Editing Bornholm disease

{{Infobox medical condition (new)
| name            = Bornholm disease
| synonyms        = Epidemic pleurodynia, epidemic myalgia, devils grip, Bamble disease
| image           = Coxsackie B4 virus.JPG
| caption         = Coxsackie B virus, the most common cause of Bornholm disease
| pronounce       = Born-howlm
| field           = 
| symptoms        = intermittent pleuritic chest pain, intermittent abdominal pain, fever
| complications   = rare complications include [[myocarditis]], [[respiratory failure]], hepatic necrosis with [[coagulopathy]], and [[disseminated intravascular coagulopathy]] (DIC)
| onset           = 
| duration        = between one day and one week
| types           = 
| causes          = Coxsackie B, Coxsackie A, Echovirus
| risks           = 
| diagnosis       = clinical diagnosis after ruling out more emergent causes of chest and abdominal pain
| differential    = [[Acute appendicitis]], [[cholecystitis]], [[pancreatitis]], [[pulmonary embolism]], [[acute coronary syndrome]], [[costochondritis]], amongst others
| prevention      = Hand hygiene
| treatment       = NSAIDs, intercostal Lidocaine injections, symptomatic treatment 
| medication      = 
| prognosis       = Favorable
| frequency       = 
| deaths          = None reported
}}
'''Bornholm disease''', also known as '''epidemic pleurodynia''',<ref name="pmid15420445">{{cite journal |last= Hopkins |first= JH |title=Bornholm disease |journal=British Medical Journal |volume=1 |issue=4664 |pages=1230–2 |date=May 1950 |pmid=15420445 |pmc=2038054 |doi= 10.1136/bmj.1.4664.1230}}</ref> is a condition characterized by myositis of the abdomen or chest caused by the [[Coxsackie B virus]] or other viruses.<ref>{{DorlandsDict|six/000083496|epidemic pleurodynia}}</ref> The myositis manifests as an intermittent stabbing pain in the musculature that is seen primarily in children and young adults.<ref name="Churchill Livingstone">{{cite book |last1=Johannessen |first1=I. |last2=Burns |first2=S.M. |title=Picornaviruses: Meningitis; paralysis, rashes, intercostal myositis; myocarditis; infectious hepatitis; common cold |date=2012 |publisher=Churchill Livingstone |pages=483–496 |doi=10.1016/B978-0-7020-4089-4.00063-9 |isbn=9780702040894 |url=https://www.sciencedirect.com/science/article/pii/B9780702040894000639}}</ref>

It is named after the [[Denmark|Danish]] island of [[Bornholm]] in the Baltic Sea where an outbreak was one of the first to be described.

==Signs and symptoms==
The expected symptoms of Bornholm disease include [[fever]], pleuritic chest pain, or epigastric [[abdominal pain]] that is frequently spasmodic.<ref>{{cite journal |last1=Johnsson |first1=T |title=Studies on the etiology of Bornholm disease (epidemic pleurodynia). II. Epidemiological observations |journal= Archiv für die gesamte Virusforschung |date=1954 |volume=5 |issue=4 |pages=401–412 |doi=10.1007/BF01243009 |pmid=13171858 |s2cid=11226206 |url=https://pubmed.ncbi.nlm.nih.gov/13171858/}}</ref> 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.<ref name="pmid13042253">{{cite journal |last1= Warin |first1= JF |last2= Davies |first2= JB |last3= Sanders |first3= FK |last4=Vizosa |first4= AD |title=Oxford epidemic of Bornholm disease, 1951 |journal=Br Med J |volume=1 |issue=4824 |pages=1345–51 |date=June 1953 |pmid=13042253 |pmc=2016648 |doi= 10.1136/bmj.1.4824.1345}}</ref> 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.<ref name="pmid8411604" /> 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 infarctions|myocardial infarction]].<ref name="pmid13042253" /> 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 <ref name="Churchill Livingstone"/>

