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Order Picornavirales
Published in Paul Pumpens, Peter Pushko, Philippe Le Mercier, Virus-Like Particles, 2022
Paul Pumpens, Peter Pushko, Philippe Le Mercier
The enterovirus D68 (EV-D 68) belongs to the Enterovirus D species and is suspected to play a definite role in acute flaccid myelitis (AFM), an uncommon but serious neurological condition, mostly in young children. Zheng Q et al. (2019) resolved atomic structures of the EV D68 major phases throughout its life cycle, including mature, cell-entry intermediate (A-particle), and empty forms and of virus complex with two monoclonal antibodies, defining therefore distinct mechanisms of viral neutralization.
Post-viral syndromes
Published in Avindra Nath, Joseph R. Berger, Clinical Neurovirology, 2020
Anusha K. Yeshokumar, Eliza Gordon-Lipkin, Brenda Banwell
Recently, there has been a rise in cases of myelitis associated with enterovirus D68 and enterovirus D71. In these cases, patients present with flaccid paralysis and a polio-like clinical picture. Termed acute flaccid myelitis (AFM), it is presumed that this disease results from direct viral infection of the anterior horn cells with secondary edema and possible demyelination of the cord [27]. While there are overlapping features with TM, key differences will allow the distinction of these two diseases. AFM presents with acute onset of flaccid paralysis of one or more extremities with loss of deep tendon reflexes in a lower motor neuron pattern, typically with pain in the affected extremity, cranial nerve palsies, and respiratory compromise. MRI of the spine demonstrates a lesion largely restricted to gray matter and spanning more than one spinal cord segment, and outcome is poor with up to 90% of patients experiencing residual deficits [27]. Created for epidemiological studies, Centers for Disease Control and Prevention (CDC) case definitions for confirmed and probable AFM are shown in Table 25.3 [28]. Similar clinical pictures have also been described associated with West Nile virus [29], adenovirus [30], and rarely, other infections [31].
Emerging trends and insights in acute flaccid myelitis: a comprehensive review of neurologic manifestations
Published in Infectious Diseases, 2023
Baljinder Singh, Sanchit Arora, Navjot Sandhu
In conclusion, this comprehensive review sheds light on the emerging trends and insights in Acute Flaccid Myelitis (AFM), a neurological condition characterised by paraplegia and cranial nerve dysfunction. The review highlights the association of AFM with Enterovirus 68 (EV-D68), a member of the Enterovirus family, and emphasises the impact of AFM on the overall quality of life of patients. Paediatric patients are particularly vulnerable to AFM, but the review emphasises that careful clinical assessment and management can help reduce the risk of mortality and paraplegia. Diagnostic techniques such as Magnetic Resonance Imaging (MRI) of the spinal cord, Reverse Transcription Polymerase Chain Reaction (rRT-PCR), and VP1 seminested PCR assay of cerebrospinal fluid (CSF), stool, and serum samples play a crucial role in identifying and confirming AFM. The review also discusses the importance of social distancing as a primary measure to control outbreaks of AFM, as recommended by public health administrations. Additionally, the potential of various vaccine options, including whole virus, live attenuated, sub-viral particles, and DNA vaccines, is explored as potential treatments for AFM. Overall, this comprehensive review provides valuable insights into the epidemiology, pathophysiology, diagnosis/clinical features, hospitalisation/mortality, management/treatment, and potential future developments in AFM. The findings underscore the need for continued research and collaboration to enhance our understanding of AFM and develop more effective strategies for its prevention, diagnosis, and treatment.
Hypothetical emergence of poliovirus in 2020: part 1. Consequences of policy decisions to respond using nonpharmaceutical interventions
Published in Expert Review of Vaccines, 2021
Kimberly M. Thompson, Dominika A. Kalkowska, Kamran Badizadegan
Historical experience with polio demonstrates that an emerging pathogen or an unnamed novel pathogen can transmit without clinical detection or public health action for extended periods of time. Although our collective ability to identify human pathogens continues to increase, diagnostic testing is often limited to a fraction of viruses, bacteria, and fungi that are known to cause the majority of human infections, and novel, rare or esoteric infections can go undetected. In the US, cases and clusters of acute flaccid myelitis reported since 2014 provide an example of polio-like illnesses caused by non-polio and yet unidentified pathogens [41–43]. The contrasting examples of rapid detection of SARS-CoV-2 compared to historical experience with polio provide an indication of the substantial advancement of technology. However, the experience with emerging nonpolio neurotropic enteroviruses (e.g. EV-68, EV-71) demonstrates that rapid detection will not always occur despite the availability of technology. Escalation to a critical status is required to drive global action, such as declaration of a Public Health Emergency of International Concern by the World Health Organization.
Brachial plexitis: an unusual presentation in sickle cell disease
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Mustafa Dawood, Justin McArthur, Abubakar Tauseef
Brachial plexitis is an uncommon cause of upper extremity weakness. The incidence is 1.64 cases among 100,000 with a male predominance. It is usually divided into two categories as either idiopathic or hereditary. Twenty-five percent to 55% cases are preceded by viral or bacterial infections. Commonly associated infections include smallpox, Borrelia burgdorferi, coxsackievirus, influenza, typhoid, HIV, and CMV. Fifteen percent of the cases have reported recent history of vaccination [1]. Other causes include trauma, post-surgical, pregnancy, and strenuous exercise [1]. A case has been reported with herpes zoster infection [2]. Radiation has also been reported as an attributed factor as 25 cases reported during the period of 1967–1980 [3]. The hereditary form is an autosomal dominant condition and believed to be due to deficiency in the protein septin family [1]. The most common initial symptom is the acute onset of shoulder-based pain which is present in 95% followed by weakness. Weakness either coincides with the onset of pain or occurs in a delayed fashion. It is unilateral in 66% of the cases and 54% involve the right side. Most common muscles group involved are deltoid, biceps, triceps, spinatus, and serratus anterior. Sensory symptoms are present in 78% of the cases of which paresthesia and hypoesthesia are the most common [1]. The condition has also been described in the pediatric population with a similar presentation as in adults [4]. In children, acute flaccid myelitis may mimic brachial plexitis clinical manifestations.