Acute Flaccid Myelitis: Mysterious Neurological Condition in Children
Update: 1/4/19: 193 confirmed cases of AFM in 39 states. 156 other patients are being monitored for the disease.
Recently there have been news reports about a mysterious illness affecting children across the U.S. The diagnosis, Acute Flaccid Myelitis (AFM), is a rare but serious condition. From August 2014 through September 2018, CDC has received information on a total of 362 cases. Most of the cases continue to occur in children. So far in 2018, there are 38 confirmed cases in 16 states across the U.S.
· 2017: 33 cases in 16 states
· 2016: 149 cases in 39 states
· 2015: 22 cases in 17 states
· 2014: 120 cases in 34 states
AFM is a sub-type of a broader class of neurological diseases called Transverse Myelitis. Transverse myelitis is inflammation of the spinal cord, which carries signals to and from the brain, via nerves, to all parts of the body. Myelitis is inflammation of the spinal cord. AFM specifically targets the spinal cord’s gray matter (contains nerve cells), causing the muscles and reflexes in the body to become weak. Until the recent classification of AFM in 2014, it is likely that many individuals with initial presentation of flaccid weakness and paralysis have been diagnosed as transverse myelitis in previous years.
Possible causes include:
· Viruses: poliovirus and non-polio enteroviruses; West Nile Virus; Adenovirus (common viruses that infect the membranes of the respiratory tract, eyes, intestines, urinary tract, and nervous system)
· Environmental toxins
· Genetic disorders
Oftentimes, despite extensive lab tests, the cause of AFM is not identified.
· Sudden onset of arm or leg weakness and loss of muscle tone and reflexes. It may result in total paralysis, partial paralysis, or weakness of just one limb
· Facial droop or weakness
· Difficulty moving the eyes
· Drooping eyelids
· Difficulty with swallowing or slurred speech
· Numbness or tingling is rare, although some people have pain in their arms or legs
· Inability to urinate
· Respiratory failure that can happen when the muscles involved with breathing become weak
· Neurological exam
· MRI of the brain and spinal cord
· Spinal tap: laboratory testing of the spinal fluid
· Nerve conduction study: stimulates specific nerves and records their ability to send the impulse to the muscle
Treatment: There is no specific treatment for AFM
· The long-term outcomes are unknown
· Goal of treatment is to reduce inflammation in the spinal cord and further prevent the individual’s immune system from attacking
· Physical and Occupational therapy for extremity weakness
Some recover quickly while other continue to have paralysis and require ongoing care.
· Up-to-date vaccinations, including Polio
· Protection against mosquito bites (West Nile Virus)
· Wash hands often with soap and water
Surveillance: Centers for Disease Control and Prevention (CDC)
· AFM is not a reportable condition in any U.S. state and routine surveillance and assessment is not performed
· The case counts represent only those cases for which information has been sent to and confirmed by CDC
· Collecting information about suspected AFM cases is relatively new, and it is voluntary for most states to send this information to CDC
· Actively investigate AFM cases and monitor disease activity
· Working closely with healthcare providers and state and local health departments to increase awareness and report suspected cases