Association of outcomes in acute flaccid myelitis with identification of enterovirus at presentation: a Canadian, nationwide, longitudinal study

Yea, Carmen; Bitnun, Ari; Branson, Helen M.; Ciftci-Kavaklioglu, Beyza; Rafay, Mubeen F.; Fortin, Olivier; Moresoli, Paola; Sébire, Guillaume; Srour, Myriam; Decaluwe, Hélène; Marois, Louis; Pelletier, Félixe; Barton, Michelle; Nouri, Maryam Nabavi; Brophy, Jason; Venkateswaran, Sunita; Pohl, Daniela; Selby, Kathryn; Jones, Kay S.; Robinson, Joan; Mineyko, Aleksandra; Licht, Christoph; Ertl‐Wagner, Birgit; Yeh, E. Ann

doi:10.1016/s2352-4642(20)30176-0

Cited by 10 publications

(20 citation statements)

References 21 publications

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“…In addition, patients with EV‐D68 more often had dyspnea and bronchodilation treatment, compared to patients infected with other EV and RV types. Our and other findings on the disease severity of EV‐D68 infections highlight the importance of surveillance of this pathogen 4,13–15 …”

Section: Discussionsupporting

confidence: 66%

“…[10][11][12] Thus, EV-D68, which was previously considered a virus causing mild upper respiratory disease, has recently been shown to cause large outbreaks of more severe disease with complications such as acute flaccid myelitis. 4,[13][14][15] Likewise, members belonging to species RV C have been shown to cause more severe upper and lower respiratory diseases than those belonging to RV types A or B. 16 However, there are conflicting results regarding the pathogenicity of different types of EVs.…”

mentioning

confidence: 99%

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Epidemiology and clinical manifestations of different enterovirus and rhinovirus types show that EV‐D68 may still have an impact on severity of respiratory infections

Larsson

Vracar

Karlsson

et al. 2022

Journal of Medical Virology

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Respiratory infections are often caused by enteroviruses (EVs). The aim of this study was to identify whether certain types of EV were more likely to cause severe illness in 2016, when an increasing spread of upper respiratory infections was observed in Gothenburg, Sweden. The EV strain in 137 of 1341 nasopharyngeal samples reactive for EV by polymerase chain reaction could be typed by sequencing the viral 5′-untranslated region and VP1 regions.Phylogenetic trees were constructed. Patient records were reviewed. Hospital care was needed for 46 of 74 patients with available medical records. The majority of the patients (83) were infected with the rhinovirus (RV). The remaining 54 were infected with EV A, B, C, and D strains of 13 different types, with EV-D68 and CV-A10 being the most common (17 vs. 14). Significantly more patients with EV-D68 presented with dyspnea, both when compared with other EV types (p = 0.003) and compared to all other EV and RV infections (p = 0.04). Phylogenetic analysis of the sequences revealed the spread of both Asian and European CV-A10 strains and 12 different RV C types. This study showed an abundance of different EV types spreading during a year with increased upper respiratory increased infections. EV-D68 infections were associated with more severe disease manifestation. Other EV and RV types were more evenly distributed between hospitalized and nonhospitalized patients. The EV type CV-A10 was also found in infected patients, which warrants further studies and surveillance, as this pathogen could cause more severe disease and outbreaks of hand, foot, and mouth disease.

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Section: Discussionsupporting

confidence: 66%

mentioning

confidence: 99%

Epidemiology and clinical manifestations of different enterovirus and rhinovirus types show that EV‐D68 may still have an impact on severity of respiratory infections

Larsson

Vracar

Karlsson

et al. 2022

Journal of Medical Virology

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“…Two others analyses have also concluded that the Bradford Hill criteria support a causative relationship between EV-D68 and AFM in humans [39,168]. Moreover, these facts may explain the high prevalence of EV-D68 in AFM, which corroborates with the high prevalence of 22.5 and 27.8 observed in California from 2012 to 2015 [118] and in Canada in 2014 and 2018 [127], respectively.…”

