Enigma surrounding Polio like illness /Acute Flaccid Myelitis in USA

Reepa Agrawal
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10 Nov, 2018

There is a spike in cases of acute flaccid myelitis (AFM) all over United States of America this year. It is not a new disease but very rare with an estimated incidence of 1 in million cases. Since 2014, the CDC has confirmed a total of 396 cases of AFM across the United States. A biennial pattern has been observed with majority of cases reported in 2014, 2016 and now in 2018 since September onwards.

This is a polio like illness characterised by acute onset of flaccid limb weakness and MRI showing changes in grey matter of spinal cord. It appears to start with a prodromal respiratory or gastrointestinal illness about 1 week before limb weakness onset. Pain in the neck or back precedes weakness in one or more limbs, and cranial nerve weakness findings such as facial droop, slurred speech and difficulty in swallowing are seen. CSF shows lymphocytic pleocytosis. It affects mostly children.

Inspite of thorough Investigations, the exact cause of this illness is not known although viruses like enterovirus, West Nile virus, adenovirus, environmental toxins and genetic causes have been implicated.

There is no definitive treatment available. The enigma surrounding the disease is frustrating for health care workers and the investigating team as well as patients and their parents. All these cases have been tested negative for polio.
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