-
Enterovirus may be linked to paralysis in
12 Colorado children, study finds
new study by researchers from
Children's Hospital Colorado suggests
a
potential
link
between
a
rare
respiratory
virus
and
a
form
of
paralysis that has so far
affected more than 100 children in the US.
Since
early
August
last
year,
107
children
over
34
US
states
have
developed acute
flaccid
paralysis
(AFP)
-
a
sudden
form
of
muscle
weakness
or
paralysis.
The
condition
is
characterized by limb weakness,
difficulty swallowing and/or facial weakness.
AFP is normally associated with
poliovirus, and global vaccinations for the virus
has meant
incidence of AFP has become
uncommon. But the number of recent cases
identified is three
times higher than
normal.
While the cause remains
unclear, the Centers for Disease Control and
Prevention (CDC) have
flagged
enterovirus D68 (EV-D68) - a non-polio virus that
causes mild to severe respiratory
illness
- as a
culprit, particularly since 2014 saw an
outbreak of the
virus
around
the same
time as cases of AFP rose.
Starting in Missouri and Illinois in
August 2014, outbreaks of EV-D68 soon started to
spread
to other parts of the US,
including Colorado - where from then until
October, several children
were admitted
to Children's Hospital Colorado with AFP.
Study leader Dr. Kevin Messacar, a
pediatric infectious disease physician and
researcher at
Children's
Hospital Colorado, and colleagues set
out to review these cases in an attempt to
gain a better understanding of the
cause.
According to the researchers,
between August 1st and September 30th, 2014, there
was a 36%
rise
in
the
number
of
respiratory-related
visits
to
Children's
Hospital
Colorado
emergency
department
and
a
77%
increase
in
respiratory-related
admission
rates,
compared
with
the
same months in 2013 and 2014.
During
the
same
period
last
year,
the
team
notes,
there
was
also
a
significant
rise
in
the
number of nasal samples testing
positive for rhinovirus and enterovirus.
respiratory
illness
who tested
positive for
rhinovirus or
enterovirus
in
the
nasopharynx,
we
identified EV-D68 in 19
(76%) specimens,
'
S
everal factors suggest a link between
EV
-D68 neurological disease'
Between
August
1st
and
October
31st,
2014,
the
researchers
identified
12
children
who
presented
at
the
hospital
with
varying
severities
of
muscle
weakness
in
their
limbs,
facial
weakness and problems swallowing.
Around a week before these symptoms started, all
of the
children had a fever and
respiratory illness.
Magnetic resonance
imaging (MRI) revealed that 10 of the children had
lesions in the spinal
cord,
while
nine
of
the
children
had
brain
stem
lesions.
The
researchers
identified
the
presence
of
enteroviruses
or
rhinoviruses
among
eight
of
the
children
-
and
five
of
these
tested positive for EV-D68.
Though
the
12
children
have
received
treatment,
10
of
the
children
with
limb
paralysis
continue
to
have
problems
and
the
researchers
say
it
is
unclear
as
to
whether
this
will
be
permanent. They add that three of the
children have shown improvements in swallowing and
facial weakness, however.
Based
on
their
findings,
published
in
The
Lancet
,
the
researchers
believe
it
is
possible
EV-D68 may be associated with
neurological disease. They say:
nerve dysfunction associated
with a community-wide outbreak of enterovirus-D68
respiratory
disease.
Although
our
findings
do
not
prove
that
enterovirus
D68
is
the
cause
of
the
neurological
presentations
described,
several
epidemiological,
virological
and
clinical
factors
suggest
an
association between the
D68 virus and neurological disease.
They
add
that if
EV-D68
outbreaks
continue,
effective
treatments
and
vaccines
against the
virus need to be a major scientific
priority.
further
investigation
confirms
the
link
between
EV-D68
and
AFP
and
cranial
nerve
dysfunction,
EV-D68
will
be
added
to
the
list
of
non-poliovirus
enteroviruses
capable
of
causing
severe,
potentially
irreversible
neurologic
damage,
and
finding
effective
antiviral
therapies
and
vaccines
will
be
a
priority,
says
senior
author
Dr.
Samuel
Dominguez,
microbial epidemiologist at the
Children's Hospital Colorado.
In June
2013,
Medical News Today
reported on a study that found a number of
children with
Crohn's disease also had
enterovirus, indicating a link between the two
conditions.
Written by Honor Whiteman
References
A
cluster of acute flaccid paralysis and cranial
nerve dysfunction temporally associated with
an
outbreak
of
enterovirus
D68
in
children
in
Colorado,
USA,
Kevin
Messacar,
et
al.,
The
Lancet
, published online 29
January 2015, abstract.
The
Lancet
news release, accessed 30
January 2015.
Additional source: CDC,
Summary of findings: investigation of acute
flaccid myelitis in US
Children, 2014,
accessed 30 January 2015.