Zur Differential-Diagnose der Bornholmer Krankheit

Zusammenfassung

Die Bornholmer Krankheit kann zahlreiche differentialdiagnostische Schwierigkeiten bieten. Je nach dem Sitz der Schmerzen kommen in Betracht: Thorakal: eine Pneumonie und eine Pleuritis; bei Kleinkindern Croup oder eine Fremdkörperaspiration. Bei Erwachsenen Interkostal-Neuralgie und Lumbago. Bei vorwiegend abdominaler Form ist die schwierigste Differentialdiagnose: Appendizitis, ferner Nabelkoliken, Hepatitis epidemica, Gallenblasenentzündung. Bei der Extremitätenform: Poliomyelitis, Polyarthritis, Muskelrheumatismus, Muskelkater. — Bei der Meningitis myalgica alle Formen von seröser Meningitis. Bei der seltenen Komplikation Orchitis und Perikarditis solche anderer Ätiologie. — Bei den Rudimentärformen: Grippe, Angina, akuter Infekt. Die Diagnose-Möglichkeiten der Bornholmer Krankheit werden aufgeführt.

Summary

Bornholm disease ist probably caused by Coxsackie virus Al, which predominantly attacks cross-striated muscle and, therefore, does not lead to permanent paralysis, except in rare cases. Children and adolescents are especially prone to infection. Incubation period is 2—5 days. The typical clinical picture consists of a sudden onset of recurrent paroxysms of chills, fever and perspiration, with severe aches. Dyspnoea and headaches are prominent. The first paroxysm is usually the worst, the acute stage abating after a few hours. A repeat attack may occur in a day or two. According to the localization of complaints, thoracic, abdominal and muscular forms are differentiated. Combined forms, however, frequently occur. The thoracic form may imitate pneumonia or pleuritis. In small children, aspiration of foreign bodies or pertussis may be suspected. Even the incipient stage of respiratory paralysis due to acute poliomyelitis may have to be excluded. The abdominal form may be mistaken for acute appendicitis, cholecystitis or hepatitis. Polyarthritis and poliomyelitis are first thought of in the form which localizes in the extremities and is marked by muscle pains. The disease may be accompanied by a serous meningitis, in which case its signs and symptoms may dominate the clinical picture. Orchitis and pericarditis are rare complications. A “rudimentary” stage of the disease (fever, headaches, myalgia and short-lived chest and abdominal aches) is particularly difficult to diagnose. The disease occurs most frequently in summer and autumn. The virus can be isolated from the faeces and complement fixation reaction and neutralization tests on blood will confirm the diagnosis.

Resumen

Sobre el diagnóstico diferencial de la enfermedad de Bornholm

La enfermedad de Bornholm puede ofrecer numerosas dificultades para el diagnóstico diferencial. Según la localización de los dolores hay que tener en cuenta: Torácico: una neumonía y una pleuritis; en niños pequeños, un crup o una aspiración de cuerpos extraños. En adultos, neuralgia intercostal y lumbago. El diagnóstico diferencial más difícil es cuando predomina la forma abdominal: »Apendicitis«, además, cólicos umbilicales, hepatitis epidémica, colecistitis. En las formas extremas: poliomielitis, poliartritis, reumatismo muscular, agujetas. En la meningitis mialgica, todas los formas de meningitis serosa. En la complicación rara, orquitis, y pericarditis y algunas otras de distinta etiología. En las formas rudimentarias: gripe, anginas, infecciones agudas. Se indican las posibilidades de diagnóstico de la enfermedad de Bornholm.