And lastly is pleurodynia. This is an interesting disease historically and also interesting because the diagnosis doesn’t get made. It has names such as Bornholm disease because of the island where it was seen, and devils grip because it gives acute chest pain, excruciating chest pain, which lasts for a few minutes and then goes away and then comes back again. Many cases of adults who are thought to have heart attacks in actual fact have pleurodynia. In children they are less likely to have chest pain or the chest pain can’t be differentiated from abdominal pain and it appears like an acute abdomen. This can come and go and really confuse people and surgeons, and certainly cardiologists.
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The next is gastrointestinal disease and since these are enteroviruses, when you discuss gastroenteritis somebody always says enterovirus. Yet a little bit of loose stool or nausea and vomiting is common. But as a cause of diarrhea without other manifestations, enteroviruses are actually quite rare. They have been statistically related with some outbreaks but by and large compared to Rotavirus for example, or Norwalk virus, are not a major cause of either diarrhea disease or nausea and vomiting. It’s funny that you have diarrhea and constipation here but after a day or two, roughly 30% of children with EcHO-9 have constipation. More importantly is abdominal pain relating to pleurodynia but also situations that look like appendicitis but aren’t, but you can also have appendicitis just due to enterovirus infections. You can have peritonitis, mesenteric adenitis. Of causes of intussusception this has become popular because of the association with Rotavirus vaccine. But both enteroviruses in the summertime are probably the most common known cause of intussusception and adenoviruses at other times of the year.
Hepatitis, severe hepatitis in neonates otherwise is not common. Other findings, pancreatitis and there is a tie with juvenile-onset diabetes and coxsackie B infections including isolation of the virus from the pancreas in fatal cases.