Twenty-nine Cases of Enterovirus-D68–associated Acute Flaccid Myelitis in Europe 2016
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Open Access
- 1 January 2019
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in The Pediatric Infectious Disease Journal
- Vol. 38 (1), 16-21
- https://doi.org/10.1097/inf.0000000000002188
Abstract
Background: Enterovirus-D68 (EV-D68) is a respiratory virus within the genus Enterovirus and the family of Picornaviridae. Genetically, it is closely related to rhinovirus that replicates in the respiratory tract and causes respiratory disease. Since 2014, EV-D68 has been associated with the neurologic syndrome of acute flaccid myelitis (AFM). Methods: In October 2016, questionnaires were sent out to a European network including 66 virologists and clinicians, to develop an inventory of EV-D68–associated AFM cases in Europe. Clinical and virologic information of case patients was requested. In addition, epidemiologic information on EV testing was collected for the period between March and October 2016. Results: Twenty-nine cases of EV-D68–associated AFM were identified, from 12 different European countries. Five originated from France, 5 from Scotland and 3 each from Sweden, Norway and Spain. Twenty-six were children (median age 3.8 years), 3 were adults. EV-D68 was detected in respiratory materials (n = 27), feces (n = 8) and/or cerebrospinal fluid (n = 2). Common clinical features were asymmetric flaccid limb weakness, cranial nerve deficits and bulbar symptoms. On magnetic resonance imaging, typical findings were hyperintensity of the central cord and/or brainstem; low motor amplitudes with normal conduction velocities were seen on electromyography. Full clinical recovery was rare (n = 3), and 2 patients died. The epidemiologic data from 16 European laboratories showed that of all EV-D68–positive samples, 99% was detected in a respiratory specimen. Conclusions: For 2016, 29 EV-D68–related AFM cases were identified in mostly Western Europe. This is likely an underestimation, because case identification is dependent on awareness among clinicians, adequate viral diagnostics on respiratory samples and the capability of laboratories to type EVs.Keywords
This publication has 39 references indexed in Scilit:
- Severe respiratory illness associated with a nationwide outbreak of enterovirus D68 in the USA (2014): a descriptive epidemiological investigationThe Lancet Respiratory Medicine, 2015
- European surveillance for enterovirus D68 during the emerging North-American outbreak in 2014Journal of Clinical Virology, 2015
- Enterovirus D68 disease and molecular epidemiology in AustraliaJournal of Clinical Virology, 2015
- Polio-Like Illness Associated With Outbreak of Upper Respiratory Tract Infection in ChildrenJournal of Child Neurology, 2015
- Sampling the upper respiratory tract for enteroviral infection is important in the investigation of an acute neurological illness in childrenEuropean Journal of Paediatric Neurology, 2015
- Electrodiagnostic findings in acute flaccid myelitis related to enterovirus D68Muscle & Nerve, 2015
- A cluster of acute flaccid paralysis and cranial nerve dysfunction temporally associated with an outbreak of enterovirus D68 in children in Colorado, USAThe Lancet, 2015
- MRI Findings in Children with Acute Flaccid Paralysis and Cranial Nerve Dysfunction Occurring during the 2014 Enterovirus D68 OutbreakAmerican Journal of Neuroradiology, 2014
- Upsurge of human enterovirus 68 infections in patients with severe respiratory tract infectionsJournal of Clinical Virology, 2011
- Sensitive, Seminested PCR Amplification of VP1 Sequences for Direct Identification of All Enterovirus Serotypes from Original Clinical SpecimensJournal of Clinical Microbiology, 2006