CDC urges healthcare providers to consider EV-D68 as a possible cause of acute, severe respiratory illness and a potential increase in AFM cases. Diagnosis
AFM is diagnosed by examining a persons nervous system in combination with reviewing images of the spinal cord. A doctor can examine a persons nervous system and the places on the body where he or she has weakness, poor muscle tone, and decreased reflexes. In addition, a doctor can do magnetic resonance imaging to look at a persons brain and spinal cord, do laboratory tests on the cerebrospinal fluid (CSF, the fluid around the brain and spinal cord), and may check nerve conduction (impulse sent along a nerve fiber) and response.Diagnosis of AFM requires acute onset limb paralysis and at least one gray-matter spinal-cord lesion. CSF should show pleocytosis. Prevention
The CDC recommends, "To prevent infections in general, persons should stay home if they are ill, wash their hands often with soap and water, avoid close contact (such as touching and shaking hands) with those who are ill, and clean and disinfect frequently touched surfaces." Treatment
Treatment involves supportive care. Physical therapy may be recommended. Occasionally mechanical ventilation is required to support breathing.If immunoglobulin, corticosteroids, plasma exchange, or antiviral medication are useful is unclear. Outcomes
Studies from 2014 to 2017 indicated a poor outcome for many cases.
It you lift the arm up, it literally drops. Sensation is usually intact. There might be slightly decreased sensation in the other arm, but these are younger kids, so theyre not always so cooperative in giving you a good sensory exam. Childrens Mercy Hospital, which had three or four cases in 2014, reported that the MRI images and symptoms closely mimicked polio. They reported: "The sudden onset of flaccid paralysis in single or multiple limbs with absolutely no sensory findings, the MRIs all showing uniformly a signal increase in the ventral horns of the spinal cord — this is exactly the same region of the spinal cord affected in polio ... Almost all of the patients have an increase in their white blood cells in the cerebrospinal fluid. Some of the patients have brainstem findings and cranial-nerve findings. "Of 64 patients meeting the CDC criteria before October 29, 2014, 80% had had a preceding respiratory illness and 75% reported fever in the days leading up to limb weakness, the onset of which was generally abrupt. By November 20, the number of confirmed cases stood at 88 from 29 states.The CDC requested that physicians provide information about cases meeting these criteria: patients diagnosed after August 1, 2014, who are no older than 21 years of age, showing acute onset of focal limb weakness, with a spinal-cord lesion largely restricted to grey matter visualized by MRI.In November 2018, the CDC reported that they were investigating 286 cases, with at least 116 confirmed cases in 31 states.