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Bornholm Disease – Causes, Symptoms and Treatment

Bornholm disease is a viral infection caused by Coxsackieviruses, characterized by sudden, severe chest or abdominal pain and fever. It typically resolves on its own within one to two weeks.

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Things worth knowing about "Bornholm Disease"

Bornholm disease is a viral infection caused by Coxsackieviruses, characterized by sudden, severe chest or abdominal pain and fever. It typically resolves on its own within one to two weeks.

What is Bornholm Disease?

Bornholm disease, also known as epidemic pleurodynia or Myalgia epidemica, is an acute viral illness caused by Coxsackieviruses, most commonly group B (types B1–B5). The disease is named after the Danish island of Bornholm, where it was first systematically described in 1930. Outbreaks tend to occur in summer and early autumn and can affect people of all ages, although children and young adults are most commonly involved.

Causes

The disease is caused by enteroviruses, primarily Coxsackieviruses group B, which belong to the Picornaviridae family. Transmission occurs through:

Fecal-oral route (contact with contaminated surfaces or objects)
Respiratory droplets from coughing or sneezing
Contact with contaminated water or food

The virus spreads easily in communities, schools, and households, which explains its epidemic nature.

Symptoms

The hallmark of Bornholm disease is the sudden onset of sharp, cramping pain in the chest or upper abdomen. Symptoms typically include:

Sudden, intense chest or upper abdominal pain, worsened by breathing, coughing, or movement
Fever (up to 40 degrees Celsius)
General malaise and fatigue
Headache
Nausea and occasional vomiting
Muscle aches (myalgia)

The pain characteristically comes in waves, lasting from a few minutes to several hours, and may recur over several days. The total duration of illness is usually between 3 and 14 days.

Diagnosis

Diagnosis is primarily clinical, based on the characteristic symptoms and patient history. Because the pain can mimic serious conditions such as myocardial infarction, pulmonary embolism, or acute abdomen, careful differential diagnosis is essential:

ECG and cardiac enzymes to rule out heart attack
Chest X-ray or ultrasound to exclude other causes
Virus isolation from stool, throat swab, or blood samples
Serological testing for Coxsackievirus antibodies
PCR testing for direct viral detection

Treatment

There is currently no specific antiviral therapy available for Coxsackievirus infections. Treatment is therefore supportive and symptomatic, focusing on:

Pain relief using non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or paracetamol (acetaminophen)
Rest and avoiding physical exertion
Adequate fluid intake to prevent dehydration
Local heat application to relieve muscle pain

Bornholm disease is self-limiting in the vast majority of cases, meaning it resolves on its own without specific treatment. Complications are rare but may occur in newborns, pregnant women, or immunocompromised individuals (e.g., myocarditis, aseptic meningitis).

Prevention

No licensed vaccine against Bornholm disease is currently available. Key preventive measures include:

Regular and thorough handwashing with soap and water
Avoiding close contact with infected individuals
Maintaining good hygiene with food and drinking water

References

Kliegman RM et al.: Nelson Textbook of Pediatrics. 21st edition. Elsevier, 2020.
Rotbart HA: Enteroviral infections of the central nervous system. Clinical Infectious Diseases, 20(4):971-981, 1995. PubMed PMID: 7795103.
Modlin JF: Coxsackieviruses, Echoviruses, Numbered Enteroviruses, and Parechoviruses. In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th edition. Elsevier, 2020.

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