Since 2012, the polio-like disease acute flaccid myelitis (AFM) has emerged in several regions of the world and has been reported mainly in children. A review article in the Lancet recently published an evidence-based overview of the cause, diagnosis and treatment of this disorder, identifying it as an emerging global public health problem.
In the article, authors on behalf of the AFM working group stated that there appears to be a possible viral association with AFM cases. There is currently evidence of non-polio enterovirus infection as the cause of AFM, especially since the disease has characteristics similar to the viral infection. Many patients with AFM report a febrile prodrome along with respiratory symptoms in the days prior to the onset of muscle weakness.
In addition, evidence links a causal association of AFM with enterovirus, which is supported by the temporal and geographic associations between AFM cases and enterovirus circulation. However, the review authors were unsure of the specific mechanisms behind viral infection that leads to AFM, and this remains a critical topic for future research.
To date, there is not a single sensitive and specific test for AFM. In addition, there are no standardized diagnostic criteria for the disease. The disease typically occurs in children, mean age 6.3 years, and less than 15 percent of cases occur in adult patients. Diagnosis often includes assessment of clinical, imaging, and cerebrospinal fluid properties. Neurological symptoms that appear 1 to 10 days after the onset of the infectious prodrome are often associated with stiff neck, headache, or renewed fever.
Many patients suffer from significant residual disabilities and need long-term rehabilitation after the acute phase of the disease. Rehabilitation and long-term clinical care for patients with AFM includes multidisciplinary inpatient rehabilitation, nerve and tendon transduction, medium to long-term rehabilitation, and long-term medical management. For long-term medical treatment, patients should continue to adhere to the vaccination protocols set out in national guidelines, undergo neurological follow-up appointments, and receive professional information on the treatment of complications, long-term ventilatory support, or artificial feeding.
The increasing incidence of AFM suggests that the disease is an emerging and significant global public health problem that requires additional research to be diagnosed and treated. In addition, the authors of this review concluded that “increased awareness of the present clinical features of AFM is required to enable accurate case identification to understand the epidemiology and burden of disease, to enable early detection to enable immediate specimen collection and enable causal diagnosis, and early initiation of potential therapies. ”
Murphy OC, Messacar K., Benson L. et al. Acute flaccid myelitis: cause, diagnosis, and treatment. Lancet. Published online on December 21, 2020. doi: 10.1016 / S0140-6736 (20) 32723-9