What is Epidemic Myalgia?
Epidemic myalgia (myalgia epidemica, epidemic pleurodinia, Bornholm disease, diabetic flu, epidemic myositis, dry pleurisy, benign dry pleurisy, epidemic muscular rheumatism, epidemic rheumatism, Sulvest disease, Finsen’s disease, acute viral infection) types 1-5), characterized by an acute onset with muscle pain in the upper abdomen and (or) in the chest, fever and headache.
Causes of Epidemic Myalgia
Epidemic myalgia (pleurodinia, Bornholm disease) is caused by the Coxsackie B viruses (types 1-5), Coxsackie A-9 and possibly some ECHO viruses (types 1, 6, 9).
Epidemic myalgia mostly occurs during outbreaks caused by the Koksaki B viruses. The disease lasts several days, rarely gives relapses.
Pathogenesis during Epidemic Myalgia
The source of infection is only human. Viruses enter the human body through the mucous membrane of the respiratory and digestive tracts and invade the lymphoid tissue, resulting in pharyngitis, diarrhea, and other clinical manifestations. After accumulation during replication, viruses from the primary focus enter the bloodstream, and then into various internal organs, affecting the muscles, nerve tissue, skin epithelial cells and tissues of other organs. After the illness, type-specific immunity develops only to the virus that caused the infection.
Symptoms of Epidemic Myalgia
Epidemic myalgia begins acutely, with fever up to 39 – 40 ° C and attacks of pain in the chest and upper abdomen. In adults, chest pain is more often observed, in children in the abdomen. Attacks of acute, cutting pain usually last 5-10 minutes and are repeated after 50-60 minutes, sometimes lasting up to 2 days. and are accompanied by profuse sweating and rapid breathing. Within an hour from the onset of painful attacks, the fever reaches a peak and decreases after they stop.
Fever often lasts 2-3 days. Half of the patients have a second wave of fever with a new attack of pain. In some patients at this time, a picture of serous meningitis develops (on the 5-7th day of the disease). Of the other symptoms, hyperemia of the mucous membrane of the pharynx, lymphadenopathy, and sometimes exanthema are often noted.
In the case of the development of epidemic myalgia in children, they complain of severe headache, as well as pain in the muscles. Most often, this pain makes itself felt in the muscles of the chest, in the back, upper and lower extremities, as well as in the upper abdomen.
The affected muscles are painful on palpation. Sometimes a pleural friction noise is heard. Radiography of the lungs does not reveal pathology. The white blood cell count is normal.
Epidemic myalgia can be combined with other manifestations of enterovirus infection, most often with serous meningitis and herpetic sore throat.
Diagnosis of Epidemic Myalgia
Abdominal syndrome in epidemic myalgia should be differentiated from acute appendicitis, cholecystitis, pancreatitis. However, it must be borne in mind that with epidemic myalgia the pains are paroxysmal, there are no symptoms of peritoneal irritation, and there is no increase in neutrophilic leukocytosis. In addition, muscle pain is noted in other parts of the body, and there is serous meningitis or another form of enterovirus infection.
It should also be taken into account that the patient’s face with epidemic myalgia is hyperemic, vascular injection of the sclera is noted. The intestinal form is observed mainly in children of the first year of life. The disease begins acutely, with an increase in temperature to 38, less often 39 ° C, abdominal pain and diarrhea appear. The stool is liquid, watery, sometimes with an admixture of mucus. The frequency of bowel movements up to 5 – 10 times a day. Often there is repeated vomiting, flatulence is characteristic. Symptoms of intoxication are mild.
To confirm the diagnosis, virus isolation and serological reactions are used.
For serological studies, paired sera are taken (the first until the 4th-5th day of illness, the second after the 14th day of illness). Diagnostic is considered an increase in antibody titer of 4 times or more. Use the neutralization reaction with reference strains of enteroviruses (on tissue cultures or sucker mice), RSK, RTGA, gel precipitation reaction.
Treatment for Epidemic Myalgia
Treatment of epidemic myalgia is symptomatic, which consists in the appointment of NSAIDs. The prognosis in most cases is favorable.
Prevention of Epidemic Myalgia
Identification and isolation of patients (for a period of 14 days). In children’s groups, all contactees are given normal human immunoglobulin (gamma globulin) at 0.3 ml / kg.