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Pleurodynia Treatment & Management

  • Author: Irina Petrache, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
Updated: Aug 13, 2015

Medical Care

No specific treatment exists. Management is supportive and includes nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and pleurisy (if present) or peripheral nerve block (eg, intercostal nerve) with 1% lidocaine (Xylocaine) infusion.

Aspirin should be avoided in children because of the potential to develop Reye syndrome.

Several experimental antiviral treatments have been tested in animal models, as follows:

  • Arbidol inhibited the coxsackievirus-5 (CVB5) cytopathic effect and decreases CVB5-RNA level in vitro and in vivo in a CVB5 systemic infection BALB/c mouse model. [16]
  • IL-12 delivered orally via genetically engineered Bifidobacterium longum downregulated the severity of virus-induced myocarditis and reduced the virus titers in the heart of a CVB3-induced myocarditis BALB/c mouse model. [17]
  • Human cardiac derived adherent proliferating cells (CAPs) characterized by CD105 +, CD73 +, CD166 +, CD44 +, CD90 +, CD14 +, CD34 +, CD45 + are similar to human mesenchymal stromal cells in terms of anti-apoptotic and immunomodulatory properties, but lack the multilineage differential potential. CAPs could not be infected by CVB3; when administered to a C57Bl/6 mouse model, engrafted in the heart, lung, liver, kidney, and spleen, it decreased the CVB3-induced myocarditis severity. [18]
  • Benzophenone C-glucosides and gallotannins from mango tree stem bark exhibit ex vivo inhibitory activity against coxsackievirus 3C protease. [19]
  • Combination of soluble extracellular domain of the coxsackie-adenovirus receptor (sCAR-Fc) and 2 short hairpin RNAs (shRdRp2.4) exerted antiviral and anti-inflammatory activity in a coxsackievirus B3-induced myocarditis murine model. [20]
  • N-benzene sulfonyl matrinic amine/amide and matrinic methyl ether analogues exhibited stronger anti-coxsackievirus B3  activity and better therapeutic properties with improved selectivity index. [21]

Pregnancy considerations

Coxsackievirus B may be transmitted to the fetus during pregnancy by transplacental route or during delivery. During pregnancy, the outcomes of coxsackievirus B infection depend on the timing of infection during the age of gestation. Two independent studies reported higher prevalence of coxsackievirus B infection in women experiencing a miscarriage than in women delivering at term or receiving a voluntary termination before 13 weeks gestation. IgM antibody against coxsackie virus B1-5 or semi-nested RT-PCR positive for coxsackievirus B3 in the placental tissue were significantly higher, by 42% and 57.1%, respectively, than in women in the control group.[22, 23] It may also be related to increased incidence of congenital heart defects, and early-onset insulin-dependent diabetes mellitus. 

Transmission of ECHO virus to neonates has also been reported during delivery, by an orofecal route. Similarly to coxsackievirus B, it may cause severe systemic infection in the neonate, such as aseptic meningitis, hepatitis, gastroenteritis, and viral pneumonitis.[24]



Activity is as tolerated.



Direct complications of pleurodynia are rare.

  • Splinting from pain may result in atelectasis and shortness of breath.
  • A postviral syndrome, also called fatigue-dysphoria syndrome, is described in children who were seropositive for coxsackievirus B and who complained of fatigue, weakness, sore throats, and dysphoria. This syndrome may also complicate the patient's recovery.
  • In rare cases, coxsackievirus B infection may be complicated by carditis, [25] aseptic meningitis, constrictive pericarditis, orchitis, myalgic encephalomyelitis, severe neonatal encephalitis with seizures, [26] hemorrhagic conjunctivitis, hepatitis, pancreatitis, and juvenile-onset diabetes mellitus.
  • Dilated cardiomyopathy is a complication of viral myocarditis. It may be acute or related to severe muscle necrosis, or it may occur several years later, possibly due to chronic inflammation and fibrosis as a result of an immune-mediated process. [25]


