The enteroviruses are spread through fecal-oral transmission. Outbreaks of this infection have been reported, included a well-documented outbreak in Oxford. Children are more commonly affected, but the attack rate among household members is high.
The usual incubation period is 2-5 days. Patients then develop paroxysmal, sharp, spasmodic pain of the skeletal muscles. Pain is usually most prominent in the chest. Pain may also occur in the muscles of the abdomen, and in some patients, other muscle groups are involved. Most patients have fever and headache. The severity of the pain varies, and is usually worse in adult patients. Pleural friction rubs are not common.
Symptoms improve after 4-6 days, except in a minority of patients in whom symptoms may persist for weeks or in whom symptoms may recur after a symptom-free period of weeks.
B33.0 – Epidemic myalgia
83264000 – Epidemic Pleurodynia
Differential Diagnosis & Pitfalls
- Pneumonia – Patients may have fever and chest pain. Chest x-ray may be obtained.
- Pulmonary embolism – Patients may have fever and chest pain. Chest CT scan may be obtained.
- Acute coronary syndrome – May be considered in patients with chest pain.
- Herpes zoster infection – May present with pain, often with allodynia. Typical skin lesions may be present or may develop shortly after presentation.
- Appendicitis, cholecystitis, or other causes of acute abdomen – Abdominal pain may be similar, and imaging studies may be necessary to establish a diagnosis.