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Clinical Features of Acute Flaccid Myelitis Temporally Associated With an Enterovirus D68 Outbreak: Results of a Nationwide Survey of Acute Flaccid Paralysis in Japan, August–December 2015

BACKGROUND: Acute flaccid myelitis (AFM) is an acute flaccid paralysis syndrome with spinal motor neuron involvement of unknown etiology. We investigated the characteristics and prognostic factors of AFM clusters coincident with an enterovirus D68 (EV-D68) outbreak in Japan during autumn 2015. METHO...

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Autores principales: Chong, Pin Fee, Kira, Ryutaro, Mori, Harushi, Okumura, Akihisa, Torisu, Hiroyuki, Yasumoto, Sawa, Shimizu, Hiroyuki, Fujimoto, Tsuguto, Hanaoka, Nozomu, Kusunoki, Susumu, Takahashi, Toshiyuki, Oishi, Kazunori, Tanaka-Taya, Keiko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5850449/
https://www.ncbi.nlm.nih.gov/pubmed/29028962
http://dx.doi.org/10.1093/cid/cix860
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author Chong, Pin Fee
Kira, Ryutaro
Mori, Harushi
Okumura, Akihisa
Torisu, Hiroyuki
Yasumoto, Sawa
Shimizu, Hiroyuki
Fujimoto, Tsuguto
Hanaoka, Nozomu
Kusunoki, Susumu
Takahashi, Toshiyuki
Oishi, Kazunori
Tanaka-Taya, Keiko
author_facet Chong, Pin Fee
Kira, Ryutaro
Mori, Harushi
Okumura, Akihisa
Torisu, Hiroyuki
Yasumoto, Sawa
Shimizu, Hiroyuki
Fujimoto, Tsuguto
Hanaoka, Nozomu
Kusunoki, Susumu
Takahashi, Toshiyuki
Oishi, Kazunori
Tanaka-Taya, Keiko
author_sort Chong, Pin Fee
collection PubMed
description BACKGROUND: Acute flaccid myelitis (AFM) is an acute flaccid paralysis syndrome with spinal motor neuron involvement of unknown etiology. We investigated the characteristics and prognostic factors of AFM clusters coincident with an enterovirus D68 (EV-D68) outbreak in Japan during autumn 2015. METHODS: An AFM case series study was conducted following a nationwide survey from August to December 2015. Radiographic and neurophysiologic data were subjected to centralized review, and virology studies were conducted for available specimens. RESULTS: Fifty-nine AFM cases (58 definite, 1 probable) were identified, including 55 children and 4 adults (median age, 4.4 years). The AFM epidemic curve showed strong temporal correlation with EV-D68 detection from pathogen surveillance, but not with other pathogens. EV-D68 was detected in 9 patients: 5 in nasopharyngeal, 2 in stool, 1 in cerebrospinal fluid (adult case), and 1 in tracheal aspiration, nasopharyngeal, and serum samples (a pediatric case with preceding steroid usage). Cases exhibited heterogeneous paralysis patterns from 1- to 4-limb involvement, but all definite cases had longitudinal spinal gray matter lesions on magnetic resonance imaging (median, 20 spinal segments). Cerebrospinal fluid pleocytosis was observed in 50 of 59 cases (85%), and 8 of 29 (28%) were positive for antiganglioside antibodies, as frequently observed in Guillain-Barré syndrome. Fifty-two patients showed variable residual weakness at follow-up. Good prognostic factors included a pretreatment manual muscle strength test unit score >3, normal F-wave persistence, and EV-D68–negative status. CONCLUSIONS: EV-D68 may be one of the causative agents for AFM, while host susceptibility factors such as immune response could contribute to AFM development.