Common hygiene measures aid in the prevention of the oral-fecal transmission of coxsackievirus B. An outbreak of pleurodynia among high school football players was traced to contaminated water; therefore, avoid direct oral contact with common drinking or ice containers in favor of individual water containers and ice packs.[28]

Coxsackievirus B is a small RNA virus that lacks a lipoprotein envelope and, hence, may be resistant to physical and chemical inactivation, including 70% alcohol or 1% quaternary ammonium compounds. Sodium hypochlorite at a concentration of 3120 ppm, at a contact time of 5 minutes, was sufficient to completely inactivate different Enterovirus strains.[29]  Good sterilization techniques that include ethylene oxide have been shown to inactivate the virus on electrophysiologic catheters.[30]


Long-Term Monitoring

Patients must receive follow-up care with their primary care providers to ensure that other potential coxsackievirus B-associated complications are diagnosed and managed in a timely manner.

Contributor Information and Disclosures

Irina Petrache, MD Professor, Department of Medicine, Wollowick Chair in COPD Research, Chief, Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health

Irina Petrache, MD is a member of the following medical societies: American Thoracic Society

Disclosure: Nothing to disclose.


Karina A Serban, MD Assistant Professor of Medicine, Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health

Karina A Serban, MD is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Zab Mosenifar, MD, FACP, FCCP Geri and Richard Brawerman Chair in Pulmonary and Critical Care Medicine, Professor and Executive Vice Chairman, Department of Medicine, Medical Director, Women's Guild Lung Institute, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD, FACP, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Helen M Hollingsworth, MD Director, Adult Asthma and Allergy Services, Associate Professor, Department of Internal Medicine, Division of Pulmonary and Critical Care, Boston Medical Center

Helen M Hollingsworth, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Chest Physicians, American Thoracic Society, Massachusetts Medical Society

Disclosure: Nothing to disclose.


Gregg T Anders, DO Medical Director, Great Plains Regional Medical Command , Brooke Army Medical Center; Clinical Associate Professor, Department of Internal Medicine, Division of Pulmonary Disease, University of Texas Health Science Center at San Antonio

Disclosure: Nothing to disclose.

Ninotchka Liban Sigua, MD Fellow, Department of Pulmonary and Critical Care, Indiana University School of Medicine

Disclosure: Nothing to disclose.

  1. Bell EJ, Grist NR. ECHO viruses, carditis, and acute pleurodynia. Am Heart J. 1971 Jul. 82(1):133-5. [Medline].

  2. Moore M, Kaplan MH, McPhee J, Bregman DJ, Klein SW. Epidemiologic, clinical, and laboratory features of Coxsackie B1-B5 infections in the United States, 1970-79. Public Health Rep. 1984 Sep-Oct. 99(5):515-22. [Medline]. [Full Text].

  3. Kaplan MH, Klein SW, McPhee J, Harper RG. Group B coxsackievirus infections in infants younger than three months of age: a serious childhood illness. Rev Infect Dis. 1983 Nov-Dec. 5(6):1019-32. [Medline].

  4. Mizuta K, Yamakawa T, Nagasawa H, Itagaki T, Katsushima F, Katsushima Y, et al. Epidemic myalgia associated with human parechovirus type 3 infection among adults occurs during an outbreak among children: findings from Yamagata, Japan, in 2011. J Clin Virol. 2013 Sep. 58 (1):188-93. [Medline].

  5. Rotbart HA, Sawyer MH, Fast S, et al. Diagnosis of enteroviral meningitis by using PCR with a colorimetric microwell detection assay. J Clin Microbiol. 1994 Oct. 32(10):2590-2. [Medline]. [Full Text].

  6. Romero JR. Reverse-transcription polymerase chain reaction detection of the enteroviruses. Arch Pathol Lab Med. 1999 Dec. 123(12):1161-9. [Medline].

