Acute flaccid myelitis-Clustering of polio-like illness in the tertiary care centre in Southern India

J Trop Pediatr. 2019 Aug 1;65(4):309-314. doi: 10.1093/tropej/fmy052.

Abstract

Introduction: Acute flaccid myelitis (AFM) is characterized by limb weakness with spinal cord grey matter lesion on imaging or electrodiagnostic evidence of spinal cord motor neuron injury. This Poliomyelitis-like illness is rare in children, and its natural course is not yet well defined.

Purpose of the study: The purpose of the study was to report the clinical presentation, laboratory findings, management and outcome of children with AFM.

Materials and methods: This is a prospective case series study.

Results: Nine children met the case definition given by CDC. All cases presented with prodromal symptoms followed by acute onset asymmetrical limb weakness. Maximum weakness is reached within 4 days from the day of onset. Cerebrospinal fluid analysis shows that pleocytosis with viral markers for arboviruses and enteroviruses was negative. Electrophysiological study revealed decreased muscle action potential in all. MRI of the spinal cord showed predominantly grey matter involvement.

Conclusion: AFM should be one of the differential diagnoses in any child presenting with acute flaccid paralysis.

Keywords: Acute flaccid myelitis; Guillain–Barre syndrome; acute flaccid paralysis; transverse myelitis.

MeSH terms

  • Administration, Intravenous
  • Administration, Oral
  • Anti-Inflammatory Agents
  • Brain / diagnostic imaging*
  • Central Nervous System Viral Diseases / diagnosis*
  • Central Nervous System Viral Diseases / drug therapy
  • Central Nervous System Viral Diseases / epidemiology
  • Child
  • Child, Preschool
  • Female
  • Gray Matter / diagnostic imaging*
  • Gray Matter / parasitology
  • Humans
  • India / epidemiology
  • Leukocytosis / cerebrospinal fluid*
  • Magnetic Resonance Imaging
  • Male
  • Methylprednisolone / administration & dosage
  • Methylprednisolone / therapeutic use
  • Myelitis / diagnosis*
  • Myelitis / drug therapy
  • Myelitis / epidemiology
  • Neuromuscular Diseases / diagnosis*
  • Neuromuscular Diseases / drug therapy
  • Neuromuscular Diseases / epidemiology
  • Paralysis / etiology*
  • Prednisolone / administration & dosage
  • Prednisolone / therapeutic use
  • Prospective Studies
  • Tertiary Care Centers
  • Treatment Outcome

Substances

  • Anti-Inflammatory Agents
  • Prednisolone
  • Methylprednisolone

Supplementary concepts

  • acute flaccid myelitis