==Etiology==
Inoculation of throat washings taken from people with this disease into the brains of newborn mice revealed that [[enterovirus]]es in the [[Coxsackie B virus]] group were likely to be the cause of pleurodynia,<ref name="pmid14774516">{{cite journal |last1= Weller |first1= TH |last2= Enders |first2= JF |last3= Buckingham |first3= M |last4= Finn |first4= JJ |title=The etiology of epidemic pleurodynia: a study of two viruses isolated from a typical outbreak |journal=J. Immunol. |volume=65 |issue=3 |pages=337–46 |date=September 1950 |doi= 10.4049/jimmunol.65.3.337 |pmid=14774516 |s2cid= 32388798 |url=http://www.jimmunol.org/cgi/pmidlookup?view=long&pmid=14774516|doi-access= free }}</ref> and those findings were supported by subsequent studies of [[Immunoglobulin M|IgM]] antibody responses measured in [[Serum (blood)|serum]] from people with pleurodynia.<ref name="pmid4199715">{{cite journal |vauthors=Schmidt NJ, Magoffin RL, Lennette EH |title=Association of group B coxsackie viruses with cases of pericarditis, myocarditis, or pleurodynia by demonstration of immunoglobulin M antibody |journal=Infect. Immun. |volume=8 |issue=3 |pages=341–8 |date=September 1973 |doi=10.1128/iai.8.3.341-348.1973 |pmid=4199715 |pmc=422854 |url=}}</ref> Other viruses in the enterovirus family, including [[echovirus]] and [[Coxsackie A virus]], are less frequently associated with pleurodynia.<ref name="pmid5581711">{{cite journal |vauthors=Bell EJ, Grist NR |title=ECHO viruses, carditis, and acute pleurodynia |journal=Am. Heart J. |volume=82 |issue=1 |pages=133–5 |date=July 1971 |pmid=5581711 |doi= 10.1016/0002-8703(71)90173-6}}</ref> Echovirus types 1,6,8,9, and 19 and Coxsackie A virus types 4,6,9, and 10 are associated with Bornholm disease. The most common strains causing Bornholm disease are Coxsackie B3 and A9. Viral proliferation in the muscles of the chest wall, diaphragm, and abdomen are thought to contribute to the typical presentation that characterizes the illness.<ref name="Respiratory Medicine Case Reports">{{cite journal |last1=Lal |first1=Amos |last2=Akhtar |first2=Jamal |last3=Isaac |first3=Sangeetha |last4=Mishra |first4=Ajay |last5=Khan |first5=Mohammad |last6=Noreldin |first6=Mohsen |last7=Abraham |first7=George |title=Unusual cause of chest pain, Bornholm Disease, a forgotten entity; case report and review of literature |journal=Respiratory Medicine Case Reports |year=2018 |volume=25 |pages=270–273 |publisher=ELSEVIER |doi=10.1016/j.rmcr.2018.10.005 |pmid=30364740 |pmc=6197799 }}</ref>

==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.<ref name="pmid1179480">{{cite journal |vauthors=Chong AY, Lee LH, Wong HB |title=Epidemic pleurodynia (Bornholm disease) outbreak in Singapore. A clinical and virological study |journal=Trop Geogr Med |volume=27 |issue=2 |pages=151–9 |date=June 1975 |pmid=1179480 }}</ref> Respiratory secretions and oral-oral methods have also shown to be modes of transmission.<ref>{{cite journal |last1=Wikswo |first1=Mary |last2=Khetsuriani |first2=Nino |last3=Fowlkes |first3=Ashley |last4=Zheng |first4=Xiaotian |last5=Penaranda |first5=Silvia |last6=Verma |first6=Natasha |last7=Shulman |first7=Stanford |last8=Sircar |first8=Kanta |last9=Robinson |first9=Christine |last10=Schmidt |first10=Terry |last11=Schnurr |first11=David |last12=Oberste |first12=Steven |title=Increased activity of Coxsackievirus B1 strains associated with severe disease among young infants in the United States, 2007-2008 |journal=Clinical Infectious Diseases |date=Sep 1, 2009 |volume=49|issue=5 |doi=10.1086/605090 |pmid=19622041 |doi-access=|pages=e44–e51 }}</ref> In previous cases the disease has been spread by sharing drink containers,<ref name="pmid8411604">{{cite journal |vauthors=Ikeda RM, Kondracki SF, Drabkin PD, Birkhead GS, Morse DL |title=Pleurodynia among football players at a high school. An outbreak associated with coxsackievirus B1 |journal=JAMA |volume=270 |issue=18 |pages=2205–6 |date=November 1993 |pmid=8411604 |doi= 10.1001/jama.270.18.2205}}</ref> and has been contracted by laboratory personnel working with the virus.<ref name="pmid14774516"/>
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.<ref name="pmid13042253" />