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spelling pubmed-58504492018-03-23 Clinical Features of Acute Flaccid Myelitis Temporally Associated With an Enterovirus D68 Outbreak: Results of a Nationwide Survey of Acute Flaccid Paralysis in Japan, August–December 2015 Chong, Pin Fee Kira, Ryutaro Mori, Harushi Okumura, Akihisa Torisu, Hiroyuki Yasumoto, Sawa Shimizu, Hiroyuki Fujimoto, Tsuguto Hanaoka, Nozomu Kusunoki, Susumu Takahashi, Toshiyuki Oishi, Kazunori Tanaka-Taya, Keiko Clin Infect Dis Articles and Commentaries BACKGROUND: Acute flaccid myelitis (AFM) is an acute flaccid paralysis syndrome with spinal motor neuron involvement of unknown etiology. We investigated the characteristics and prognostic factors of AFM clusters coincident with an enterovirus D68 (EV-D68) outbreak in Japan during autumn 2015. METHODS: An AFM case series study was conducted following a nationwide survey from August to December 2015. Radiographic and neurophysiologic data were subjected to centralized review, and virology studies were conducted for available specimens. RESULTS: Fifty-nine AFM cases (58 definite, 1 probable) were identified, including 55 children and 4 adults (median age, 4.4 years). The AFM epidemic curve showed strong temporal correlation with EV-D68 detection from pathogen surveillance, but not with other pathogens. EV-D68 was detected in 9 patients: 5 in nasopharyngeal, 2 in stool, 1 in cerebrospinal fluid (adult case), and 1 in tracheal aspiration, nasopharyngeal, and serum samples (a pediatric case with preceding steroid usage). Cases exhibited heterogeneous paralysis patterns from 1- to 4-limb involvement, but all definite cases had longitudinal spinal gray matter lesions on magnetic resonance imaging (median, 20 spinal segments). Cerebrospinal fluid pleocytosis was observed in 50 of 59 cases (85%), and 8 of 29 (28%) were positive for antiganglioside antibodies, as frequently observed in Guillain-Barré syndrome. Fifty-two patients showed variable residual weakness at follow-up. Good prognostic factors included a pretreatment manual muscle strength test unit score >3, normal F-wave persistence, and EV-D68–negative status. CONCLUSIONS: EV-D68 may be one of the causative agents for AFM, while host susceptibility factors such as immune response could contribute to AFM development. Oxford University Press 2018-03-01 2017-10-06 /pmc/articles/PMC5850449/ /pubmed/29028962 http://dx.doi.org/10.1093/cid/cix860 Text en © The Author(s) 2017. Published by Oxford University Press for the Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Articles and Commentaries
Chong, Pin Fee
Kira, Ryutaro
Mori, Harushi
Okumura, Akihisa
Torisu, Hiroyuki
Yasumoto, Sawa
Shimizu, Hiroyuki
Fujimoto, Tsuguto
Hanaoka, Nozomu
Kusunoki, Susumu
Takahashi, Toshiyuki
Oishi, Kazunori
Tanaka-Taya, Keiko
Clinical Features of Acute Flaccid Myelitis Temporally Associated With an Enterovirus D68 Outbreak: Results of a Nationwide Survey of Acute Flaccid Paralysis in Japan, August–December 2015
title Clinical Features of Acute Flaccid Myelitis Temporally Associated With an Enterovirus D68 Outbreak: Results of a Nationwide Survey of Acute Flaccid Paralysis in Japan, August–December 2015
title_full Clinical Features of Acute Flaccid Myelitis Temporally Associated With an Enterovirus D68 Outbreak: Results of a Nationwide Survey of Acute Flaccid Paralysis in Japan, August–December 2015
title_fullStr Clinical Features of Acute Flaccid Myelitis Temporally Associated With an Enterovirus D68 Outbreak: Results of a Nationwide Survey of Acute Flaccid Paralysis in Japan, August–December 2015
title_full_unstemmed Clinical Features of Acute Flaccid Myelitis Temporally Associated With an Enterovirus D68 Outbreak: Results of a Nationwide Survey of Acute Flaccid Paralysis in Japan, August–December 2015
title_short Clinical Features of Acute Flaccid Myelitis Temporally Associated With an Enterovirus D68 Outbreak: Results of a Nationwide Survey of Acute Flaccid Paralysis in Japan, August–December 2015
title_sort clinical features of acute flaccid myelitis temporally associated with an enterovirus d68 outbreak: results of a nationwide survey of acute flaccid paralysis in japan, august–december 2015
topic Articles and Commentaries
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5850449/
https://www.ncbi.nlm.nih.gov/pubmed/29028962
http://dx.doi.org/10.1093/cid/cix860
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