Accumulation of three pediatric cases of acute flaccid myelitis in autumn 2015 in Nagasaki, Japan

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  • 長崎県で2015年秋に発症した急性弛緩性脊髄炎の3例

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Abstract

<p>  During the outbreak of enterovirus D68 (EV-D68)-associated respiratory diseases in North America in autumn 2014, a number of cases of acute flaccid paralysis (AFP) were reported. Similarly, the accumulation of AFP cases was observed in Japan during the outbreak of EV-D68 in autumn 2015. During this season, we cumulatively experienced three cases of acute flaccid myelitis (AFM) in Nagasaki. A 12-year-old girl, a 4-year-old boy and a 2-year-old girl developed AFP 4-9 days after antecedent infections. T2-weighted images of spinal magnetic resonance imaging showed high-intensity lesions, particularly affecting the anterior horns in all three cases. Cerebrospinal fluid studies indicated pleocytosis in all three and increased protein levels in two. Peripheral nerve conduction studies showed a reduction in the F wave incidence in all three patients. They were treated with intravenous immunoglobulin, methylprednisolone pulse therapy, and plasma exchange, none of which appeared effective. They all had mild-to-severe sequelae, but became less severe by rehabilitation. Rehabilitation is important for AFM that not have effective therapy in acute phase. Although EV-D68 has been strongly suspected to be an etiological agent of AFM in previous reports, we were unable to detect EV-D68 in any of our patients. Since EV-D68 can be detected only in the early stage of infection, sample collection from our cases might have been too late. Further studies are needed to clarify the role of EV-D68 in the pathogenesis of AFM.</p>

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  • NO TO HATTATSU

    NO TO HATTATSU 49 (6), 408-412, 2017

    The Japanese Society of Child Neurology

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