Severe Acute Flaccid Myelitis Associated With Enterovirus in Children: Two Phenotypes for Two Evolution Profiles?

Abstract

Acute flaccid myelitis (AFM) is an acute paralysis syndrome defined by a specific inflammation of the anterior horn cells of the spinal cord. From 2014, worrying waves of life-threatening AFM consecutive to enterovirus infection (EV-D68 and EV-A71) have been reported. We describe 10 children displaying an AFM with an EV infection, the treatments performed and the 1 to 3-years follow-up. Two groups of patients were distinguished: 6 children ("polio-like group") had severe motor disability whereas 4 other children ("brainstem group") displayed severe brainstem weakness requiring ventilation support. Electrodiagnostic studies (n = 8) support the presence of a motor neuronopathy associated to myelitis. The best prognosis factor seems to be the motor recovery after the first 4 weeks of the disease.

Re-emergence of enterovirus D68 in Europe after easing the COVID-19 lockdown, September 2021

“…We recommend sequence analysis of EV-D68 to determine the relatedness of viruses circulating in Europe, and their potential link to a novel B3 subclade reported in 2019 [7]. The existing surveillance systems as well as laboratory and clinical networks relating to EV-D68 should be activated as this infection can have severe consequences [17][18][19][20].…”

Acute Flaccid Myelitis: Review of Clinical Features, Diagnosis, and Management with Nerve Transfers

“…After removal of duplicates and initial screening, 500 were reviewed and assessed for eligibility. After application of inclusion and exclusion criteria, 99 articles were included in this study (55 case reports/series, 1,4–7,9–57 33 retrospective cohort studies, 2,3,58–88 seven cross-sectional studies, 89–95 and four case-control studies 96–99 ) (Fig. 1).…”

“…4–7 Many patients also report cranial nerve involvement and neck/trunk weakness. 1,5,7,13,14,20,23,25,33,49,52,54,58,61,77,87 The most severe manifestation of weakness in AFM is respiratory failure from phrenic nerve involvement necessitating mechanical ventilation.…”

Thermal stabilization of enterovirus A 71 and production of antigenically stabilized empty capsids

“…Enterovirus A 71 (EVA71) is the primary causative agent of hand, foot and mouth disease (HFMD), a generally mild, self-limiting condition affecting young children. In severe cases the disease can present with neurological complications reminiscent of poliomyelitis [1–4]. The financial and humanitarian cost associated with HFMD has encouraged the development of a number of vaccines against EVA71.…”