With all that is out there on the internet these days things can easily become misconstrued, exaggerated, or even news broadcast offering unreliable and misguided information by not gathering factual based information. With that being said, I felt it important to set the record straight. Here is the most up to date information that I can find based on Facts about AFM ~ EV-D68 – It offers precise and clear information.
By, American Academy of Pediatrics –
As a side note Cambria did not have EV-D68, she had the rhinovirus.
Is EV-D68 infection a cause of acute flaccid myelitis in children?
Enterovirus D68 (EV-D68) was first identified in California in 1962. Initially, it was classified as a rhinovirus but now is classified as one of more than 100 non-polio enteroviruses. For several decades after the initial description, EV-D68 was rarely recovered from patients. Between 2008 and 2014, the virus was isolated occasionally from clusters of children younger than 5 years of age with severe respiratory illness.
Which of the following statements are false?
Answer: d and e are not correct
In the summer and fall of 2014, a nationwide outbreak of EV-D68 occurred and was associated with severe respiratory tract disease. In September 2014, the Centers for Disease Control and Prevention (CDC) began to receive reports of AFM, and a possible association with EV-D68 was considered. During this enterovirus season, the CDC confirmed more than 1,100 infections, largely among children, many of whom had a history of asthma. Many more people likely experienced a mild EV-D68 infection for which medical treatment was not sought or from whom cultures were not obtained.
During the 2015 enterovirus season, the CDC received about 700 specimens for enterovirus testing, and none were positive for EV-D68. During most of 2016, sporadic EV-D68 detections occurred in the U.S., but evidence of unusual activity was not apparent. (See AAP News article “CDC: 108 cases of acute flaccid myelitis this year,” http://bit.ly/2hYZ9k7.) (correction; 144 cases across 37 states of acute flaccied myelitis. LMA)
EV-D68 should be considered especially during the summer and fall as a cause of unexplained, severe acute respiratory illness in children especially during clusters of disease. Nasopharyngeal or oropharyngeal specimens that test positive for enterovirus or rhinovirus should be considered for molecular testing using real-time polymerase chain reaction (PCR) or nested PCR. Virus may be detected in stool or rectal swabs for a longer period than from respiratory specimens.
Infection-control precautions for suspected cases should include standard, contact and droplet precautions. Non-enveloped viruses such as EV-D68 may be less susceptible to alcohol inactivation than enveloped viruses. Hand hygiene with soap and water upon removal and prior to donning of gloves may be preferred to alcohol-based hand rub.
Between 2012 and 2015, an increasing number of reports of a distinct syndrome of acute flaccid paralysis with anterior myelitis was noted. Symptoms were similar to those caused by polio viruses and to avoid confusion, the term acute flaccid myelitis (AFM) was proposed. AFM is defined as a case of acute flaccid weakness with either spinal cord gray matter lesions detected on imaging or evidence of spinal cord motor neuron injury on electrodiagnostic testing.
A typical case of AFM is preceded by a median of five days with rhinorrhea, cough or pharyngitis. Gastrointestinal symptoms (vomiting, diarrhea) are reported in about two-thirds of patients. Most patients report improvement of symptoms prior to return of fever and onset of muscle stiffness or pain around the time of neurologic deficit onset. Over a period of a few hours to a few days, there is progression from full strength to neurologic deficit. Weakness is flaccid with decreased or absent reflexes in one to four extremities and generally is asymmetric. Limb weakness may be accompanied by cranial nerve dysfunction resulting in hypophonia (soft speech), dysarthria, dysphagia, facial weakness and diplopia.
Optimal management of a patient with AFM is not clear. Immunomodulatory agents, antiviral agents, intravenous immune globulin, high-dose corticosteroids and plasmapheresis have not been evaluated in a controlled fashion, and no significant improvement or deterioration has been described with these interventions.
Three antiviral drugs in clinical trials for treatment of other enterovirus infections (pleconaril, pocapavir, vapendavir) do not demonstrate activity against EV-D68 in vitro. Fluoxetine (Prozac), a selective serotonin reuptake inhibitor, interferes with EV-D68 replication in vitro, but its role as a therapeutic agent has not been evaluated.
