Acute flaccid myelitis: cause, diagnosis, and management
Olwen C. Murphy, Kevin Messacar, Lina Benson, Riley Bove, Jessica L. Carpenter, Thomas O. Crawford, Janet Dean, Roberta L. DeBiasi, Jay Desai, Matthew J. Elrick, Raquel Farias‐Moeller, Grace Gombolay, Benjamin Greenberg, Matthew Harmelink, Sue J. Hong, Sarah Hopkins, Joyce Oleszek, Catherine Otten, Cristina Sadowsky, Teri Schreiner, Kiran T. Thakur, Keith Van Haren, Carolina Carballo, Pin Fee Chong, Amary Fall, Vykuntaraju K. Gowda, Jelte Helfferich, Ryutaro Kira, Ming Lim, Eduardo López, Elizabeth Wells, E. Ann Yeh, Carlos A. Pardo, Andrea Salazar-Camelo, Divakar S. Mithal, Molly Wilson-Murphy, Andrea Bauer, Colyn J. Watkins, Mark J. Abzug, Samuel R. Dominguez, Craig A. Press, Michele Yang, Nusrat Ahsan, Leigh Ramos‐Platt, Emmanuelle Tiongson, Mitchel Seruya, Ann Tilton, Elana Katz, Matthew P. Kirschen, Apurva Shah, Erlinda R. Ulloa, Sabrina W. Yum, Lileth Mondok, Megan Blaufuss, Amy Rosenfeld, Wendy Vargas, Jason Zucker, Anusha K. Yeshokumar, Allison Navis, Kristen Chao, Kaitlin Hagen, Michelle Melicosta, Courtney Porter, Margaret A. Tunney, Richard H. Scheuermann, Priya Duggal, Andrew Pekosz, Amy J. Bayliss, Meghan Moore, Allan J. Belzberg, Melania M. Bembea, C. J. M. O’Brien, Rebecca Riggs, Jessica Nance, Aaron M. Milstone, Jessica L. Rice, Maria A. García‐Dominguez, Eoin P. Flanagan, Jan‐Mendelt Tillema, Glendaliz Bosques, Sonal Bhatia, Eliza Gordon‐Lipkin, Dawn Deike, Gadi Revivo, Dan A. Zlotolow, Gabrielle deFiebre, Peggy Lazerow, Timothy Lotze, Ari Bitnun, Kristen M. Davidge, Jiri Vajsar, Amy M. Moore, Chamindra G. Konersman, Kendall Nash, Jonathan B. Strober, Nalin Gupta, Charles Y. Chiu, Michael Sweeney, William T. Jackson, Dennis Simon
Abstract
Acute flaccid myelitis (AFM) is a disabling, polio-like illness mainly affecting children. Outbreaks of AFM have occurred across multiple global regions since 2012, and the disease appears to be caused by non-polio enterovirus infection, posing a major public health challenge. The clinical presentation of flaccid and often profound muscle weakness (which can invoke respiratory failure and other critical complications) can mimic several other acute neurological illnesses. There is no single sensitive and specific test for AFM, and the diagnosis relies on identification of several important clinical, neuroimaging, and cerebrospinal fluid characteristics. Following the acute phase of AFM, patients typically have substantial residual disability and unique long-term rehabilitation needs. In this Review we describe the epidemiology, clinical features, course, and outcomes of AFM to help to guide diagnosis, management, and rehabilitation. Future research directions include further studies evaluating host and pathogen factors, including investigations into genetic, viral, and immunological features of affected patients, host-virus interactions, and investigations of targeted therapeutic approaches to improve the long-term outcomes in this population.