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What an infectious disease expert wants you to know about acute flaccid myelitis

MUSC Children’s Health has seen one case so far this year involving the mystery illness

Drooping eyes or other facial features, trouble swallowing or slurred speech and sudden weakness in an arm or leg are symptoms of acute flaccid myelitis. Infographic courtesy of CDC
Helen Adams | | October 19, 2018

Acute flaccid myelitis has struck at least one child in South Carolina. The patient was treated at MUSC Children’s Health and released to go home. A neurologist will continue to monitor the child’s condition.

AFM, with its tendency to cause temporary paralysis in an arm or leg, has shaken up some parents. Most people who have been diagnosed with it are 18 or younger. The average age is about 4. 
Doctors don’t know what causes AFM. So far this year, the Centers for Disease Control and Prevention has received reports of more than 120 people who may have it. About 60 cases have been confirmed.
Sandra Fowler directs the Division of Pediatric Infectious Diseases at MUSC Children’s Health. She says parents should be aware of the symptoms of AFM but also keep in mind that the condition is rare and there are many other illnesses that are much more likely to affect children. 
“We need to put things in perspective. Forty-thousand people died last year from influenza. There’s been a child in Florida who died of the flu already this year and it’s only October.”
AFM affects the area of the spinal cord called gray matter, causing muscles and reflexes to become weak. “There can be pain and weakness in a limb,” Fowler says. “It’s usually sudden onset in one arm or one leg. It’s very like polio, but it’s not polio.”
The arm or leg goes limp. “It’s what we call hanging flaccid paralysis. They can’t move it.”
Other possible symptoms, according to the CDC, include:
  • Facial drooping 
  • Difficulty moving eyes
  • Drooping eyelids
  • Difficulty swallowing
  • Slurred speech
The CDC has been investigating AFM since 2014 when it first saw an increase in cases. “There have been maybe about 350 cases in that amount of time throughout the country, so it’s very rare, but clusters of it have been reported,” Fowler says.
“I think it is an infectious disease, that’s my personal opinion, and I think it probably is some type of unrecognized virus. Maybe it’s an enterovirus or a subtype of enterovirus that’s harder to figure out. The CDC has been working very hard to try to figure out what it is, and they haven’t identified it yet.
“The more cases you have, the more you have to work with. There aren’t that many cases. It is frustrating. I wish we did know exactly. I have a feeling it’s going to be something there’s not any other specific treatment for. And there’s some postulation that it’s not actually the damage from the virus itself, it’s from the body’s immune response to the virus. So that could be a component that has not been dissected out. Most of the treatments people use tend to be things that modify the inflammatory response.”
Recovery from AFM can take weeks or months. “Many kids do require some prolonged physical therapy.” One child with AFM died in 2017.
Her advice: take the steps that reduce the risk of catching or transmitting any infectious disease. “It’s going to be hand washing, getting your immunizations and covering your cough. Don’t go to work or school with a fever.”
She says anyone with symptoms of AFM should get medical care right away.

CDC confirms 62 cases of rare polio-like neurological condition (Reuters, Oct. 18, 2018)

South Carolina among states reporting rare paralyzing illness in children (The Post and Courier, October 16, 2018) 

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