By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Pleurodynia is a chest condition caused by viral infection. It presents with flu-like symptoms. The disease is characterized by the presence of chest pain or abdominal pain. Other names –Epidemic Pleurodynia, Epidemic myalgia, Bornholm Disease, Sylvest’s disease, Devils grip – slightest movement of rib cage causes a sharp increase in pain. This makes breathing difficult. The attacks of pain are unpredictable. They appear ‘out of the blue’ and the patient will have a feeling like an iron grip around the ribcage. This is the reason that the disease is also named as ‘devil’s grip’, Devil’s grippe, Epidemic benign dry pleurisy/Bamble disease.
Read – Dyspnoea – Difficulty in breathing: Causes, Pathophysiology, Diagnosis
How does pleurodynia occur?
Pleura is the lining / covering around lung. The pain of pleurodynia arises from these pleura, the chest or upper part of abdomen while breathing. It is called epidemic pleurodynia since it is caused as an epidemic brought about by one of the several viruses. In epidemic pleurodynia the pain comes from the muscles in the chest that joins the ribs together i.e. intercostal muscles. The pain is similar to that coming from the pleura and hence the name pleurodynia. It is usually caused by one of the group B coxsackieviruses. It is less often caused by group A coxsackievirus or an echovirus.
Read – Bronchitis Causes, Symptoms, Types, Treatment, Ayurveda Concept
Symptoms of Pleurodynia
The symptoms usually come on a few days after exposure to the virus. The symptoms can come over suddenly. The viruses on entering the body multiply in the throat and intestines. They then spread into the bloodstream. When immunity is low, fever, headache, nausea, vomiting and sore throat develop. Few people who are infected develop classic muscle pain in the chest and upper abdominal region. This is when the virus causes inflammation in the muscles.
Chest pain worsens with deep breathing. This is called pleuritic pain. The pain can be of severe and stabbing nature or it can just be a mild cramp in the sides. One side of the chest or abdomen is affected usually. Occasionally the pain includes muscles of arms or neck. Pain comes in waves which last for about 15-30 minutes. In some people pain may last for many hours. The severity of pain is so much that the patient would feel trouble breathing. There may also be a lot of sweating and the patient may also become anxious.
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Nature of symptoms
Typically the illness lasts for only a few days.
Sometimes the symptoms of pleurodynia may also last for up to 2-3 weeks.
On the other hand the symptoms may also appear and disappear for many weeks before finally clearing up.
Main symptom – Severe pain in the chest or upper part of abdomen. Pain of pleurodynia is described as pleuritic chest pain or epigastric abdominal pain that is frequently spasmodic.
Nature of the pain of pleurodynia
Usually occurs on only one side of the body
Last for 15-30 minutes
Occur in bouts and is intermittent
Usually sharp or stabbing in nature
Gets worse when you breathe in deeply, cough or move
May cause difficulty in breathing
Pain on touch may be present in the affected area
Dull aching sensation may be anyways present in between the bouts of symptoms
Patients may find relief from pain by lying still for a brief time period
Other symptoms
Fever
Cough
Sore throat
Headache
Pains and aches in the muscles
The symptoms persist for 1-2 days in children. In adults they last for 2-6 days. In some patients symptoms recur after going away. Pain and fever keeps coming and going over a period of 3 weeks or more in some rare cases of pleurodynia.
Tachycardia and arrhythmias have been detected along with this disease by using ECG. Murmurs, rubs and pericardial effusions are also detected in some people with pleurodynia on physical examination. In some cases there is also the presence of maculopapular rashes.
Read – Ayurvedic Heart Care And Treatment For Cardiac Disorders
When to see the doctor?
You need to talk to your doctor as soon as possible if you happen to experience sudden or severe chest pain. Pleurodynia might cause serious illness in newborn babies. If you feel that you have been exposed you need to see your doctor immediately if you have a newborn or if you are in the late stages of your pregnancy.
Causes of Pleurodynia
The group of viruses belonging to the enterovirus group is usually responsible for causing pleurodynia. These are contagious and spread from one person to the other. Therefore outbreaks can often occur in crowded environments (schools, child-care facilities etc). They include one or more of the below mentioned –
Coxsackievirus A
Coxsackievirus B
Echovirus
Group B coxsackieviruses commonly cause this condition in comparison to other viruses. These viruses are transmitted from person to person by – Fecal-oral contamination or
Direct mouth to mouth contact. Touching the contaminated items and then putting those fingers in their mouths before washing them properly can also cause pleurodynia in some people. Soiled diapers, shared toys and toilets are some of the contaminated items which can cause this condition.
