Clinical features of acute flaccid myelitis temporally associated with an enterovirus D68 outbreak: Results of a nationwide survey of acute flaccid paralysis in Japan, August-December 2015

Pin Fee Chong; Ryutaro Kira; Harushi Mori; Akihisa Okumura; Hiroyuki Torisu; Sawa Yasumoto; Hiroyuki Shimizu; Tsuguto Fujimoto; Nozomu Hanaoka; Susumu Kusunoki; Toshiyuki Takahashi; Kazunori Oishi; Keiko Tanaka-Taya; Etsushi Toyofuku; Tetsuhiro Fukuyama; Tatsuharu Sato; Yuya Takahashi; Akane Kanazawa; Masato Hiyane; Takao Fukushima; Taira Toki; Ryoko Hayashi; Sonoko Kubota; Wakako Ishii; Manami Akasaka; Haruna Miyazawa; Mitsuo Motobayashi; Mari Asaoka; Takashi Shiihara; Yoshitaka Miyoshi; Tomohiko Tsuru; Kenta Ikeda; Masaru Matsukura; Ryoko Nakamura; Kengo Moriyama; Yuji Sugawara; Yuichi Takami; Takako Fujita; Tamami Yano; Mariko Kasai; Takashi Uchida; Masashi Fujita; Mitsugu Uematsu; Atsuko Hata; Hideto Ogata; Tomoyuki Miyamoto; Kataharu Sumi; Yu Ishida; Eri Takeshita; Tomoya Kawazoe; Takayoshi Kawabata; Chiharu Miyatake; Akiko Yakuwa; Yu Kakimoto; Hiroshi Terashima; Masaya Kubota; Yuichi Abe; Michiaki Nagura; Hideo Yamanouchi; Satomi Mori; Yukihiko Konishi; Mariko Ikegami; Yuko Tomonaga; Yumiko Takashima; Kazushi Ichikawa; Nobuko Moriyama; Chizu Oba; Mitsuru Kashiwagi; Sosuke Yoshikawa; Kenichi Tanaka; Genrei Ohta; Ayako Hattori; Daisuke Ieda; Sahoko Ono; Tomoshige Tanimura; Kyoko Ban; Nobuyoshi Sugiyama; Nozomi Kouzan; Yuki Yamada; Mika Inoue; Kenichi Sakajiri; Ken Ohyama; Miho Yamamuro; Hidetoshi Ishigaki; Azusa Seino; Shuichi Igarashi; Takahito Nakamoto; Kanae Sugimoto; Mitsuhiro Ochi; Eri Hamanaka; Kazuki Ohi; Hidefumi Kawasaki; Masahiko Nishitani; Hiroshi Uno; Masaru Inoue; Mai Okuyama; Ayako Yamamoto; Ryota Sato; Norihiko Azuma; Sakiko Mabuchi; Yoko Shida; Yu Hashimoto; Motoi Yoshimura; Yuki Matsuhisa; Kotaro Nakano; Yukio Yamashita; Eriko Kikuchi; Asuka Yamamoto; Naru Igarashi; Noboru Yoshida; Shingo Nishiki; Daisuke Yasutomi; Nobuyoshi Kusano; Ryohei Wakahara; Masayuki Furuyama; Hitoshi Mikami; Hiroaki Taniguchi; Yasuhiro Yoshii; Atsushi Narabayashi; Tomofumi Nakamura; Yasuo Kaburagi; Akiko Nagasao; Motoi Kuwahara; Kenichi Kaida

doi:10.1093/cid/cix860

Clinical features of acute flaccid myelitis temporally associated with an enterovirus D68 outbreak: Results of a nationwide survey of acute flaccid paralysis in Japan, August-December 2015

Pin Fee Chong, Ryutaro Kira, Harushi Mori, Akihisa Okumura, Hiroyuki Torisu, Sawa Yasumoto, Hiroyuki Shimizu, Tsuguto Fujimoto, Nozomu Hanaoka, Susumu Kusunoki, Toshiyuki Takahashi, Kazunori Oishi, Keiko Tanaka-Taya, Etsushi Toyofuku, Tetsuhiro Fukuyama, Tatsuharu Sato, Yuya Takahashi, Akane Kanazawa, Masato Hiyane, Takao FukushimaTaira Toki, Ryoko Hayashi, Sonoko Kubota, Wakako Ishii, Manami Akasaka, Haruna Miyazawa, Mitsuo Motobayashi, Mari Asaoka, Takashi Shiihara, Yoshitaka Miyoshi, Tomohiko Tsuru, Kenta Ikeda, Masaru Matsukura, Ryoko Nakamura, Kengo Moriyama, Yuji Sugawara, Yuichi Takami, Takako Fujita, Tamami Yano, Mariko Kasai, Takashi Uchida, Masashi Fujita, Mitsugu Uematsu, Atsuko Hata, Hideto Ogata, Tomoyuki Miyamoto, Kataharu Sumi, Yu Ishida, Eri Takeshita, Tomoya Kawazoe, Takayoshi Kawabata, Chiharu Miyatake, Akiko Yakuwa, Yu Kakimoto, Hiroshi Terashima, Masaya Kubota, Yuichi Abe, Michiaki Nagura, Hideo Yamanouchi, Satomi Mori, Yukihiko Konishi, Mariko Ikegami, Yuko Tomonaga, Yumiko Takashima, Kazushi Ichikawa, Nobuko Moriyama, Chizu Oba, Mitsuru Kashiwagi, Sosuke Yoshikawa, Kenichi Tanaka, Genrei Ohta, Ayako Hattori, Daisuke Ieda, Sahoko Ono, Tomoshige Tanimura, Kyoko Ban, Nobuyoshi Sugiyama, Nozomi Kouzan, Yuki Yamada, Mika Inoue, Kenichi Sakajiri, Ken Ohyama, Miho Yamamuro, Hidetoshi Ishigaki, Azusa Seino, Shuichi Igarashi, Takahito Nakamoto, Kanae Sugimoto, Mitsuhiro Ochi, Eri Hamanaka, Kazuki Ohi, Hidefumi Kawasaki, Masahiko Nishitani, Hiroshi Uno, Masaru Inoue, Mai Okuyama, Ayako Yamamoto, Ryota Sato, Norihiko Azuma, Sakiko Mabuchi, Yoko Shida, Yu Hashimoto, Motoi Yoshimura, Yuki Matsuhisa, Kotaro Nakano, Yukio Yamashita, Eriko Kikuchi, Asuka Yamamoto, Naru Igarashi, Noboru Yoshida, Shingo Nishiki, Daisuke Yasutomi, Nobuyoshi Kusano, Ryohei Wakahara, Masayuki Furuyama, Hitoshi Mikami, Hiroaki Taniguchi, Yasuhiro Yoshii, Atsushi Narabayashi, Tomofumi Nakamura, Yasuo Kaburagi, Akiko Nagasao, Motoi Kuwahara, Kenichi Kaida

