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Acute Flaccid Myelitis: Something Old and Something New
David M Morens1, Gregory K Folkers1, Anthony S Fauci2
1National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
Abstract:
Since 2014, acute flaccid myelitis (AFM), a long-recognized condition associated with polioviruses, nonpolio enteroviruses, and various other viral and nonviral causes, has been reemerging globally in epidemic form. This unanticipated reemergence is ironic, given that polioviruses, once the major causes of AFM, are now at the very threshold of global eradication and cannot therefore explain any aspect of AFM reemergence. Instead, the new AFM epidemic has been temporally associated with reemergences of nonpolio enteroviruses such as EV-D68, until recently thought to be an obscure virus of extremely low endemicity. This perspective reviews the enigmatic epidemiologic, virologic, and diagnostic aspects of epidemic AFM reemergence; examines current options for clinical management; discusses future research needs; and suggests that the AFM epidemic offers important clues to mechanisms of viral disease emergence.
Insights
Acute flaccid myelitis (AFM) is reemerging globally, driven by nonpolio enteroviruses like EV-D68, not polioviruses. This epidemic offers insights into viral disease emergence mechanisms.
Area of Science:
- Neurology
- Epidemiology
- Virology
Background:
- Acute flaccid myelitis (AFM) is a recognized neurological condition.
- AFM reemergence globally since 2014 is linked to nonpolio enteroviruses, particularly EV-D68.
- Polio eradication efforts do not explain the current AFM epidemic.
Purpose of the Study:
- To review the epidemiology, virology, and diagnostics of epidemic AFM.
- To examine clinical management options for AFM.
- To discuss future research needs in AFM.
Main Methods:
- Review of epidemiological data on AFM outbreaks.
- Analysis of virologic findings associated with AFM.
- Examination of diagnostic approaches for AFM.
Main Results:
- The current AFM epidemic is associated with nonpolio enteroviruses, notably EV-D68.
- Polio viruses are not the cause of the recent AFM reemergence.
- Understanding EV-D68's role is crucial for AFM management.
Conclusions:
- The reemergence of AFM highlights the complex nature of viral disease emergence.
- Further research is needed to understand the mechanisms behind EV-D68-associated AFM.
- Effective clinical management strategies for AFM require further development.
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