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Acute flaccid myelitis and enterovirus D68: lessons from the past and present
Jelte Helfferich1, Marjolein Knoester2, Coretta C Van Leer-Buter2
1Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30001, 9700 RB, Groningen, The Netherlands. j.helfferich@umcg.nl.
Abstract:
Acute flaccid myelitis is characterized by the combination of acute flaccid paralysis and a spinal cord lesion largely restricted to the gray matter on magnetic resonance imaging. The term acute flaccid myelitis was introduced in 2014 after the upsurge of pediatric cases in the USA with enterovirus D68 infection. Since then, an increasing number of cases have been reported worldwide. Whereas the terminology is new, the clinical syndrome has been recognized in the past in association with several other neurotropic viruses such as poliovirus.Conclusion: This review presents the current knowledge on acute flaccid myelitis with respect to the clinical presentation and its differential diagnosis with Guillain-Barré syndrome and acute transverse myelitis. We also discuss the association with enterovirus D68 and the presumed pathophysiological mechanism of this infection causing anterior horn cell damage. Sharing clinical knowledge and insights from basic research is needed to make progress in diagnosis, treatment, and prevention of this new polio-like disease. What is Known: • Acute flaccid myelitis (AFM) is a polio-like condition characterized by rapid progressive asymmetric weakness, together with specific findings on MRI • AFM has been related to different viral agents, but recent outbreaks are predominantly associated with enterovirus D68. What is New: • Improving knowledge on AFM must increase early recognition and adequate diagnostic procedures by clinicians. • The increasing incidence of AFM urges cooperation between pediatricians, neurologists, and microbiologists for the development of treatment and preventive options.
Insights
Acute flaccid myelitis (AFM) is a polio-like illness causing paralysis and spinal cord lesions, often linked to enterovirus D68. Increased knowledge and collaboration are vital for early recognition, diagnosis, and treatment of this emerging disease.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Acute flaccid myelitis (AFM) is a rare neurological condition characterized by acute flaccid paralysis and spinal cord lesions.
- The term AFM gained prominence in 2014 following a surge in pediatric cases associated with enterovirus D68.
- AFM shares clinical similarities with poliovirus infections, highlighting its polio-like nature.
Purpose of the Study:
- To review current knowledge on the clinical presentation and diagnosis of AFM.
- To discuss the differential diagnosis of AFM, including Guillain-Barré syndrome and acute transverse myelitis.
- To explore the association between AFM and enterovirus D68, including its presumed pathophysiological mechanisms.
Main Methods:
- Literature review of clinical presentations and diagnostic findings for AFM.
- Comparative analysis of AFM with Guillain-Barré syndrome and acute transverse myelitis.
- Discussion of enterovirus D68's role and proposed mechanisms in AFM pathogenesis.
Main Results:
- AFM presents as rapid, progressive, asymmetric weakness with characteristic MRI findings.
- Enterovirus D68 is a predominant viral agent linked to recent AFM outbreaks.
- Understanding AFM requires integrating clinical insights with basic research findings.
Conclusions:
- Enhanced clinical recognition and diagnostic procedures are crucial for managing AFM.
- The rising incidence of AFM necessitates interdisciplinary collaboration for effective treatment and prevention strategies.
- Continued research is essential for advancing the diagnosis, treatment, and prevention of this polio-like disease.
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