Pleurodynia R07.3

The clinical picture of pleurodynia was first described in the dissertation "De febribus Eyderostadenses corripientibus epidemica, vulgo stubble fever" by the Dane Hannaeus in 1732.

Towards the end of the 19th century the disease appeared in the form of epidemics in Iceland and Norway and was called "Bamle disease" after the place Bamle there.

The Danish physician Eynar Sylvest was the first to describe the pleurodynia in detail in international literature, after an epidemic occurred on the Danish island of Bornholm in the years 1930 - 1932. Since then the disease has been named after the island as so-called "Bornholm disease".

Pleurodynia is an extremely painful myalgia of the intercostal muscles. It can occur on one or both sides.

Pleurodynia is caused by different human enteroviruses (HEV). These are unenveloped RNA viruses that are relatively resistant to environmental influences. They are divided into the groups A to D.

Coxsackie and echo viruses are mainly responsible for pleurodynya.

The Coxsackie A viruses belong to the group of HEV-A and HEV-C and are divided into further serogroups (22 in total).

Coxsackie B viruses belong to the HEV-B group and are also divided into several serotypes (6 in total).

The echoviruses belong to the HEV B species, which are divided into 27 serotypes.

The most common infectious causes of pleurodynia are:

• Coxsackievirus type B 1, 2, 3, 4, 5
• Echoviruses HEV-B serotype 6 and 9 (often trigger epidemic diseases)

The first descriptions of the disease date from the middle of the 19th century, when pleurodynya appeared in North America and Australia. In Europe, the first cases of the disease were recorded in Switzerland in 1879 and since 1930 the pleurodynynya has appeared in Germany. However, the disease then spread rapidly throughout Europe and later worldwide.

Coxsackie and echo viruses are particularly common in countries with a low socioeconomic status. In temperate zones, the virus spreads mainly during the summer and autumn months. The level of infestation of the population is very high.

The risk of nosocomial infections with one of the two pathogens is particularly important in neonatal and premature infant wards.

Transmission

Both coxsackie and echoviruses are highly infectious and relatively resistant to the environment. They are transmitted by smear infection from person to person.

At the beginning of the disease with coxsackie- or echoviruses, they are also detectable in the nasopharynx. During this time, aerogenic transmission is also possible.

The incubation period is 2 - 8 days. The actual symptoms usually last about one week.

Infections with echoviruses are asymptomatic up to 95%.

In the remaining 5 % and when the disease is triggered by Coxsackie viruses, the following symptoms exist:

• The beginning of the disease is often due to complete well-being
• Presence of severe - mostly respiratory - thoracic pain that occurs intermittently and lasts for about 15 to 30 minutes (the pain should not be confused with that of pleuritis sicca)
• in children the pain is often more localised in the upper abdomen
• Pressure pain in the area of the affected musculature
• Chills
• fever (this is highest about one hour after the onset of the pain attacks)
• Tachypnea
• Headaches
• Weld outbreaks
• occasional nausea and vomiting

auscultation:

It may be possible to auscultate pleural rubs (in about 25% of cases).

Laboratory: Pathogen detection is possible in CSF, pharyngeal washings, conjunctival smear and stool. Due to the high infestation of the population, antibody detection is of little importance. The blood count is usually unremarkable.

Chest X-ray: mostly inconspicuous

• Rib fracture (previous trauma?)
• Herpes zoster (local skin lesions, papules visible?)
• Pleuritis sicca (auscultation, sonography etc.)
• Myocardial infarction (respiratory dependence, radiation, ECG, troponin etc.)
• Pulmonary embolism (echo, D-dimer, MDCT etc.)

Severe breath-dependent pain is associated with the risk of reduced ventilation of the lungs, so analgesics (non-steroidal anti-inflammatory drugs) should be administered.

Otherwise the disease is self-limited.

The disease heals within a few days. Recurrences are very rare, but not impossible.

A special danger exists only in neonatal or premature infant wards.

Adequate hand hygiene ensures the prophylaxis of exposure.

Obligation to notify

According to the IfSG there is no obligation to report individual Coxsackievirus or echovirus detections. However, if an epidemic is suspected, the laboratory manager must immediately notify the laboratory in accordance with § 7 (2) IfSG .

1. Darai G et al (2009) Lexicon of Human Infectious Diseases: Pathogen, symptoms, diagnosis. Springer publishing house 201
2. Gerok W et al.(2007) Internal medicine - reference work for the medical specialist. Schattauer publishing house 415, 476
3. Herold G et al (2017) Internal Medicine. Herold Publishing House 241, 878
4. Kiehl W et al (2012) Infections caused by enteroviruses. Compendium Infectiology and Infection Control. Hoffmann Publishing House. Robert Koch Institute
5. Kasper DL et al (2015) Harrison's Principles of Internal Medicine. Mc Graw Hill Education 831, 892, 1291 - 1292
6. Kasper DL et al (2015) Harrison's Internal Medicine. Thieme Publishing House 1578
7. Windorfer A (1963) The Bornholm disease. German medical weekly magazine. (21) Georg Thieme Publishing House 1077-1082