Acute Flaccid Myelitis in Pediatric Patients

A December 2018 article by Roy Benaroch, MD, published by KevinMD.com, and blogged on ‘Pediatric Insider’, describes physical profiles defining this Acute Flaccid Myelitis (AFM). You may have seen reports of a ‘polio-like’ illness causing pediatric paralysis. 80 cases were reported in the USA in 2018. Although the cause is currently unknown, several viral infections have been found in AFM children.

Here’s what to watch for:

  • Sudden (defined as beginning in the last few hours or days) illness causing extremity paralysis in singular or multiple limbs.
  • Typical presentation: Fever, runny nose, cough, vomiting or diarrhea 1-2 weeks prior to AFM symptoms.
  • Lesser seen symptoms: Stiff neck, headache, pain in limbs, eyelid or facial droop, difficulty swallowing, speaking or a hoarse or weak voice.
  • Near complete paralysis to varying degrees of paralysis follows two weeks after viral infection.
  • Affected body parts are weak and floppy.
  • The disease starts in the spinal cord and may mimic severe trauma.
  • History is key in diagnosis.
  • MRI shows distinctive changes of inflammation, confirming diagnosis.
  • Most cases appear in late summer and early fall; August through October.
  • Average age of occurrence: 4-6 years.
  • Most commonly, no viral infection is found.
  • Investigation of specific viral causes includes but is not yet definitive: enterovirus D68, West Nile Virus, Japanese Encephalitis viruses, herpes viruses and adenoviruses.

Children with this profile need hospitalization. Neurologists and infectious disease specialists direct care to include IV immunoglobulin, steroids, and plasmapheresis. Some children recover quickly while others may need long-term care. This article focuses on how to prevent viral infections by educating parents and children.