Attacking Acute Flaccid Myelitis
Your ten-year-old son is just getting over a prolonged cold, when he has started showing signs of weakness and problems breathing on his own. You take him to the emergency room. The doctor says he has acute flaccid myelitis.
Acute flaccid myelitis (AFM) is sometimes caused by enterovirus (EV) D68. AFM has been compared to polio because it can cause paralysis or muscle weakness, though the vast majority of people infected with the virus do not experience muscle symptoms.
In general, infants, children and teenagers are most likely to get infected with EV-D68 and become ill because they do not yet have immunity from previous exposures to enteroviruses. Children with asthma may have a higher risk for severe respiratory illness caused by EV-D68 infection.
Adults can get infected with enteroviruses, but they are more likely to have no symptoms or mild symptoms.
Remember enteroviruses are transmitted through close contact with an infected person, or by touching objects or surfaces contaminated with the virus and then touching the mouth, nose or eyes.
To count as AFM, patients must suffer sudden muscle weakness or paralysis, typically in the arm or leg, along with evidence of damage to the gray matter of the spinal cord.
The majority of cases begin with fever and respiratory symptoms similar to the cold or flu. This is followed by neurological difficulties such as weakness in the arms or legs, a decrease in reflexes, facial weakness, drooping eyelids, difficulty moving the eyes, slurred speech and trouble with swallowing. Occasionally, numbness or pain may be present, and in some cases, patients experience trouble breathing.
More than 90 percent of AFM cases have occurred in children less than 18 years of age. Even with extensive lab testing, AFM is difficult to diagnose, because it is similar to other conditions like poliovirus, West Nile virus and adenoviruses. But unlike polio, where there is an effective vaccine, AFM has no official cause and no vaccine.
A lab test to diagnose the condition has not yet been developed, which makes vigilance by parents and health care providers about potential cases all the more important. Because the later symptoms of the condition can mirror those of other neurological diseases, such as Guillain-Barre syndrome, AFM is even more difficult to diagnose. There is no known cure, so at this time, treatment focuses on physical and occupational therapy to restore movement.
Some experts are investigating whether genetic or environmental factors are involved.
There is no specific treatment for AFM, and long-term outcomes for AFM patients are unknown.
While cases have been on the rise since 2014, AFM still affects a small population—less than one in a million people in the United States annually.
The Centers for Disease Control and Prevention recommends that people follow normal disease prevention steps such as washing hands frequently, staying current on vaccines and avoiding mosquito bites.
Remember most people recover from colds, which is what AFM symptoms look like at first. But parents need to trust their instincts. If your child doesn’t seem to be getting better, seek out a doctor right away.