Causes of AFM include polio virus and non-polio enteroviruses (such as enteroviruses A71 and D70), West Nile virus, Japanese encephalitis virus, St. Louis encephalitis virus and adenoviruses. Non-infectious causes include environmental toxins, genetic disorders, Guillain-Barré syndrome and acute disseminated encephalomyelitis.
Although a mild to moderate pleocytosis in the cerebrospinal fluid (CSF) generally is present, no infectious agent has been isolated consistently from the CSF of patients with AFM. Despite similarities with poliomyelitis, the inability to detect wild type polio virus or polio vaccine-derived stains from the stool of patients with AFM indicates that poliovirus is unlikely to be involved.
The proposed association between EV-D68 infection and AFM is based on epidemiologic evidence. The increase in AFM and EV-D68 infections both temporally and geographically suggests an association. The biologic plausibility of an association is substantiated by evidence supporting other non-polio enteroviruses as a cause of paralysis.
Dr. Meissner is professor of pediatrics at Floating Hospital for Children, Tufts Medical Center. He also is an ex officio member of the AAP Committee on Infectious Diseases and associate editor of the AAP Visual Red Book.
Copyright © 2017 American Academy of Pediatrics
Discussion on AFM
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Prior to Cambria getting ill she was a normal 2.5 year old toddler ~ running all around, jumping, singing, dancing, riding her bike, swimming and just playing all day long! She has always had a beautiful light around her like a little Angel sent to us straight from Heaven ~ Thank you GOD
Back on September 23rd 2016 Our baby Cambria Annabella Tate AKA CamiCAT was stricken with Acute Flaccid Myelitis (AFM). It is a rare and extremely dangerous virus that attacks the nervous system. We were admitted at Balboa Naval Medical Hospital in San Diego, CA at 7:45pm and in less than 15 hours the virus had taken over – she was put in a medically induced coma, she had “Impending Respiratory Failure” and put on a ventilator! Scariest moments of my life!
As I look back in time here is what I remember.. Hours before she was taken in to the operating room to preform a MRI Cami looked up at me as I was holding her in my arms and she said ~ I Love You, I Love You, I Love You!! It was like tunnel vision as our eyes were locked on each other – I was crying and I was so scared – everything was spiralling out of control – I told her the same and tried comforting her the best I knew how! The fear we all had that day was undeniable. The picture is from that moment.. I took that picture and posted it on Facebook requesting prayer. What nobody knew, but a few people like close friends and family members was that Cambria was dying! The MRI proved in fact she had Acute Flaccid Paralysis/Myelitis. She had Grey Matter in her cerebellum, top and bottom of her spinal cord. I will never forget as we all gathered in to her Doctors small office in the PICU as he went over in detail the pictures of her MRI. We all stood there in shock! How could this be… what happened… how did we get here… I remember like it was yesterday pulling Dr. Zabroki aside after we had discussed in detail what her diagnosis was, and it was grim, we were told a lot at the time, but all I heard was “there is no cure” so with that being said after the discussion we all stood together as a family including her Doctor and prayed! I pulled Dr Zabroki aside and made him promise to do what ever he had to do to save her, to always be upfront and honest with us and that’s precisely what he did – I think I was literally begging him as I held him in my arms with my hands gripping into his clothing… I don’t think he slept after that for at least 48 hours. He Compiled the most up to date data and scientific research including a new form of treatment with the use of Prozac as an antiviral only being done on mice models at the time by a scientist in Colorado.
Acute flaccid myelitis (AFM) is a rare but serious condition that affects the nervous system, specifically the spinal cord, which can cause the muscles and reflexes in the body not to work normally. This type of condition is not new. Anyone can get AFM or neurologic conditions like it, and there are different possible causes, such as viruses, toxins, and genetic disorders.
Most patients will have sudden onset of limb weakness and loss of muscle tone and reflexes. Some patients, in addition to the limb weakness, will experience:
• facial droop/weakness,
• difficulty moving the eyes,
• drooping eyelids, or
• difficulty with swallowing or slurred speech.
Numbness or tingling is rare in patients with AFM, though some patients have pain in their arms or legs. Some patients with AFM may be unable to pass urine. Cambria had the most severe symptom of AFM, which, is respiratory failure that can happen when the muscles involved with breathing become weak. This can require urgent ventilator support (breathing machines). If you or your child develops any of these symptoms, you should seek medical care right away.
Please visit the CDC for the most up to date information pertaining to AFM ~ See the link posted below.