Enterovirus D68–Associated Acute Flaccid Myelitis in Immunocompromised Woman, Italy

Giombini, Emanuela; Rueca, Martina; Barberi, Walter; Iori, Anna Paola; Castilletti, Concetta; Scognamiglio, Paola; Vairo, Francesco; Ippolito, Giuseppe; Capobianchi, Maria Rosaria; Valli, Maria Beatrice

doi:10.3201/eid2310.170792

Cited by 24 publications

(30 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similar to other neuroinvasive EVs, EV-D68 can readily induce flaccid paralysis in mouse models and has been detected in CSF specimens of patients with AFM, albeit rarely. [18][19][20][21][22][23][24][25][26] In 2014, EV-D68 was the most common virus detected, accounting for 20% of respiratory specimens tested. However, multiple testing strategies (including virus-specific PCR or RT-PCR, broad "family-specific" PCR or RT-PCR, and metagenomic sequencing) did not identify a convincing single etiologic signal in sterile-site specimens.…”

Section: Discussionmentioning

confidence: 99%

Acute Flaccid Myelitis in the United States: 2015–2017

Ayers

Lopez

Lee³

et al. 2019

Pediatrics

View full text Add to dashboard Cite

BACKGROUND: Acute flaccid myelitis (AFM) is a neurologic condition characterized by flaccid limb weakness. After a large number of reports of AFM in 2014, the Centers for Disease Control and Prevention began standardized surveillance in the United States to characterize the disease burden and explore potential etiologies and epidemiologic associations. METHODS: Persons meeting the clinical case criteria of acute flaccid limb weakness from January 1, 2015, through December 31, 2017, were classified as confirmed (spinal cord gray matter lesions on MRI) or probable (white blood cell count .5 cells per mm 3 in cerebrospinal fluid [CSF]). We describe clinical, radiologic, laboratory, and epidemiologic findings of pediatric patients (age #21 years) confirmed with AFM. RESULTS: Of 305 children reported from 43 states, 193 were confirmed and 25 were probable. Of confirmed patients, 61% were male, with a median age of 6 years (range: 3 months to 21 years; interquartile range: 3 to 10 years). An antecedent respiratory or febrile illness was reported in 79% with a median of 5 days (interquartile range: 2 to 7 days) before limb weakness. Among 153 sterile-site specimens (CSF and serum) submitted to the Centers for Disease Control and Prevention, coxsackievirus A16 was detected in CSF and serum of one case patient and enterovirus D68 was detected in serum of another. Of 167 nonsterile site (respiratory and stool) specimens, 28% tested positive for enterovirus or rhinovirus. CONCLUSIONS: AFM surveillance data suggest a viral etiology, including enteroviruses. Further study is ongoing to better characterize the etiology, pathogenesis, and risk factors of this rare condition. c IHRC Inc. contracting agency to the Division of Viral Diseases,

show abstract

Section: Discussionmentioning

confidence: 99%

Acute Flaccid Myelitis in the United States: 2015–2017

Ayers

Lopez

Lee³

et al. 2019

Pediatrics

View full text Add to dashboard Cite

show abstract

“…6,15,18 Some of the reported adult cases have occurred in immunocompromised individuals. 10,19 Several case series have noted a slight male preponderance of cases. 7,12 A retrospective analysis of a small number of cases of AFM suggested independent associations with Asian ancestry, history of asthma, atopic dermatitis, or head injury, 20 although validation in a larger cohort would certainly be required to consider these as risk factors.…”

Section: Epidemiologymentioning

confidence: 99%

Acute Flaccid Myelitis: A Clinical Review

Murphy

Pardo

2020

Semin Neurol

View full text Add to dashboard Cite

Acute flaccid myelitis (AFM) is an emerging disorder primarily affecting children that is characterized by acute flaccid paralysis accompanied by abnormalities of the spinal cord gray matter on magnetic resonance imaging. In most cases, prodromal fever or respiratory symptoms occur, followed by acute-onset flaccid limb weakness. Respiratory, axial, bulbar, facial, and extraocular muscles may also be affected. The clinical manifestations have been described as “polio-like,” due to striking similarities to cases of poliomyelitis. The primary site of injury in AFM is the anterior horn cells of the spinal cord, resulting in a motor neuronopathy. Seasonal peaks of cases have occurred in the United States every 2 years since 2012. However, AFM remains a rare disease, which can make it challenging for physicians to recognize and differentiate from other causes of acute flaccid paralysis such as Guillain–Barre syndrome, spinal cord stroke, and transverse myelitis. Epidemiological evidence suggests that AFM is linked to a viral etiology, with nonpolio enteroviruses (in particular enterovirus D68) demonstrating a plausible association. The epidemiology, possible etiological factors, clinical features, differential diagnosis, treatment, and outcomes of AFM are discussed in this review.

show abstract

“…Simultaneously, similar upsurges were described by groups in Norway, Denmark, Germany, France, Spain, Portugal, Sweden, Wales (United Kingdom), Scotland (United Kingdom) and in the United States ( Dyrdak et al, 2016 ; ECDC, 2016 ; Wang et al, 2017 ). In addition, cases of EV-D68 were also linked with AFM in Wales (2 cases), Scotland (5 cases), England (1 case), Sweden (3 cases), Italy (2 cases), Spain (3 cases), France (at least 1) and Argentina (15 cases) with strains clustering with a divergent B3 lineage ( Antona et al, 2016 ; Dyrdak et al, 2016 , ECDC, 2016 ; PAHO/WHO, 2016 ; Williams et al, 2016 ; Cabrerizo et al, 2017 ; Esposito et al, 2017 ; Giombini et al, 2017 ; Kirolos et al, 2017 ; Stacpoole et al, 2017 ). A subsequent surveillance study ( Knoester et al, 2018 ) presented the results of a survey which found a total of 29 cases reported of EV-D68 infections associated with AFM in Europe in 2016.…”

Section: Introductionmentioning

confidence: 99%

Enterovirus D68 – The New Polio?

et al. 2018

View full text Add to dashboard Cite

Enterovirus D68 (EV-D68) has emerged over the recent years, with large outbreaks worldwide. Increased occurrence has coincided with improved clinical awareness and surveillance of non-polio enteroviruses. Studies showing its neurotropic nature and the change in pathogenicity have established EV-D68 as a probable cause of Acute Flaccid Myelitis (AFM). The EV-D68 storyline shows many similarities with poliovirus a century ago, stimulating discussion whether EV-D68 could be ascertaining itself as the “new polio.” Increasing awareness amongst clinicians, incorporating proper diagnostics and integrating EV-D68 into accessible surveillance systems in a way that promotes data sharing, will be essential to reveal the burden of disease. This will be a necessary step in preventing EV-D68 from becoming a threat to public health.

show abstract

Enterovirus D68–Associated Acute Flaccid Myelitis in Immunocompromised Woman, Italy

Cited by 24 publications

References 15 publications

Acute Flaccid Myelitis in the United States: 2015–2017

Acute Flaccid Myelitis in the United States: 2015–2017

Acute Flaccid Myelitis: A Clinical Review

Enterovirus D68 – The New Polio?

Contact Info

Product

Resources

About