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Epidemic pleurodynia — Clinical Guidelines

Overview

Epidemic pleurodynia, also known as Bornholm disease, is an acute viral illness characterized by fever, myalgia, and chest pain due to inflammation of the pleura, primarily caused by coxsackievirus B3 4.

Diagnosis

Clinical Criteria: Acute onset of sharp, localized chest or upper abdominal pain, often pleuritic in nature 4.

Laboratory Tests: Throat swab specimens may be positive for coxsackievirus B3 in up to 60% of cases 4.

Imaging: Chest radiography may show pulmonary infiltrates or pleural effusions in about 45% of cases 4.

Elevated Creatine Kinase: Rarely elevated, observed in less than 6% of cases 4.

Management

Supportive Care: Focus on pain management and rest 4.

No Specific Antiviral Therapy: Currently, no antiviral treatment is recommended for coxsackievirus B3 infections 4.

Special Populations

Pediatrics: Epidemic pleurodynia can occur in children, with cases reported in a pediatric population 4.

Comorbidities: Patients with known heart diseases or pulmonary consolidations are typically excluded from case definitions, suggesting careful evaluation in those with underlying conditions 4.

Key Recommendations

Clinical Diagnosis Based on Symptoms and Imaging: Diagnose epidemic pleurodynia based on characteristic clinical presentation and imaging findings (Evidence: Moderate 4).

Exclude Other Conditions: Exclude other causes of chest pain, particularly in patients with pre-existing heart or pulmonary conditions (Evidence: Moderate 4).

Supportive Treatment: Provide symptomatic relief focusing on pain management and adequate rest (Evidence: Expert opinion 4).

References

1 Parry AE, Kirk MD, Durrheim DN, Olowokure B, Colquhoun S, Housen T. Emergency response and the need for collective competence in epidemiological teams. Bulletin of the World Health Organization 2021. link 2 Hossain P, Das Gupta R, YarZar P, Salieu Jalloh M, Tasnim N, Afrin A et al.. 'Feminization' of physician workforce in Bangladesh, underlying factors and implications for health system: Insights from a mixed-methods study. PloS one 2019. link 3 Kodama T, Koike S, Matsumoto S, Ide H, Yasunaga H, Imamura T. The working status of Japanese female physicians by area of practice: cohort analysis of taking leave, returning to work, and changing specialties from 1984 to 2004. Health policy (Amsterdam, Netherlands) 2012. link 4 Huang WT, Lee PI, Chang LY, Kao CL, Huang LM, Lu CY et al.. Epidemic pleurodynia caused by coxsackievirus B3 at a medical center in northern Taiwan. Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 2010. link60079-5) 5 Levsky ME, Rosin A, Coon TP, Enslow WL, Miller MA. A descriptive analysis of authorship within medical journals, 1995-2005. Southern medical journal 2007. link 6 McMurray JE, Cohen M, Angus G, Harding J, Gavel P, Horvath J et al.. Women in medicine: a four-nation comparison. Journal of the American Medical Women's Association (1972) 2002. link

Epidemic pleurodynia