Bornholm disease natural history

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Arooj Naz, M.B.B.S

Overview

Patients experience sudden chest pain that is often described as a sharp, cutting or knife-like sensation as well as a fever that often lasts about 4 to 7 day. Recovery is gradual and may take up-to 10 days with relapses being a common finding but the disease is rarely fatal. Complications are unlikely, but affect children more commonly. These include acute viral meningitis, orchitis, hepatic necrosis and coagulopathy, Pericarditis and disseminated intravascular coagulopathy, amongst others. The prognosis is generally very good, requiring symptomatic treatment for pain and bed rest. In cases including orchitis, suspensory bandages may prove useful.

Natural History

The chest pain associated with Bornholm disease often lasts about 4 to 7 days.The duration of disease often correlates with the duration of fever.[1] Affected induviduals often experience a short prodromal period of generalized malaise that precedes the occurrence of chest pain, which is described as a sharp, cutting or knife-like sensation.[2] Although the disease is rarely fatal, the chest pain persists. During recovery, the patient may experience weakness and recover gradually over a period of 10 days. Relapses during the weeks following the initial episode are a characteristic feature of this disease.

Complications

About 5% of people develop complications. These include:

Less common complications include: [3]

Clinical studies have shown that children affected with the Coxsackie B3 strain had the highest rate of complication, approximately 9.2%. The most common complication complications included DIC followed by respiratory distress, shock and hepatic necrosis.[6]

An unlikely complication included meningeal involvement, this was noted in an outbreak that occurred in Sweden with less than 10% of patients being affected.[7]

Prognosis

The prognosis is very good as the disease often results in complete recovery with mostly supportive care.[3]

  • For male patients that experienced orchitis, treatment focused on bed rest as well as the use of suspensory bandages.[8]

References

  1. Lal A, Akhtar J, Isaac S, Mishra AK, Khan MS, Noreldin M; et al. (2018). "Unusual cause of chest pain, Bornholm disease, a forgotten entity; case report and review of literature". Respir Med Case Rep. 25 ( ): 270–273. doi:10.1016/j.rmcr.2018.10.005. PMC 6197799. PMID 30364740.
  2. JAMIESON WM, PRINSLEY DM (1947). "Bornholm disease in the tropics". Br Med J. 2 (4514): 47–50. doi:10.1136/bmj.2.4514.47. PMC 2055212. PMID 20251794.
  3. 3.0 3.1 Lal A, Akhtar J, Isaac S, Mishra AK, Khan MS, Noreldin M; et al. (2018). "Unusual cause of chest pain, Bornholm disease, a forgotten entity; case report and review of literature". Respir Med Case Rep. 25: 270–273. doi:10.1016/j.rmcr.2018.10.005. PMC 6197799. PMID 30364740.
  4. Lee CJ, Huang YC, Yang S, Tsao KC, Chen CJ, Hsieh YC; et al. (2014). "Clinical features of coxsackievirus A4, B3 and B4 infections in children". PLoS One. 9 (2): e87391. doi:10.1371/journal.pone.0087391. PMC 3913601. PMID 24504149.
  5. DISNEY ME, HOWARD EM, WOOD BS, FINDLAY GM (1953). "Bornholm disease in children". Br Med J. 1 (4824): 1351–4. doi:10.1136/bmj.1.4824.1351. PMC 2016664. PMID 13042254.
  6. Lee CJ, Huang YC, Yang S, Tsao KC, Chen CJ, Hsieh YC; et al. (2014). "Clinical features of coxsackievirus A4, B3 and B4 infections in children". PLoS One. 9 (2): e87391. doi:10.1371/journal.pone.0087391. PMC 3913601. PMID 24504149.
  7. LANGDALE-SMITH HG, LANGDALE-SMITH DM, WILKINSON BR (1957). "Epidemic of meningoencephalitis and Bornholm disease". Br Med J. 1 (5022): 805–7. doi:10.1136/bmj.1.5022.805. PMC 1973220. PMID 13404313.
  8. JAMIESON WM, PRINSLEY DM (1947). "Bornholm disease in the tropics". Br Med J. 2 (4514): 47–50. doi:10.1136/bmj.2.4514.47. PMC 2055212. PMID 20251794.

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