Pleurodynia among football players at a high school. An outbreak associated with coxsackievirus B1.

OBJECTIVE: Enteroviral outbreaks involving athletic teams have been described, although the mode of transmission has been unclear. In September 1991, an outbreak of pleurodynia among high school football players provided an opportunity to identify possible modes of transmission. DESIGN: Retrospective cohort outbreak investigation. SETTING: Public high school in upstate New York. RESULTS: Illness was reported by 17 (20%) of the football players. Behaviors involving contact with common water containers were associated with illness, including eating ice cubes from the team ice chest (relative risk [RR], 9.2; 95% confidence interval [CI], 1.3 to 65.5) and drinking water from the team cooler (RR, 6.3; 95% CI, 1.5 to 25.7). Coxsackievirus B1 was isolated in four (50%) of the eight stool specimens collected. CONCLUSIONS: Contamination of common water containers by an infected player may have contributed to or initiated the outbreak. In addition to discouraging direct oral contact with common drinking containers, use of individual water containers and ice packs for injuries was recommended.

Routine use of mu-antibody-capture ELISA for the serological diagnosis of Coxsackie B virus infections.

The role of coxsackie B viruses (CBV) in myo/pericarditis has been well documented; however, interpretation of static high neutralising antibody titres in individual patients has always been difficult. In introducing the mu-antibody capture ELISA test for the detection of CBV-specific IgM, we hoped to overcome this problem. A regimen for the routine serological diagnosis of CBV infections was introduced, using the CBV IgM ELISA as a screening test, followed by neutralisation tests (NT) to confirm the positive results. Seven hundred and sixty patients and 304 healthy adult controls were tested. The percentage CBV IgM positive in each of the clinical categories myo/pericarditis (33%) chest pain (22%), myalgic encephalomyelitis (31%), myalgia/Bornholm (19%) and controls (9%) was similar to those found in previous studies using NT alone. Cross-reactions with other enteroviruses, including hepatitis A (Enterovirus 72), were observed but did not prove to be a problem in the illness studied, since most involved adults. Both homotypic and heterotypic CBV IgM responses were found. Matching IgM and NT indicated a recent CBV infection. Positive IgM with negative NT titres suggested a recent infection with an enterovirus other than a CBV.

A study of Coxsackie B virus infections, 1972-1983.

The results of a twelve-year study of Coxsackie B virus (CBV) infections in patients with a variety of acute and chronic illnesses are reported. CBVs were isolated from only 123 patients most of whom were children with respiratory illness. Virus diagnosis in adults was based mainly on the detection of significant rising or static high neutralizing antibody titres. Between 1972 and 1979 most investigations centred on patients with suspected viral heart disease, 12% of whom were found to have diagnostically significant CBV titres. In studies on patients with definite myo-pericarditis the number positive increased to 33%. In 1980 clinical interest switched to the possible role of CBV in myalgic encephalomyelitis (ME), an illness of diverse symptomatology. Investigation of suspected cases of ME in 1983 showed that 16% were serologically positive compared to 4% of normal adults in the West of Scotland. In patients with well-documented ME this figure rose to 41%. The demand by clinicians for CBV neutralizing antibody tests has increased over the past twelve years and continues to escalate annually, especially in patients with chronic relapsing illness.

Myalgia nuchae as a manifestation of epidemic influenza.

Two cases of acute cervical myalgia in connection with symptoms of malaise and fever are presented. Both patients had serologically proven influenza infections, types A and B. No previous reports have been found of any association of the present syndrome with influenza infection.

Epidemic pleurodynia (Bornholm disease) outbreak in Singapore. A clinical and virological study.

In 1974, an outbreak of Bornholm disease occurred in Singapore. The period 1st May to 31st July was delineated for study. From the clinical presentation 53 patients were placed into two categories "typical Bornholm disease" and "atypical Bornholm disease". The clinical features of only those in the "typical Bornholm disease" group including those with positive Coxsackie B3 virus isolation were described. The virological studies, both faecal isolation for virus and serology were correlated with clinical diagnosis. Fever and characteristic abdominal or chest pain appear to be constant features of Bornholm disease. Positive faecal virus isolation are significantly high in the "typical Bornholm disease" group. Bornholm disease could be diagnosed clinically with fair accuracy. The importance of diagnosing Bornholm disease is emphasized.

Association of group B coxsackie viruses with cases of pericarditis, myocarditis, or pleurodynia by demonstration of immunoglobulin M antibody.

Tests for immunoglobulin M (IgM) antibody to group B coxsackieviruses were performed on sera from 259 patients with a clinical diagnosis of pericarditis, myocarditis, or pleurodynia on whom there were no definitive serological or virus isolation findings to establish a viral etiology, and on 259 "control" patients with clinical diagnoses of viral or mycoplasmal pneumonia or pneumonitis. IgM antibodies to coxsackievirus types B1, B3, B4, B5, and B6 were detected by a micro-immunodiffusion technique, and antibodies to virus type B2 were detected by reduction of neutralizing antibodies with ethanethiol. Of the patients with pericarditis, myocarditis, or pleurodynia, 27% (70) had IgM antibody to group B coxsackieviruses, as compared with 8% in the control group. On retrospective review of the clinical diagnosis, some of the patients in the control group with IgM antibody were found to have had additional clinical findings which could be attributed to a coxsackievirus infection. Coxsackievirus IgM antibody was demonstrable in 30% of 113 patients in the study group for whom virus isolation had been attempted with negative results. The presence of coxsackievirus IgM is discussed in relation to the time of serum collection, age of the patients, and month of onset of illness.