SEP 08, 2019 2:33 PM PDT

Acute Flaccid Myelitis and Its Association With Enterovirus D68

WRITTEN BY: Dena Aruta

Acute flaccid myelitis (AFM), a polio-like infection, caught the attention of physicians in the U.S. during late summer and early fall in 2014. The outbreak was characterized by severe lower respiratory infections with paralysis and respiratory failure in a small subset of affected children. The CDC began tracking cases of AFM in August 2014, and there have been 587 confirmed cases to date. It is still unclear why only a small number of children get this disease, and a definitive etiology has not yet been determined. However, there is growing evidence that enterovirus D68 (EV-D68) is associated with AFM. The video below gives a brief overview of AFM:

 

group of researchers at the Children's Hospital of Philadelphia (CHOP) led by P. Uprety, MSPH, Ph.D.analyzed the prevalence of EV-D68 in children with AFM at CHOP between 2009-2018. Due to the paucity of longitudinal studies of the evolution of the virus, They also performed whole-genome sequencing (WGS) to track the occurrence of any mutations from year-to-year. 

During the 10-year surveillance of EV-D68 and AFM at CHOP, the researchers found that there was a peak in the circulation of the virus during even years except for a peak in 2009 and absence between 2010-2011. Half of the specimens tested were taken from samples stored in the laboratory. Also, AFM peaked during the same times in the study population with a correlation between the number of AFM cases and prevalence of EV-D68. 

In order to determine which clades of EV-D68 were present in the CHOP specimens, they performed WGS from 26 specimens of children without AFM and four diagnosed with AFM as well as completing polyprotein sequences from 28 of the 30 samples. Analyses revealed the presence of A and C clades in the 2009 specimens and one specimen containing the B1 clade. The B3 clade was introduced between 2014-2016, which probably emerged rather than evolved from an ancestor of B1. The implications of this finding suggest that in 2020 there may be another clade that emerges making future surveillance vital.  

One of the major controversies surrounding EV-D68 being the causative agent of AFM is the inability to isolate it from CSF specimens even though the disease affects the gray matter of the spinal cord. Other viruses may be involved including EV-A71 and coxsackievirus A16; all stool specimens tested from patients with AFM have been negative for poliovirus. 

 

About the Author
  • After earning my Bachelor of Science degree in biology/chemistry from Virginia Polytechnic Institute and State University (aka Va. Tech), I went on to complete clinical rotations in laboratory medicine at Roanoke Memorial Hospital. I spent the next 21 years working in healthcare as a clinical microbiologist. In 2015, I combined my fascination with medicine and passion for writing into a freelance career, and I haven't looked back. Even though my expertise is in microbiology and infectious diseases, I'm adept at writing about any medical topic. Being a freelance writer allows me to pursue a career where I can work at home with my two feline assistants, Luke and Grace. I'm a firm supporter of animal rights and volunteer for a local rescue during my free time. 
You May Also Like
JAN 26, 2020
Clinical & Molecular DX
JAN 26, 2020
Can Google Health's AI interpret X-rays as well as radiologists?
Patients presenting with severe coughs, chest pain or suspected infections are more than likely to be sent for a chest X-ray -- the most commonly taken med...
JAN 26, 2020
Genetics & Genomics
JAN 26, 2020
A New Type of Muscle Cell That Could be a Target for Gene Therapy is ID'ed
Muscles have a supply of restorative stem cells called satellite cells, and now they have identified a new type....
JAN 26, 2020
Earth & The Environment
JAN 26, 2020
La Niña is associated with higher incidence of life-threatening diarrhea
Findings published recently in the journal Nature Communications suggest that La Niña climate conditions are linked to an increase in the incidence ...
JAN 26, 2020
Genetics & Genomics
JAN 26, 2020
Making Bad Fat Turn Good
Researchers want to turn unhealthy white fat, which stores calories, to healthier brown or beige fat that burns calories....
JAN 26, 2020
Cell & Molecular Biology
JAN 26, 2020
Changing Two Cellular Pathways Extends Lifespan Significantly
Altering two signaling pathways extended the lives of a research model called C elegans by an astonishing 500 percent....
JAN 26, 2020
Neuroscience
JAN 26, 2020
A Quarter of Children with Autism are Left Undiagnosed
Researchers from Rutgers University have found that 25% of children under the age of 8 with autism in the US are left undiagnosed, something that may be a ...
Loading Comments...