Section: Plos Neglected Tropical Diseasesmentioning

confidence: 78%

“…Seven deaths in patients with ARI were reported among 1353 participants in two included studies conducted in the United Kingdom and USA [ 20 , 58 ]. The CFR due to EV-D68 infections ranged from 0 to 4.4% in the 10 included studies with a combined random effect rate of 0.0% (95% CI: 0.0–0.1) ( Fig 3 )[ 18 , 20 , 53 , 58 , 59 , 65 , 102 , 112 , 113 , 127 ]. No statistical heterogeneity was observed in the overall estimate of the CFR (I2 = 27.5% [0.0%; 65.2%]).…”

Section: Resultsmentioning

confidence: 99%

Global prevalence and case fatality rate of Enterovirus D68 infections, a systematic review and meta-analysis

et al. 2022

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A substantial amount of epidemiological data has been reported on Enterovirus D68 (EV-D68) infections after the 2014 outbreak. Our goal was to map the case fatality rate (CFR) and prevalence of current and past EV-D68 infections. We conducted a systematic review (PROSPERO, CRD42021229255) with published articles on EV-68 infections in PubMed, Embase, Web of Science and Global Index Medicus up to January 2021. We determined prevalences using a model random effect. Of the 4,329 articles retrieved from the databases, 89 studies that met the inclusion criteria were from 39 different countries with apparently healthy individuals and patients with acute respiratory infections, acute flaccid myelitis and asthma-related diseases. The CFR estimate revealed occasional deaths (7/1353) related to EV-D68 infections in patients with severe acute respiratory infections. Analyses showed that the combined prevalence of current and past EV-D68 infections was 4% (95% CI = 3.1–5.0) and 66.3% (95% CI = 40.0–88.2), respectively. The highest prevalences were in hospital outbreaks, developed countries, children under 5, after 2014, and in patients with acute flaccid myelitis and asthma-related diseases. The present study shows sporadic deaths linked to severe respiratory EV-D68 infections. The study also highlights a low prevalence of current EV-D68 infections as opposed to the existence of EV-D68 antibodies in almost all participants of the included studies. These findings therefore highlight the need to implement and/or strengthen continuous surveillance of EV-D68 infections in hospitals and in the community for the anticipation of the response to future epidemics.

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“…Although a negative result does not exclude AFM, there is emerging evidence that virus detection is associated with more severe illness and poor recovery. 30 Serum testing to evaluate for alternative diagnoses should include anti-MOG IgG and NMO IgG. Depending on the geographic location, serum and CSF antibody testing for West Nile Virus should be considered.…”

Section: Diagnostic Testingmentioning

confidence: 99%

A Review of the Diagnosis and Management of Acute Flaccid Myelitis in the Emergency Department

Daniels¹,

Conners

2022

Pediatr Emer Care

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Since 2014, biennial rises in acute flaccid myelitis (AFM) have brought attention to this rare but debilitating condition. Children with AFM typically present with acute onset, flaccid weakness accompanied by longitudinally extensive gray matter injury demonstrated on magnetic resonance imaging. A clearer understanding of the epidemiology and suspected pathogenesis of AFM may result in increased recognition. The purpose of this review article is to guide emergency physicians in recognizing key clinical features, initiating diagnostic evaluation and providing appropriate interventions for children with suspected AFM.

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Association of outcomes in acute flaccid myelitis with identification of enterovirus at presentation: a Canadian, nationwide, longitudinal study

Cited by 10 publications

References 21 publications

Epidemiology and clinical manifestations of different enterovirus and rhinovirus types show that EV‐D68 may still have an impact on severity of respiratory infections

Epidemiology and clinical manifestations of different enterovirus and rhinovirus types show that EV‐D68 may still have an impact on severity of respiratory infections

Global prevalence and case fatality rate of Enterovirus D68 infections, a systematic review and meta-analysis

A Review of the Diagnosis and Management of Acute Flaccid Myelitis in the Emergency Department

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