Acute Flaccid Myelitis

"AFM [acute flaccid myelitis] is a priority for the CDC [Centers for Disease Control and Prevention], as we expect an outbreak this year."                                            "The virus comes in two-year cycles, it will be circulating the same time as flu and COVID-19."                                                                                                               "We do not know how the COVID 19 pandemic and social distancing measures will affect AFM; cases may be fewer, or outbreak could be delayed."                               Robert Redfield, MD, director, Centers for Disease Control and Prevention (CDC)

Kari Hoglund / iStock

What are the symptoms of acute flaccid myelitis (AFM)?

Most people with AFM will suddenly have

• Arm or leg weakness
• A loss of muscle tone and reflexes

Some people also have other symptoms, including

• Facial drooping/weakness
• Trouble moving the eyes
• Drooping eyelids
• Trouble swallowing
• Slurred speech

 

The word has gone out from the U.S. Centers for Disease Control and Prevention for parents and pediatricians to be on special alert for the appearance of a rare neurological condition afflicting children. The condition is capable of leading to long-term paralysis and even, albeit infrequently, death. Acute flaccid myelitis has been known to strike children at low levels for years, and then in 2014 serious outbreaks of the condition occurred in the U.S. when 120 children were struck by it. Since that time, the condition has appeared in steadily increased numbers every other year, late summer and fall.

This year has seen its emergence with sixteen American children diagnosed and one death resulting, to the end of July while another 38 cases are under investigation. Though the precise cause of the condition is not yet known, AFM is thought to result from a complication of a viral infection, the likeliest culprit identified as an outbreak strain of enterovirus D68. 

The most immediate symptom of its onset is muscular weakness. Once identified, children who develop the symptoms should be taken immediately to hospital. "AFM is a medical emergency that requires immediate care", cautioned CDC director Robert Redfield, explaining it to be a serious condition of the spinal cord where paralysis can develop in a matter of hours.

The concern within the agency is that in the atmosphere prevailing with the coronavirus outbreak, parents may tend to hesitate before rushing children to a doctor, choosing to wait instead to see whether the symptoms will pass and the child will recover at home. Early and aggressive physical therapy, explained Dr.Redfield, may help strengthen the muscular function retained to help avoid permanent weakness or paralysis.

Fever or respiratory difficulties may present as the initial symptoms, so common that they can readily be mistaken for preliminary symptoms of any number of oncoming illnesses. Because of the general presence of COVID-19 and fears of contracting the coronavirus there are hopes that vigilance for unusual symptoms may spike greater awareness leading to an abundance of caution. Yet fears have arisen that cautions taken to avoid coronavirus may also serve to avert, reduce or delay attention to AFM outbreaks in 2020, the year when the focus is entirely on the SARS-CoV-2 virus.

Sharing some of the same symptoms of polio, which has been eliminated from the dire conditions pool threatening humanity through a concerted vaccine eradication of the disease, patients with AFM test negative to the poliovirus. The medical community is bracing for the possibility that 2020 will turn out to be the worst year ever, given a rising number of cases with each outbreak. 

In 2018 over half of the 238 children affected required intensive care. A quarter of those children were placed on ventilators. This is a condition for which there is no cure. And which on average strikes children at age five.

How is acute flaccid myelitis (AFM) diagnosed?

AFM causes many of the same symptoms as other neurologic diseases, such as transverse myelitis and Guillain-Barre syndrome. This can make it difficult to diagnose. To make a diagnosis, a doctor

• Will do a neurologic exam, including looking at where there is weakness, poor muscle tone, and decreased reflexes
• Will look at pictures of the spinal cord and brain. This may include images from an MRI.
• May do lab tests on the cerebrospinal fluid (the fluid around the brain and spinal cord)
• May check nerve speed (nerve conduction velocity) and the response of muscles to the messages from the nerves (electromyography)

It is important that the tests are done as soon as possible after the symptoms start.

What are the treatments for acute flaccid myelitis (AFM)?

There is no specific treatment for AFM. A doctor who specializes in treating brain and spinal cord illnesses (neurologist) may recommend treatments for specific symptoms. For example, physical and/or occupational therapy may help with arm or leg weakness. Researchers do not know the long-term outcomes of people with AFM.

Can acute flaccid myelitis (AFM) be prevented?

Since the cause of AFM is unknown, there is no there is no specific way to prevent it. However, viruses may play a role in AFM, and you can take steps to help prevent getting or spreading viral infections by

• Washing hands often with soap and water
• Avoiding touching your face with unwashed hands
• Avoiding close contact with people who are sick
• Cleaning and disinfecting surfaces that you frequently touch, including toys
• Covering coughs and sneezes with a tissue or upper shirt sleeve, not hands
• Staying home when sick

Centers for Disease Control and Prevention