==Physical exam findings==
In a studied case of Bornholm disease the chest pain was unable to be reproduced on palpation and failed to improve with changes in position. The pain was made worse during deep inhalation. A pleural rub was present, however lung auscultation was clear and rashes were absent.<ref name="Respiratory Medicine Case Reports" />

==Laboratory findings and imaging==
In a prior case of Bornholm disease the laboratory results showed the [[white blood cell]] count, [[hemoglobin]], [[hematocrit]], [[creatinine]], liver function test (LFT), [[troponin]], and [[creatine kinase]] (CK) were all within normal limits. The chest x-ray showed bilateral [[pleural effusions]] which resolved after infection. The [[erythrocyte sedimentation rate]] (ESR) and [[C-reactive protein]] (CRP) levels were found to be elevated. The [[electrocardiogram]] (EKG) did not show any abnormalities related to ischemia.<ref name="Respiratory Medicine Case Reports" />

==Treatment and prognosis==
Treatment is symptomatic and includes the administration of non-steroidal anti-inflammatory agents or the application of heat to the affected muscles. Intercostal 2% xylocaine injections with normal saline have been used to relieve symptoms in certain cases.<ref>{{cite journal |last1=Tagarakis |first1=G |last2=et |first2=al |title=Bornholm disease-a pediatric clinical entity that can alert a thoracic surgeon |journal=Journal of Paediatrics and Child Health |date=2011 |volume=47 |issue=10 |pages=242|doi=10.1111/j.1440-1754.2011.02054.x |pmid=21501275 |s2cid=196244700 }}</ref> Relapses during the weeks following the initial episode are a characteristic feature of this disease.<ref name="pmid5341038">{{cite journal |author=Vogelsang TM |title=The occurrence of Bamble Disease (epidemic pleurodynia) in Norway |journal=Med Hist |volume=11 |issue=1 |pages=86–90 |date=January 1967 |pmid=5341038 |pmc=1033670 |doi= 10.1017/s0025727300011765}}</ref> Bornholm disease typically lasts between one day and one week with an average illness duration of four days. In 20% of cases studied, the illness lasted between one and two weeks. The illness in children was found to be shorter than the illness in adults.<ref>{{cite journal |last1=Warin |first1=J.F. |last2=Davies |first2=J.B.M |last3=Sanders |first3=F.K. |last4=Vizoso |first4=A.D. |title=Oxford Epidemic of Bornholm Disease |journal=British Medical Journal |date=1951 |volume=1 |issue=4824 |pages=1345–1351 |doi=10.1136/bmj.1.4824.1345 |pmid=13042253 |pmc=2016648 }}</ref> Patients typically make a complete recovery with supportive care.<ref>{{cite journal |last1=Chong |first1=A.Y.H |last2=Lee |first2=L.H. |last3=Wong |first3=H.B. |title=Epidemic Pleurodynia (Bornholm Disease) outbreak in Singapore. A clinical and virological study (Article) |journal=Tropical and Geographic Medicine |date=1975 |volume=27 |issue=2 |pages=151–159 |pmid=1179480 |url=https://www.scopus.com/record/display.uri?eid=2-s2.0-0016824166}}</ref> Although recovering from Bornholm disease is expected, some rare complications include [[myocarditis]], [[respiratory failure]], hepatic necrosis with [[coagulopathy]], and [[disseminated intravascular coagulopathy]] (DIC).<ref>{{cite journal |last1=Lee |first1=Chia-Jie |last2=Huang |first2=Yhu-Chering |last3=Yang |first3=Shuan |last4=Tsao |first4=Kuo-Chien |last5=Chen |first5=Chih-Jung |last6=Hsieh |first6=Yu-Chia |last7=Chiu |first7=Cheng-Hsun |last8=Lin |first8=Tzou-Yien |title=Clinical features of coxsackievirus A4, B3, and B4 infections in children |journal=PLOS ONE |date=2014 |volume=9 |issue=2 |pages=e87391 |doi=10.1371/journal.pone.0087391 |pmid=24504149 |pmc=3913601 |bibcode=2014PLoSO...987391L |doi-access=free }}</ref> Aseptic meningitis, pericarditis and pleurisy are also known potential complications of Bornholm disease.<ref name="Churchill Livingstone"/> Another uncommon complication is [[orchitis]] that manifests as unilateral testicular pain and swelling in the days or weeks following the expected symptoms of Bornholm disease.<ref>{{cite book |last1=Craighead |first1=John |title=Pathology and Pathogenesis of Human Viral Disease-Chapter 1- Enteroviruses |chapter=CHAPTER 1 - Enteroviruses |date=2007 |publisher=Academic Press |pages=1–28 |doi=10.1016/B978-012195160-3/50002-9 |isbn=9780121951603 |chapter-url=https://www.sciencedirect.com/science/article/pii/B9780121951603500029}}</ref>

