Clinical Features of Acute Flaccid Myelitis Temporally Associated With an Enterovirus D68 Outbreak: Results of a Nationwide Survey of Acute Flaccid Paralysis in Japan, August–December 2015

Abstract

Fifty-nine acute flaccid myelitis cases were reported nationwide, coincident with enterovirus D68 (EV-D68) outbreak from August to December 2015. Strong temporal association was noted, and EV-D68 was detected from some cerebrospinal fluid and blood specimens. Antiganglioside antibodies were identified in some patients, and prognostic factors were analyzed.

Comparative quantitative clinical, neuroimaging, and functional profiles in children with acute flaccid myelitis at acute and convalescent stages of disease

“…9 In contrast to previously reported US cohorts, our patients were notably younger, with a median age at onset of 4 years compared with the California and Colorado reports where the median age at onset was 7 years but similar to the recently described Japanese cohort. 2,9 New in this series, we present quantitative clinical and imaging profiles that may help distinguish AFM from other myelopathies also presenting in childhood, especially inflammatory myelopathies (e.g. demyelinating, autoimmune, or postinfectious) and spinal cord ischaemia.…”

“…2,18 At this time, no causal link implicating EV-D68 as the aetiological agent for AFM has been established. Current evidence rests on a temporal association between cases and an epidemiological rise in community cases, 9 EV-D68 detection mostly in nasopharyngeal secretions in a small percentage of AFM cases and exclusion of other infectious aetiologies, including poliovirus and West Nile virus. 9,10 Of note, also in the AFM temporal profile is the hyperacute onset of neurological symptoms reaching nadir within 6 hours.…”

“…Current evidence rests on a temporal association between cases and an epidemiological rise in community cases, 9 EV-D68 detection mostly in nasopharyngeal secretions in a small percentage of AFM cases and exclusion of other infectious aetiologies, including poliovirus and West Nile virus. 9,10 Of note, also in the AFM temporal profile is the hyperacute onset of neurological symptoms reaching nadir within 6 hours. Spinal cord ischaemia also presents with a hyperacute onset of flaccid paresis/paralysis and grey matter involvement, but, unlike AFM, it is generally accompanied by sensory or bowel/bladder dysfunction and is rarely associated with upper respiratory infection symptoms or moderate pleocytosis.…”

Pial arteriovenous fistula of the spine in a child with hemiplegia

“…Moreover, we administered intravenous immunoglobulin for AFM or GBS. In 2015, a series of AFM cases were reported, which prompted us to suspect AFM in this case .…”

Respiratory illness and acute flaccid myelitis in the Tokai district in 2018

“…[2][3][4] Previous studies have shown that the peak incidences of AFM and severe respiratory illness coincide. 5 In Japan, an EV-D68 outbreak occurred in the autumn of 2015 in association with a cluster of AFM cases 6 and an increased level of severe respiratory illness. 7 The outbreak first presented as increased numbers of children with severe respiratory illness and / or asthma exacerbation.…”