Acute flaccid myelitis and enterovirus D68
Acute flaccid myelitis and enterovirus D68
Polio or poliomyelitis has affected many people in the previous century. Through the implementation of an effective vaccine against poliovirus, it nowadays only rarely occurs. However, in the past decade, children were seen with a similar condition caused by other viruses, such as enterovirus D68. This condition, which may be associated with severe paralysis, is called ‘acute flaccid myelitis’ (AFM), independent of the causative virus. In 2016, the first children in the Netherlands were diagnosed with AFM. These children developed severe weakness of their limbs, while respiratory and bulbar muscles were also affected in some. All these children were vaccinated against polio and no poliovirus was found. Instead, enterovirus D68 was detected in respiratory material in several of them. This virus usually causes a respiratory tract infection, which may be severe. However, in rare cases it can damage anterior horn cells in the spinal cord, thereby causing paralysis.AFM is rare, with approximately two cases per year in the Netherlands. For doctors, it is difficult to recognize and differentiate it from other conditions, that also cause rapidly progressive weakness. Therefore, we aimed to find clinical and diagnostic features that may help in making the right diagnosis. Collaboration between neurologists and microbiologists is essential for this. There is currently no effective treatment, but differentiation with conditions that are treatable is important. We must remain aware of AFM and monitor new cases. This will hopefully create opportunities for treatment and possibly prevention through vaccination.