==Differential diagnoses==
[[Acute appendicitis]], [[cholecystitis]], [[pancreatitis]], [[pulmonary embolism]], [[acute coronary syndrome]], [[costochondritis]], amongst others<ref name="Respiratory Medicine Case Reports" />

==History==
In 1872, [[Anders Daae (physician)|Anders Daae]] and Christian Horrebow Homann reported an epidemic of pleurodynia occurring in the community of [[Bamble]], [[Norway]], giving rise to the name "Bamble disease". Subsequent reports, published only in Norwegian, referred to the disease by this name. [[Niels Ryberg Finsen]] also described the disease in Iceland in 1874.<ref>{{cite journal |last1=Huebner |first1=Robert |last2=Risser |first2=Joe |last3=Bell |first3=Joseph |last4=Beeman |first4=Edward |last5=Beigelman |first5=Paul |last6=Strong |first6=James |title=Epidemic Pleurodynia in Texas- A Study of 22 Cases |journal=New England Journal of Medicine |date=1953 |volume=248 |issue=7 |pages=267–274 |doi=10.1056/NEJM195302122480701|pmid=13025678 }}</ref> In 1933, [[Ejnar Sylvest]] gave a doctoral thesis describing a Danish outbreak of this disease on Bornholm Island entitled "Bornholm disease-myalgia epidemica", and this name has persisted. In 1949 the Coxsackie B virus was isolated and established as an etiology of Bornholm disease.<ref name="pmid5341038"/>

==Other names==
Bornholm disease is also known as Bamble disease,<ref name="pmid5341038"/> the devil's grip, devil's grippe, epidemic myalgia, epidemic pleurodynia.<ref name="pmid8411604" />

== References ==
{{Reflist}}

== External links ==
{{Medical resources
|  DiseasesDB      = 29152 
|  ICD10           = {{ICD10|B|33|0|b|25}} 
|  ICD9            = {{ICD9|074.1}} 
|  ICDO            = 
|  OMIM            = 
|  MedlinePlus     = 
|  eMedicineSubj   = article 
|  eMedicineTopic  = 300049 
|  MeshID          = D011000
}}
* [http://patient.info/health/bornholm-disease-leaflet Bornholm Disease] on patient.co.uk

{{Viral diseases}}

[[Category:Enterovirus-associated diseases]]
[[Category:Bornholm]]