acute neurologic illness with limb paralysis; acute flaccid myelitis (AFM)
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Etiology
- enteroviruses play a role in the etiology of acute flaccid myelitis[10]
- enterovirus D68 20% (< 1%), enterovirus A71 (< 1%)[5]
- enteroviruses or rhinoviruses in 22%[2], 54%[5]
- enterovirus & rhinovirus detected in 36% of respiratory samples tested at the CDC; 69% of these were enterovirus D68[9]
- no cases of poliovirus[4]
- adenoviruses[3]
- West Nile virus[3][9]
- arechovirus, mycoplasma, Epstein-Barr virus, human herpesvirus 6[9]
Epidemiology
- children
- 51 cases in children in 23 states (2014)
- possible cluster of AFM in Washington state fall 2016[3]
- 2 confirmed cases, 7 suspected cases under evaluation[3]
- 106 cases in 29 states Nov 2018
- 158 cases in 33 states have been confirmed Dec 2018[7][8]
- 186 cases in 39 states as of Dec 28, 2018[8]
- 193 confirmed pediatric cases from 41 states
Clinical manifestations
- most patients have fever or respiratory symptoms 3-10 days prior to developing limb weakness[5]
- 83% of patients report symptoms before onset of AFM, including respiratory (66%) & gastrointestinal (29%).
- acute onset of focal limb weakness
- 45% of patients hwith 3 or 4 limbs involved[9]
- 36% present with quadriplegia[9]
- 33% require mechanical ventilation[9]
- 36% of patients without improvement in clinical status after 3 weeks[2]
Diagnostic criteria
- age 21 years or younger
- acute onset of focal limb weakness; onset on Aug. 1, 2014 or later
- MRI showing a spinal cord lesion largely restricted to gray matter
Diagnostic procedures
- lumbar puncture with CSF analysis
- no enterovirus or other pathogen[2]
Radiology
- MRI of spinal cord
- spinal cord lesion largely restricted to gray matter
- cervical spine abnormalities in 80%[9]
- brain MRI shows brainstem abnormalities in 38%[9]
Complications
Management
- supportive
- prognosis: spectrum of recovery is highly variable
More general terms
References
- ↑ Centers for Disease Control and Prevention (CDC) Investigation of Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children, Fall 2014. http://www.cdc.gov/ncird/investigation/viral/sep2014.html
- ↑ 2.0 2.1 2.2 2.3 2.4 Sofair A, Chavey WE Cause of Acute Limb Paralysis in Children Still Unknown Physician's First Watch, Jan 9, 2015 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
Centers for Disease Control and Prevention (CDC) Notes from the Field: Acute Flaccid Myelitis Among Persons Aged <=21 Years - United States, August 1-November 13, 2014 MMWR Weekly. January 9, 2015 / 63(53);1243-1244 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6353a3.htm - ↑ 3.0 3.1 3.2 3.3 3.4 Washington State Department of Health AFM Investigation. Nov 2, 2016 http://www.doh.wa.gov/Emergencies/AFMInvestigation
- ↑ 4.0 4.1 Young K, Fairchild DG, Di Francesco L Acute Flaccid Myelitis Cases Confirmed in 22 States Physician's First Watch, Oct 17, 2018 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org https://www.cdc.gov/acute-flaccid-myelitis/afm-surveillance.html
- ↑ 5.0 5.1 5.2 5.3 McKay SL, Lee AD, Lopez AS, et al. Increase in Acute Flaccid Myelitis - United States, 2018. MMWR Morb Mortal Wkly Rep. ePub: 13 November 2018 https://www.cdc.gov/mmwr/volumes/67/wr/mm6745e1.htm
- ↑ Centers for Disease Control and Prevention (CDC) CDC Establishes AFM Task Force. CDC Press Releas. Nov 19, 2018 https://www.cdc.gov/media/releases/2018/p1119-cdc-establishes-afm-task-force.html
- ↑ 7.0 7.1 Centers for Disease Control and Prevention (CDC) Weekly Update for Number of U.S. AFM Cases. Dec 3, 2018 https://www.cdc.gov/media/releases/2018/s1203-us-afm-case.html
- ↑ 8.0 8.1 8.2 Lopez A, Lee A, Guo A et al. Vital Signs: Surveillance for Acute Flaccid Myelitis - United States, 2018. MMWR Morb Mortal Wkly Rep. ePub: 9 July 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31295232 https://www.cdc.gov/mmwr/volumes/68/wr/mm6827e1.htm
- ↑ 9.0 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9 Ayers T, Lopez A, Lee A et al. Acute flaccid myelitis in the United States: 2015-2017. Pediatrics 2019 Oct 7; PMID: https://www.ncbi.nlm.nih.gov/pubmed/31591135 https://pediatrics.aappublications.org/content/early/2019/10/03/peds.2019-1619
- ↑ 10.0 10.1 Schubert RD, Hawes IA, Ramachandran PS et al Pan-viral serology implicates enteroviruses in acute flaccid myelitis. Nature Medicine (2019). Oct 21. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31636453 https://www.nature.com/articles/s41591-019-0613-1
- ↑ Centers for Disease Control and Prevention (CDC) Acute Flaccid Myelitis Home. AFM Investigation AFM in the United States. AFM Investigation https://www.cdc.gov/acute-flaccid-myelitis/afm-surveillance.html