  7. Nolte FS. Case studies in cost effectiveness of molecular diagnostics for infectious diseases: pulmonary tuberculosis, enteroviral meningitis, and BK virus nephropathy. Clin Infect Dis. 2006 Dec 1. 43(11):1463-7. [Medline].

  8. Noordhoek GT, Weel JF, Poelstra E, Hooghiemstra M, Brandenburg AH. Clinical validation of a new real-time PCR assay for detection of enteroviruses and parechoviruses, and implications for diagnostic procedures. J Clin Virol. 2008 Feb. 41(2):75-80. [Medline].

  9. Patel DD, Kapoor A, Ayyagari A, Dhole TN. Development of a simple restriction fragment length polymorphism assay for subtyping of coxsackie B viruses. J Virol Methods. 2004 Sep 15. 120(2):167-72. [Medline].

  10. Jaianand K, Saravanan N, Gunasekaran P, Sheriff AK. Development of a new method for diagnosis of Group B Coxsackie genome by reverse transcription loop-mediated isothermal amplification. Indian J Med Microbiol. 2011 Apr-Jun. 29(2):110-7. [Medline].

  11. Goldwater PN. Immunoglobulin M capture immunoassay in investigation of coxsackievirus B5 and B6 outbreaks in South Australia. J Clin Microbiol. 1995 Jun. 33(6):1628-31. [Medline]. [Full Text].

  12. McCartney RA, Banatvala JE, Bell EJ. Routine use of mu-antibody-capture ELISA for the serological diagnosis of Coxsackie B virus infections. J Med Virol. 1986 Jul. 19(3):205-12. [Medline].

  13. Roehrig JT, Hombach J, Barrett AD. Guidelines for Plaque-Reduction Neutralization Testing of Human Antibodies to Dengue Viruses. Viral Immunol. 2008 Jun. 21 (2):123-32. [Medline].

  14. Coates HV, Alling DW, Chanock RM. An antigenic analysis of respiratory syncytial virus isolates by a plaque reduction neutralization test. Am J Epidemiol. 1966 Mar. 83 (2):299-313. [Medline].

  15. Yang L, He D, Tang M, Li Z, Liu C, Xu L, et al. Development of an enzyme-linked immunosorbent spot assay to measure serum-neutralizing antibodies against coxsackievirus B3. Clin Vaccine Immunol. 2014 Mar. 21 (3):312-20. [Medline].

  16. Miteva K, Haag M, Peng J, Savvatis K, Becher PM, Seifert M. Human cardiac-derived adherent proliferating cells reduce murine acute Coxsackievirus B3-induced myocarditis. PLoS One. 2011. 6(12):e28513. [Medline].

  17. Yu Z, Huang Z, Sao C, et al. Bifidobacterium as an oral delivery carrier of interleukin-12 for the treatment of Coxsackie virus B3-induced myocarditis in the Balb/c mice. Int Immunopharmacol. 2012 Jan. 12(1):125-30. [Medline].

  18. Blumental S, Reynders M, Willems A, et al. Enteroviral infection of a cardiac prosthetic device. Clin Infect Dis. 2011 Mar 15. 52(6):710-6. [Medline].

  19. Abdel-Mageed WM, Bayoumi SA, Chen C, Vavricka CJ, Li L, Malik A, et al. Benzophenone C-glucosides and gallotannins from mango tree stem bark with broad-spectrum anti-viral activity. Bioorg Med Chem. 2014 Apr 1. 22 (7):2236-43. [Medline].

  20. Stein EA, Pinkert S, Becher PM, Geisler A, Zeichhardt H, Klopfleisch R, et al. Combination of RNA interference and virus receptor trap exerts additive antiviral activity in coxsackievirus B3-induced myocarditis in mice. J Infect Dis. 2015 Feb 15. 211 (4):613-22. [Medline].

  21. Wang SG, Kong LY, Li YH, Cheng XY, Su F, Tang S, et al. Structure-activity relationship of N-benzenesulfonyl matrinic acid derivatives as a novel class of coxsackievirus B3 inhibitors. Bioorg Med Chem Lett. 2015 Sep 1. 25 (17):3690-3. [Medline].

