Frontiers in Neurology (May 2020)
Acute Flaccid Myelitis in Children in Zhejiang Province, China
- Liming Gong,
- Yilong Wang,
- Yilong Wang,
- Weiqing Zhang,
- Weiqing Zhang,
- Chen Chen,
- Xinghui Yang,
- Xinghui Yang,
- Lu Xu,
- Lu Xu,
- Congying Zhao,
- Congying Zhao,
- Lihua Jiang,
- Lihua Jiang,
- Zhefeng Yuan,
- Zhefeng Yuan,
- Zhezhi Xia,
- Zhezhi Xia,
- Peifang Jiang,
- Peifang Jiang,
- Qiong Ge,
- Juying Yan,
- Yi Sun,
- Yin Chen,
- Zhengyan Zhao,
- Yanjun Zhang,
- Feng Gao,
- Feng Gao
Affiliations
- Liming Gong
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
- Yilong Wang
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Yilong Wang
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Weiqing Zhang
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Weiqing Zhang
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Chen Chen
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
- Xinghui Yang
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Xinghui Yang
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Lu Xu
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Lu Xu
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Congying Zhao
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Congying Zhao
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Lihua Jiang
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Lihua Jiang
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Zhefeng Yuan
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Zhefeng Yuan
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Zhezhi Xia
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Zhezhi Xia
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Peifang Jiang
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Peifang Jiang
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Qiong Ge
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
- Juying Yan
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
- Yi Sun
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
- Yin Chen
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
- Zhengyan Zhao
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Yanjun Zhang
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
- Feng Gao
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Feng Gao
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- DOI
- https://doi.org/10.3389/fneur.2020.00360
- Journal volume & issue
-
Vol. 11
Abstract
In July–December 2018, an outbreak of polio-like acute flaccid myelitis (AFM) occurred in Zhejiang province, China. Enterovirus (EV)-D68 infection has been reported to be associated with AFM. This study aimed to investigate the clinical presentation, laboratory findings, and outcomes of AFM patients. We investigated the clinical and virologic information regarding the AFM patients, and real-time PCR, sequencing, and phylogenetic analysis were used to investigate the cause of AFM. Eighteen cases met the definition of AFM, with a median age of 4.05 years (range, 0.9–9 years), and nine (50%) were EV-D68 positive. Symptoms included acute flaccid limb weakness and cranial nerve dysfunction. On magnetic resonance imaging, 11 (61.1%) patients had spinal gray matter abnormalities. Electromyography results of 16 out of 17 patients (94.1%) were abnormal. Cerebrospinal fluid (CSF) pleocytosis was common (94.4%), while CSF protein concentration was normal in all patients. There was little improvement after early aggressive therapy. Phylogenetic analysis revealed that EV-D68 subclade B3 was the predominant lineage circulating in Zhejiang province in 2018.
Keywords
- acute flaccid myelitis
- enterovirus
- spinal gray matter
- pleocytosis
- magnetic resonance imaging
- cerebrospinal fluid
