Children partially paralyzed: Facts on acute flaccid myelitis

Recently making headlines is a rare complication occurring from some viruses called acute flaccid myelitis (AFM). It affects the spinal cord and causes partial paralysis.

There were three new cases of suspected AFM reported in children on Tuesday in Pittsburgh, Pennsylvania. The children are being treated at the UPMC Children’s Hospital of Pittsburgh where they’re currently undergoing diagnostic procedures and treatment.

“Isolation protocols and infection control procedures are in place, and we are working with the CDC and the Allegheny County Health Department to further monitor and evaluate the patient conditions,” according to a UPMC Children’s Hospital spokesperson.

There have been more than 38 cases of AFM reported this year since Sept. 30, from 16 states, according to the Centers for Disease Control and Prevention (CDC).

Since September, six children in Minnesota have been affected, and Colorado has reported 14 cases.

Most of Colorado’s cases are part of an outbreak of enterovirus A71, which is a particular strain of the virus family to which polio belongs, though two children were infected with enterovirus D68, which is also a particular strain of the virus family to which polio belongs. All the Coloradans were hospitalized, and most have recovered.

Over the past four years — August 2014 through August 2018 — the CDC has received information on a total of 262 cases across the U.S., with most cases occurring in children. The CDC estimates that fewer than one in a million will get AFM every year in the United States.

What is Acute Flaccid Myelitis (AFM)?

It’s a rare condition that affects the spinal cord, the part of the nervous system that carries brain instructions to the rest of the body, according to the CDC. AFM is caused by a variety of things such as viruses, environmental toxins, and genetic disorders.

How is it transmitted?

Many of the diseases associated with AFM are transmitted through the digestive system via fecal-hand-oral contamination. The virus then infects cells of the mouth, nose, and throat. It can incubate for up to 14 days.

What are the symptoms?

The symptoms look like a respiratory illness with fever, but some progress to neurologic symptoms begin. Because it affects the spinal cord, most will suddenly have arm or leg weakness and loss of muscle tone and reflexes. However, some will also have the following symptoms:

— facial droop/weakness
— difficulty moving the eyes
— drooping eyelids or difficulty with swallowing or slurred speech

The most severe symptom of an AFM is a respiratory failure when the nerves affect the muscles that move the lungs.

Who is affected?

It predominantly affects children and young adults.

What are the causes?

Common causes include viruses: poliovirus and other enteroviruses, west nile virus, which is commonly transmitted via a mosquito, adenovirus and other environmental toxins and genetic disorders. There are many types of enteroviruses, and a few have been linked to AFM.

How is it diagnosed?

Doctors do a physical exam to determine the involvement of the nervous system. They can also order a magnetic resonance imaging (MRI) to look at the brain and spinal cord, as well as a lab evaluation of the fluid around the brain and spinal cord. A clinician can also look at nerve conduction, how well electrical impulses are flowing along the nerves.

What is the treatment?

There’s no specific treatment for AFM. Supportive care — the same kind of care you give someone with the flu — helps, but a clinician may recommend physical or occupational therapy to help with arm or leg weakness.

How can it be prevented?

Make sure your child gets the poliovirus vaccine. It works. Protect against bites from mosquitoes by using repellent in addition to staying indoors at dusk and dawn. To keep viruses at bay, washing hands often will lower the chance of getting sick or spreading germs.

Dr. Tambetta Ojong is a family medicine resident at SUNY Downstate Medical Center and a member of the ABC News Medical Unit.

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