  22. Axelsson C, Bondestam K, Frisk G, Bergstrom S, Diderholm H. Coxsackie B virus infections in women with miscarriage. J Med Virol. 1993 Apr. 39 (4):282-5. [Medline].

  23. Hwang JH, Kim JW, Hwang JY, Lee KM, Shim HM, et al. Coxsackievirus B infection is highly related with missed abortion in Korea. Yonsei Med J. 2014 Nov. 55 (6):1562-7. [Medline].

  24. Tang JW, Bendig JW, Ossuetta I. Vertical transmission of human echovirus 11 at the time of Bornholm disease in late pregnancy. Pediatr Infect Dis J. 2005 Jan. 24(1):88-9. [Medline].

  25. Gaaloul I, Riabi S, Harrath R, Hunter T, Hamda KB, Ghzala AB, et al. Coxsackievirus B detection in cases of myocarditis, myopericarditis, pericarditis and dilated cardiomyopathy in hospitalized patients. Mol Med Rep. 2014 Dec. 10 (6):2811-8. [Medline].

  26. Ronellenfitsch S, Tabatabai J, Bottcher S, Diedrich S, Frommhold D, et al. First report of a Chinese strain of coxsackie B3 virus infection in a newborn in Germany in 2011: a case report. J Med Case Rep. 2014 May 27. 8:164. [Medline].

  27. McEvoy GK. Nonsteroidal Anti-inflammatory Agents. AHFS Drug information. Bethesda, Md: American Society of Health-System Pharmacists; 2000.

  28. Ikeda RM, Kondracki SF, Drabkin PD, Birkhead GS, Morse DL. Pleurodynia among football players at a high school. An outbreak associated with coxsackievirus B1. JAMA. 1993 Nov 10. 270(18):2205-6. [Medline].

  29. Kadurugamuwa JL, Shaheen E. Inactivation of human enterovirus 71 and coxsackie virus A16 and hand, foot, and mouth disease. Am J Infect Control. 2011 Nov. 39(9):788-9. [Medline].

  30. Druce JD, Russell JS, Birch CJ, Vickery K, Harper RW, Smolich JJ. Cleaning and sterilization protocol for reused cardiac electrophysiology catheters inactivates hepatitis and coxsackie viruses. Infect Control Hosp Epidemiol. 2005 Aug. 26(8):720-5. [Medline].

  31. Bell EJ, McCartney RA, Riding MH. Coxsackie B viruses and myalgic encephalomyelitis. J R Soc Med. 1988 Jun. 81(6):329-31. [Medline]. [Full Text].

  32. Dussart P, Cartet G, Huguet P, et al. Outbreak of acute hemorrhagic conjunctivitis in French Guiana and West Indies caused by coxsackievirus A24 variant: phylogenetic analysis reveals Asian import. J Med Virol. 2005 Apr. 75(4):559-65. [Medline].

  33. Huber S, Ramsingh AI. Coxsackievirus-induced pancreatitis. Viral Immunol. 2004. 17(3):358-69. [Medline].

  34. Spotnitz MD, Lesch M. Idiopathic dilated cardiomyopathy as a late complication of healed viral (Coxsackie B virus) myocarditis: historical analysis, review of the literature, and a postulated unifying hypothesis. Prog Cardiovasc Dis. 2006 Jul-Aug. 49(1):42-57. [Medline].

  35. Ornoy A, Tenenbaum A. Pregnancy outcome following infections by coxsackie, echo, measles, mumps, hepatitis, polio and encephalitis viruses. Reprod Toxicol. 2006 May. 21(4):446-57. [Medline].

  36. Thomas L, Reichl M. Pulmonary embolism in patients attending the accident and emergency department with pleuritic chest pain. Arch Emerg Med. 1991 Mar. 8(1):48-51. [Medline]. [Full Text].

