[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]
Eur J Paediatr Neurol. 2019 Jan 11. pii: S1090-3798(18)30281-2. doi: 10.1016/j.ejpn.2019.01.001. [Epub ahead of print]
Acute flaccid myelitis caused by enterovirus D68: Case definitions for use in clinical practice.
Kramer R1, Lina B2, Shetty J3.
Author information: 1 European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control, Stockholm, Sweden; Centre National de Référence des Enterovirus et Parechovirus, Laboratoire de Virologie, Institut des Agent Infectieux, HCL, Hôpital de la Croix-Rousse, Lyon, France. Electronic address: email@example.com. 2 Centre National de Référence des Enterovirus et Parechovirus, Laboratoire de Virologie, Institut des Agent Infectieux, HCL, Hôpital de la Croix-Rousse, Lyon, France; Virpath, CIRI, Université de Lyon, INSERM U1111, CNRS 5308, ENS de Lyon, UCBL, Lyon, France. 3 Paediatric Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK; Child Life and Health, University of Edinburgh, Edinburgh, UK.
Acute flaccid myelitis (AFM) was increasingly detected in recent years, coinciding with upsurges of enterovirus D68 (EV-D68) infections. We reviewed the evidence for a causal relationship between both. Based on reported cases, we provide case definitions for AFM caused by EV-D68 infections to enable a standard procedure for affected patients. Current case definitions are focussing on epidemiological aspects but clinical case definitions are still missing. We propose the following case definitions to be used in clinical practice in order to mirror clinical realities and facilitate a common systematic approach in case management: A possible case is defined as a person presenting with either acute myelitis/paralysis or Guillain-Barré Syndrome (GBS), particularly during periods of EV-D68 circulation. A probable case is defined as a person presenting with symptoms of either acute myelitis/paralysis or GBS and at least one of the following criteria: i) MRI abnormality representing with T2 hyperintensity in spinal cord grey matter with or without hyperintensity at dorsal brain stem, ii) investigations showing an axonal neuropathy including reduced compound motor action potentials with normal conduction velocities and absence of conduction blocks compatible with anterior horn cell disease or iii) detection of enteroviruses in a respiratory specimen obtained from the lower respiratory tract during periods of EV-D68 circulation. A confirmed case is defined as a person presenting with acute flaccid myelitis/paralysis, MRI abnormality and detection of enterovirus-D68-specific nucleic acids in a respiratory specimen using a validated PCR assay targeting the VP1 gene with subsequent sequencing and typing.
Copyright © 2019 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.
KEYWORDS: Acute flaccid myelitis; Clinical case definitions; Enterovirus D68; Enteroviruses; Paralysis
PMID: 30670331 DOI: 10.1016/j.ejpn.2019.01.001
Keywords: AFM; EV-D68; GBS.