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epidemic pleurodynia; Bornholm disease; epidemic myalgia; Devil's grip; Dabney's grip
Etiology:
1) acute infection with Coxsackie B virus
2) other nonpolio enteroviruses, including
a) echoviruses type 6 & 19
b) coxsackievirus A
Epidemiology:
1) most commonly in children < 15 years
a) 50% < 5 years
b) 30% < 1 year
2) more common in males
Pathology: incubation period of 2-14 days
Clinical manifestations:
1) sudden onset of sharp epigastric rib pain
a) accentuated by movement
b) splinting during attacks
2) duration of symptoms: several days to weeks
3) upper respiratory tract symptoms
a) mild pharyngitis
b) rhinitis
c) dry cough
4) headache
5) fever (morning & evening)
6) pleural friction rub (25% of patients)
7) transient erythematous rash (30%)
8) nausea, vomiting, diarrhea (50%)
9) otitis (25%)
10) epigastric pain
11) testicular pain (ie, orchitis) in 10% of males
Laboratory:
1) culture of virus from throat & feces
2) serology
a) positive complement fixation test
b) rising titers of Coxsackie B-specific antibodies
Complications:
- mortality highest in infants; 10% in 1st 4 weeks of life
Management:
1) no specific treatment exists
2) management is supportive
3) nonsteroidal anti-inflammatory drugs (NSAIDs) for pain & pleurisy (if present)
4) avoid aspirin in children because of the potential to develop Reye syndrome
Related
coxsackie B virus
General
viral infection
pleurodynia
References
- DeGowin & DeGowin's Diagnostic Examination, 6th edition,
RL DeGowin (ed), McGraw Hill, NY 1994, pg 923
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 794