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Epidemic pleurodynia is highly contagious. It occurs in clusters. Many people in a particular area wherein this disease has become epidemic get this disease around the same time. About 90% of epidemics occur in summer and early fall. The disease commonly afflicts people younger than 30 years of age. Older people may also be affected. These viruses are believed to cause inflammation of the muscles of the chest and upper abdomen. This inflammation eventually leads to the characteristic pain of pleurodynia.
The infection with viruses caused by one or more of the below mentioned ways –
Contact with feces
Contact with secretions of nose and mouth of a person infected with one of the mentioned viruses
Touching a contaminated object (drinking glass, toy etc) and then touching your face, mouth or nose
Intake of contaminated food or drink
Getting exposed to the droplets when an infected person coughs or sneezes and breathing in the same droplets
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Complications
Tachycardia – rapid heart rate
Pericarditis – inflammation of the heart layers
Myocarditis – inflammation of heart muscles
Meningitis – inflammation of the layers of the brain
Hepatitis – inflammation of liver
Orchitis – inflammation of testicles
Read – Treatment Of Swelling Of Testes (Orchitis) Kuranda Roga Chikitsa
Diagnosis of Pleurodynia
Diagnosis of this condition is based on signs and symptoms. Thorough examination of chest will be done by the physician by pressing on chest muscles to see if it triggers pain or spasm therein. If during that time there is an outbreak occurring in area it will help in confirming the diagnosis. Additional tests will be conducted to rule out the other conditions which cause pain in heart or lungs since pain in the chest is the main symptom of pleurodynia.
Additional tests – blood tests, X-rays of chest or abdomen, EKG and lab tests of body fluids or feces. For suspected cases in babies or pregnant women a definitive diagnosis of pleurodynia is important. Culturing methods and blood tests will help in identifying and detecting the viruses that cause pleurodynia.
Preventive measures
Avoid sharing items.
Practice good hygiene.
Hand washing is the most important preventive measure. You need to frequently wash your hands in the below mentioned situations –
before eating food or handling it
after using the toilet
after changing the diaper
before touching your face, nose or mouth
children should avoid putting toys or fingers into their mouth
Read – Hand Foot and Mouth Disease Prevention Tips, Remedies
Treatment of Pleurodynia
Treatment of pleurodynia is basically symptomatic. NSAIDs and heat application to the affected muscles are the main treatment approaches. Acetaminophen or ibuprofen will help in easing the pain. Intercostal xylocaine injections for pain relief in certain cases. Patients typically make complete recovery with good supportive care. Newborn babies will be at risk of developing severe illness. Treatment with immunoglobulin is recommended if the baby is exposed to the infection.
The infection of pleurodynia goes away within a few days in healthy people. Pain relievers will be recommended to relieve muscle pain.
Outlook
Many healthy individuals recover from this condition and do not develop complications. The illness typically lasts for several days. But it may also last for several weeks in some cases.
In newborn babies the disease can be of severe type. Immediate medical attention should be sought out for if the newborn is exposed to the infection and also in the later stages of pregnancy if the pregnant woman is exposed.
Read – Symptoms That Hint Towards Different Diseases In Babies
Research
The interrelationship of pleurodynia, benign pericarditis and aseptic meningitis – In the epidemic pleurodynia outbreak (1958) in Southern Ontario 3 main disease entities were encountered – epidemic pleurodynia, acute benign pericarditis and aseptic meningitis, alone or in combination.(A)
Another study has established the relationship between Coxsackie B5 Virus in association with Pericarditis and Pleurodynia. (B)
In a public high school at New York City in 1991 an outbreak of pleurodynia among the football players was found to be associated with Coxsackievirus B1. It was concluded that contamination of common water containers by an infected player may have contributed to or initiated the outbreak of the disease.(C)
Unusual cause of chest pain, Bornholm disease, a forgotten entity; case report and review of literature (D)
Ayurveda Concept
The symptoms of Pleurodynia match with those of a condition named ‘Parsva Shula’ explained in Ayurveda. This condition has been explained by Master Sushruta.
Parsva Shula means pain in the flanks. The term is often equated with ‘pain in the sides of the chest’. The pathogenesis of parsva shula explained by Master Sushruta tells that the disease is manifested when kapha blocks vata in the parsva and kukshi i.e. sides of the chest and also abdomen. This probably points towards the disease symptoms, mainly pain manifested in the sides of thoracic wall / ribcage and also abdomen. When we look at the description of pleurodynia and the way it manifests we learn that the pain is a ‘pleuritic chest pain’ or ‘epigastric abdominal pain’ that is frequently spasmodic.
Ayurvedic treatment
Pleurodynia shall be treated on the lines of ‘treatment of parsva shula’.
Read related: Parsva Shula Causes, Symptoms, Pathogenesis, Treatment, Modern View
