What is 'acute flaccid myelitis (AFM)' which leads to the death of the limbs of the child and the worst in the worst case?
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Acute loosening myelitis (AFM) is a disease resembling acute gray myelitis (polio), which is a sudden onset of weakness in the arms and legs and palpitations, and is characterized by lesions in the spinal cord by MRI scans. AFM is almost always a disease that occurs in children, and sometimes there are residual effects or death due to dyspnea, but at the time of writing the cause and treatment etc are not clear. Researchers gather information about AFM, and study measures and effective treatments.
Mysterious illness that paralyzes healthy kids prompts plea from CDC | Ars Technica
https://arstechnica.com/science/2019/07/mysterious-illness-that-paralyses-healthy-kids-prompts-plea-from-cdc/
AFM first attracted attention when the number of children with polio-like symptoms surged in the United States in 2014, and it has been known to healthcare professionals for several years. In 2014, 120 AFMs were confirmed in 34 states in the United States, but 22 cases in 2015, 149 cases in 39 states and Washington DC in 2016, 35 cases in 2017, 2018 The number of cases is gradually rising while showing biennial epidemic patterns, with 233 cases confirmed in 41 states. At the time of writing, the number of onset cases in 2019 is only 11 and it seems that it applies to the biennial epidemic pattern, but since AFM cases peak in summer and autumn, they can not be made cautious yet With the situation.
Most affected AFM patients are children, and the average age of the patients is as low as 5 years. Nearly all of the affected people were admitted to the hospital, 60% of patients had to receive intensive care, and 27% needed respiratory support. However, researchers have not found an effective treatment for AFM, and in some cases symptoms may completely heal over time, and in some cases sequelae may remain or may result in death.
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Because the symptoms of AFM are similar to polio, many researchers think that the cause of AFM is related to a type of enterovirus belonging to the group including polio virus . In fact, Enterovirus A71 , a member of the Enterovirus genus and a major cause of hand-foot-and-mouth disease , is known to cause polio-like symptoms.
In addition, AFM was first noticed in 2014 at the same time as the spread of enterovirus D68 (EV-D68) , a type of enterovirus that causes respiratory diseases. Researchers immediately suspected the association between EV-D68 and AFM, and in fact it was found that the patient had been infected with EV-D68 in some of the AFM cases in 2014, 'Seen in AFM patients There is a report that the damage to the spinal cord is similar to the damage to the motor neurons caused by the invasion of the poliovirus into the spinal cord.
In addition, more than 90% of AFM patients had mild respiratory infections and fever prior to becoming aware of major symptoms such as weakness in their extremities. In addition, enteroviruses, like AFM, reach a peak of infection from late summer to autumn. From these circumstantial evidences as well, the hypothesis is that enteroviruses that cause respiratory infections enter the spinal cord and damage motor neurons.
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On the other hand, obtaining evidence to support the association between EV-D68 and AFM is very difficult, and as a result of checking the bacterial infection in 123 of the cases confirmed in 2018, it was positive for EV-D68. There were only 38 cases. The other 10 cases were EV-A71 positive and the other 14 cases were infected with another enterovirus genus. In addition, although cerebrospinal fluid samples could be collected from 74 cases out of 233 cases, only 1 cases were positive for EV-D68, and only 1 case was positive for EV-A71 others. did.
Investigators are thinking about the result, in fact, that the Enterovirus genus had not invaded the spinal cord, or that samples of cerebrospinal fluid were taken after the virus was gone. Therefore, at the time of writing the article, it is notified that AFM and suspected patients are reported as soon as they are identified.
Other than the identification of the virus that causes AFM, there remain questions such as 'Why is it only prevalent among children?' 'Why is there a biennial epidemic pattern?' Researchers have also identified cases where brothers and sisters were infected with EV-D68, but only one of them had developed AFM, suggesting that there may be other causes other than just viral infection. It has been. One hypothesis is that aggravation of symptoms caused by multiple viral infections may lead to AFM, for example, the combination of the mosquito-borne West Nile virus and the adenovirus that causes a cold with the enterovirus genus will generate AFM Some researchers speculate that this is not the case.
However, Tom Clark of the Centers for Disease Prevention and Control still claims that the cause behind AFM is unknown and that more data should be collected before making specific guesses. Mr. Clark said, 'AFM is a rare disease,' but if children suddenly show symptoms such as weakness in their extremities, they should be taken seriously and immediately consult a physician.
by Semevent
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