Guadalupe Pérez1, María T Rosanova2, María C Freire3, María I Paz4, Silvina Ruvinsky2, Carlos Rugilo5, Víctor Ruggieri4, Daniel Cisterna3, Soledad Martiren2, Cristina Lema3, Andrea Savransky4, Soledad González2, Leila Martínez3, Diana Viale6, Rosa Bologna2. 1. Servicio de Control Epidemiológico e Infectología. Hospital de Pediatría "Prof. Dr. Juan P. Garrahan". guaperez@hotmail.com. 2. Servicio de Control Epidemiológico e Infectología. Hospital de Pediatría "Prof. Dr. Juan P. Garrahan". 3. Servicio de Neurovirus. Instituto Nacional de Enfermedades Infecciosas (INEI)-Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) "Dr. G. Carlos Malbrán". 4. Servicio de Neurología. Hospital de Pediatría "Prof. Dr. Juan P.Garrahan". 5. Servicio de Diagnóstico por Imágenes. Hospital de Pediatría "Prof. Dr. Juan P. Garrahan". 6. Servicio de Microbiología. Hospital de Pediatría "Prof. Dr. Juan P. Garrahan".
Abstract
INTRODUCTION: The association between enterovirus D68 and acute flaccid myelitis was first described in the United States in 2014. Since then, sporadic cases have been reported in Canada and Europe. This study describes a series of cases of acute flaccid myelitis at Hospital de Pediatría "Prof. Dr. Juan P. Garrahan," in Buenos Aires, Argentina, during 2016. METHODS: Descriptive, retrospective study. All patients with acute flaccid myelitis and lesions in the spinal cord involving the gray matter, as observed in the magnetic resonance imaging (MRI) scan, hospitalized from 04/01/2016 to 07/01/2016, were included in the study. Samples of nasopharyngeal secretions, fecal swabs and cerebrospinal fluid were collected and processed to look for the causative agent. RESULTS: Ten patients were included. The median age was 4 years old (range from 3 months to 5 years old). Eight patients had a self-limiting febrile condition before the onset of neurological symptoms. Neurological findings were flaccid weakness in, at least, one limb, cervical paralysis (n= 2) and facial paralysis (n= 2). All patients had longitudinal lesions in the spinal cord, with gray matter involvement, mainly in the anterior horn. In all cases, a lumbar puncture (spinal tap) was performed. Pleocytosis was observed in 7 patients. In four children, enterovirus D68 was identified in nasopharyngeal secretions, and in one, it was detected in the cerebrospinal fluid. Neurological deficit persisted in all patients at the time of discharge. CONCLUSIONS: The first outbreak of acute flaccid myelitis associated to enterovirus D68 is reported in Argentina. Active epidemiological surveillance will help to determine the true incidence, epidemiology and etiology of this disease. Sociedad Argentina de Pediatría
INTRODUCTION: The association between enterovirus D68 and acute flaccid myelitis was first described in the United States in 2014. Since then, sporadic cases have been reported in Canada and Europe. This study describes a series of cases of acute flaccid myelitis at Hospital de Pediatría "Prof. Dr. Juan P. Garrahan," in Buenos Aires, Argentina, during 2016. METHODS: Descriptive, retrospective study. All patients with acute flaccid myelitis and lesions in the spinal cord involving the gray matter, as observed in the magnetic resonance imaging (MRI) scan, hospitalized from 04/01/2016 to 07/01/2016, were included in the study. Samples of nasopharyngeal secretions, fecal swabs and cerebrospinal fluid were collected and processed to look for the causative agent. RESULTS: Ten patients were included. The median age was 4 years old (range from 3 months to 5 years old). Eight patients had a self-limiting febrile condition before the onset of neurological symptoms. Neurological findings were flaccid weakness in, at least, one limb, cervical paralysis (n= 2) and facial paralysis (n= 2). All patients had longitudinal lesions in the spinal cord, with gray matter involvement, mainly in the anterior horn. In all cases, a lumbar puncture (spinal tap) was performed. Pleocytosis was observed in 7 patients. In four children, enterovirus D68 was identified in nasopharyngeal secretions, and in one, it was detected in the cerebrospinal fluid. Neurological deficit persisted in all patients at the time of discharge. CONCLUSIONS: The first outbreak of acute flaccid myelitis associated to enterovirus D68 is reported in Argentina. Active epidemiological surveillance will help to determine the true incidence, epidemiology and etiology of this disease. Sociedad Argentina de Pediatría
Entities:
Keywords:
acute flaccid myelitis; enterovirus; human enterovirus D68; pediatrics; poliomyelitis
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