  37. Branch WT Jr, McNeil BJ. Analysis of the differential diagnosis and assessment of pleuritic chest pain in young adults. Am J Med. 1983 Oct. 75(4):671-9. [Medline].

  38. Crum-Cianflone NF. Bacterial, fungal, parasitic, and viral myositis. Clin Microbiol Rev. 2008 Jul. 21(3):473-94. [Medline]. [Full Text].

  39. Dagan R, Jenista JA, Prather SL, Powell KR, Menegus MA. Viremia in hospitalized children with enterovirus infections. J Pediatr. 1985 Mar. 106(3):397-401. [Medline].

  40. Disney ME, Howard EM, Wood BS, Findlay GM. Bornholm disease in children. Br Med J. 1953 Jun 20. 1(4824):1351-4. [Medline]. [Full Text].

  41. Fraser RG, Pare JA. Coxsackievirus respiratory infection. Diag Dis Chest. 1978. 2:834-35.

  42. Gaaloul I, Riabi S, Harrath R, Evans M, Salem NH, Mlayeh S. Sudden unexpected death related to enterovirus myocarditis: histopathology, immunohistochemistry and molecular pathology diagnosis at post-mortem. BMC Infect Dis. 2012. 12:212. [Medline].

  43. Gomez Rodriguez N, Ibanez Ruan J, Gonzalez Rodriguez M. [Coxsackie virus infection associated with myositis and polyarthritis]. An Med Interna. 2008 Feb. 25(2):90-2. [Medline].

  44. Grattagliano I, Portincasa P, Mastronardi M, Palmieri VO, Palasciano G. Esomeprazole-induced central fever with severe myalgia. Ann Pharmacother. 2005 Apr. 39(4):757-60. [Medline].

  45. Lau RC. Coxsackie B virus infections in New Zealand patients with cardiac and non-cardiac diseases. J Med Virol. 1983. 11(2):131-7. [Medline].

  46. Mintz L, Drew WL. Relation of culture site to the recovery of nonpolio enteroviruses. Am J Clin Pathol. 1980 Sep. 74(3):324-6. [Medline].

  47. Murray BJ. Complications following coxsackievirus B infection. Am Fam Physician. 1988 Nov. 38(5):115-8. [Medline].

  48. Pichichero ME, McLinn S, Rotbart HA, Menegus MA, Cascino M, Reidenberg BE. Clinical and economic impact of enterovirus illness in private pediatric practice. Pediatrics. 1998 Nov. 102(5):1126-34. [Medline].

  49. Roth B, Enders M, Arents A, Pfitzner A, Terletskaia-Ladwig E. Epidemiologic aspects and laboratory features of enterovirus infections in Western Germany, 2000-2005. J Med Virol. 2007 Jul. 79(7):956-62. [Medline].

  50. Storch GA. Essentials of Diagnostic Virology. New York, NY: Churchill Livingstone; 2000.

  51. Swanink CM, Veenstra L, Poort YA, Kaan JA, Galama JM. Coxsackievirus B1-based antibody-capture enzyme-linked immunosorbent assay for detection of immunoglobulin G (IgG), IgM, and IgA with broad specificity for enteroviruses. J Clin Microbiol. 1993 Dec. 31(12):3240-6. [Medline]. [Full Text].

  52. Tagarakis GI, Georgios TI, Karangelis D, Dimos K, Tsolaki F, Fani T. Bornholm disease--a pediatric clinical entity that can alert a thoracic surgeon. J Paediatr Child Health. 2011 Apr. 47(4):242. [Medline].

  53. Wilson PM, Kusumakar V, McCartney RA, Bell EJ. Features of Coxsackie B virus (CBV) infection in children with prolonged physical and psychological morbidity. J Psychosom Res. 1989. 33(1):29-36. [Medline].

  54. Yagi S, Schnurr D, Lin J. Spectrum of monoclonal antibodies to coxsackievirus B-3 includes type- and group-specific antibodies. J Clin Microbiol. 1992 Sep. 30(9):2498-501. [Medline]. [Full Text].

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