrosis. This results in intense chest or upper abdominal pain, often exacerbated by movement. The virus spreads via the fecal-oral route, and infection typically occurs in cycles or outbreaks. The pain is often sudden and intermittent, linked to the infection of the intercostal muscles and possibly the diaphragm. Fever, headache, and general malaise may accompany this condition. The body’s immune response eventually clears the virus, leading to symptom resolution.
Carrier Status: Epidemic pleurodynia, also known as Bornholm disease, is not typically associated with a chronic carrier status. It is an acute viral illness caused primarily by Coxsackie B viruses. After recovery, individuals generally do not become carriers of the virus.
Mechanism: Epidemic pleurodynia, also known as Bornholm disease, is caused by Coxsackie B viruses (particularly types B1, B2, B3, and B5), which are part of the Enterovirus genus within the Picornaviridae family.

**Mechanism:**
The disease primarily targets striated muscles in the chest and upper abdomen. The Coxsackie B virus is transmitted through the fecal-oral route, respiratory droplets, or contact with infected surfaces. Once inside the body, the virus replicates in the gastrointestinal tract before disseminating to other tissues, including the muscles and possibly the central nervous system.

**Molecular Mechanisms:**
1. **Viral Entry and Replication:** Coxsackie B viruses enter host cells through specific surface receptors, such as the Coxsackievirus and adenovirus receptor (CAR). Following attachment, the viral RNA is released into the cytoplasm, where it undergoes replication and translation using the host's cellular machinery.
2. **Cytotoxic Effects:** The virus-induced cytotoxicity occurs due to direct cell lysis during viral replication and the formation of membranous vesicles in infected cells. This lysis of muscle cells leads to the characteristic inflammation and pain seen in pleurodynia.
3. **Immune Response:** The host immune response to the infection involves both the innate and adaptive immune systems. Innate immune responses are initiated by the recognition of viral components through pattern recognition receptors (PRRs) such as Toll-like receptors (TLRs). The release of pro-inflammatory cytokines like interferons (IFNs) stimulates antiviral states in neighboring cells. The adaptive immune response involves the activation of B and T cells, leading to the production of specific antibodies and cellular immunity against the virus.

These mechanisms combined lead to the symptomatic manifestations of epidemic pleurodynia, such as sudden onset chest pain, abdominal pain, fever, and sometimes headache and malaise.
Treatment: Epidemic pleurodynia, also known as Bornholm disease, is generally treated with supportive care. This includes:

1. **Pain management**: Over-the-counter pain medications such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help alleviate pain and fever.

2. **Rest**: Adequate rest is important to help the body recover.

3. **Fluids**: Staying hydrated is essential, especially if the illness is accompanied by fever or loss of appetite.

There is no specific antiviral treatment for epidemic pleurodynia, as it is typically caused by coxsackieviruses, which are self-limiting. Symptoms usually resolve on their own within a few days to weeks. If symptoms persist or worsen, it is important to seek medical advice.
Compassionate Use Treatment: Epidemic pleurodynia, also known as Bornholm disease, is primarily caused by Coxsackie B viruses. Supportive care is the mainstay of treatment, including rest, hydration, and pain management with NSAIDs or other analgesics.

Regarding compassionate use treatment, off-label, or experimental treatments:
1. **Compassionate Use**: This typically involves the use of antiviral medications not explicitly approved for epidemic pleurodynia but potentially beneficial in severe cases.
2. **Off-label Treatments**: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are often used off-label to manage pain and inflammation. In some cases, corticosteroids might be considered for severe inflammation, though this is not standard practice.
3. **Experimental Treatments**: Given that the disease is viral, experimental treatments might include antiviral drugs or immunomodulatory agents, though specific evidence supporting their efficacy in epidemic pleurodynia is currently limited.

Always consult a healthcare provider for personalized treatment recommendations.
Lifestyle Recommendations: Lifestyle recommendations for epidemic pleurodynia (also known as Bornholm disease or devil's grip) focus on symptom management and supporting the body's ability to fight the infection. Here are some general suggestions:

1. **Rest**: Ensure adequate rest to help the body recover.
2. **Hydration**: Drink plenty of fluids to stay hydrated.
3. **Pain Management**: Over-the-counter pain relief medications like ibuprofen or acetaminophen can help alleviate pain and fever.
4. **Apply Heat**: Using heating pads or warm compresses on the chest or abdomen can help reduce muscle pain.
5. **Avoid Strenuous Activity**: Minimize physical exertion to prevent worsening of symptoms.
6. **Healthy Diet**: Maintain a balanced diet to support the immune system.
7. **Good Hygiene**: Practice good hygiene, including frequent handwashing, to prevent the spread of the virus.

These recommendations can aid in comfort and recovery, but it's essential to consult a healthcare provider for personalized advice and proper diagnosis.
Medication: Epidemic pleurodynia, also known as Bornholm disease, is generally caused by Coxsackie B viruses. There is no specific antiviral medication for epidemic pleurodynia, and treatment primarily focuses on relieving symptoms. Pain management can include analgesics such as ibuprofen or acetaminophen to reduce pain and fever. It is also important to rest and stay hydrated. In more severe cases, a healthcare provider may recommend additional treatments.
Repurposable Drugs: Currently, there are no specific drugs that have been repurposed for the treatment of epidemic pleurodynia, also known as Bornholm disease. This condition is typically caused by a viral infection, most commonly by Coxsackie B virus. Treatment is generally supportive, focusing on pain relief and managing symptoms. Pain relief can often be achieved with over-the-counter medications such as ibuprofen or acetaminophen. It is important to consult with a healthcare provider for appropriate diagnosis and management.
Metabolites: Epidemic pleurodynia, also known as Bornholm disease, is a viral infection primarily caused by coxsackie B viruses. The disease mainly affects the muscles, particularly those around the chest, causing severe pain.

Since epidemic pleurodynia is a viral infection, there is limited direct information available about specific metabolites associated with it. However, common metabolites involved in viral infections include various cytokines and chemokines as part of the immune response, as well as energy metabolites affected by muscle inflammation and stress.

Further detailed metabolomic studies specifically focused on epidemic pleurodynia would be needed to identify any unique or significant metabolites associated with this condition.
Nutraceuticals: There is no established role for nutraceuticals in the treatment or prevention of epidemic pleurodynia. Nutraceuticals are products derived from food sources that provide health benefits beyond basic nutrition, but their efficacy in managing this specific viral illness, caused by Coxsackie B viruses, has not been documented in scientific literature. Treatment typically focuses on symptomatic relief, such as using pain relievers and anti-inflammatory medications.
Peptides: Epidemic pleurodynia, also known as Bornholm disease, does not have a direct treatment involving peptides or nanotechnology. The condition is typically caused by coxsackievirus B, leading to intense chest and abdominal pain. Management is primarily supportive, involving rest, hydration, and pain relief with analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs). Currently, peptides and nanotechnology-based treatments are not a standard part of managing this viral infection.