医学部

研究成果: ジャーナルへの寄稿 › 記事 › 査読

106 被引用数 (Scopus)

抄録

Background. Acute flaccid myelitis (AFM) is an acute flaccid paralysis syndrome with spinal motor neuron involvement of unknown etiology. We investigated the characteristics and prognostic factors of AFM clusters coincident with an enterovirus D68 (EV-D68) outbreak in Japan during autumn 2015. Methods. An AFM case series study was conducted following a nationwide survey from August to December 2015. Radiographic and neurophysiologic data were subjected to centralized review, and virology studies were conducted for available specimens. Results. Fifty-nine AFM cases (58 definite, 1 probable) were identified, including 55 children and 4 adults (median age, 4.4 years). Te AFM epidemic curve showed strong temporal correlation with EV-D68 detection from pathogen surveillance, but not with other pathogens. EV-D68 was detected in 9 patients: 5 in nasopharyngeal, 2 in stool, 1 in cerebrospinal fluid (adult case), and 1 in tracheal aspiration, nasopharyngeal, and serum samples (a pediatric case with preceding steroid usage). Cases exhibited heterogeneous paralysis patterns from 1-to 4-limb involvement, but all definite cases had longitudinal spinal gray matter lesions on magnetic resonance imaging (median, 20 spinal segments). Cerebrospinal fluid pleocytosis was observed in 50 of 59 cases (85%), and 8 of 29 (28%) were positive for antiganglioside antibodies, as frequently observed in Guillain-Barré syndrome. Fifty-two patients showed variable residual weakness at follow-up. Good prognostic factors included a pretreatment manual muscle strength test unit score >3, normal F-wave persistence, and EV-D68-negative status. Conclusions. EV-D68 may be one of the causative agents for AFM, while host susceptibility factors such as immune response could contribute to AFM development.

本文言語	英語
ページ（範囲）	653-664
ページ数	12
ジャーナル	Clinical Infectious Diseases
巻	66
号	5
DOI	https://doi.org/10.1093/cid/cix860
出版ステータス	出版済み - 3月 2018

UN SDG

この成果は、次の持続可能な開発目標に貢献しています

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10.1093/cid/cix860

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引用スタイル

Chong, P. F., Kira, R., Mori, H., Okumura, A., Torisu, H., Yasumoto, S., Shimizu, H., Fujimoto, T., Hanaoka, N., Kusunoki, S., Takahashi, T., Oishi, K., Tanaka-Taya, K., Toyofuku, E., Fukuyama, T., Sato, T., Takahashi, Y., Kanazawa, A., Hiyane, M., ... Kaida, K. (2018). Clinical features of acute flaccid myelitis temporally associated with an enterovirus D68 outbreak: Results of a nationwide survey of acute flaccid paralysis in Japan, August-December 2015. Clinical Infectious Diseases, 66(5), 653-664. https://doi.org/10.1093/cid/cix860

@article{16ef8f73da59433bbd0f65e9a0270958,

title = "Clinical features of acute flaccid myelitis temporally associated with an enterovirus D68 outbreak: Results of a nationwide survey of acute flaccid paralysis in Japan, August-December 2015",

abstract = "Background. Acute flaccid myelitis (AFM) is an acute flaccid paralysis syndrome with spinal motor neuron involvement of unknown etiology. We investigated the characteristics and prognostic factors of AFM clusters coincident with an enterovirus D68 (EV-D68) outbreak in Japan during autumn 2015. Methods. An AFM case series study was conducted following a nationwide survey from August to December 2015. Radiographic and neurophysiologic data were subjected to centralized review, and virology studies were conducted for available specimens. Results. Fifty-nine AFM cases (58 definite, 1 probable) were identified, including 55 children and 4 adults (median age, 4.4 years). Te AFM epidemic curve showed strong temporal correlation with EV-D68 detection from pathogen surveillance, but not with other pathogens. EV-D68 was detected in 9 patients: 5 in nasopharyngeal, 2 in stool, 1 in cerebrospinal fluid (adult case), and 1 in tracheal aspiration, nasopharyngeal, and serum samples (a pediatric case with preceding steroid usage). Cases exhibited heterogeneous paralysis patterns from 1-to 4-limb involvement, but all definite cases had longitudinal spinal gray matter lesions on magnetic resonance imaging (median, 20 spinal segments). Cerebrospinal fluid pleocytosis was observed in 50 of 59 cases (85%), and 8 of 29 (28%) were positive for antiganglioside antibodies, as frequently observed in Guillain-Barr{\'e} syndrome. Fifty-two patients showed variable residual weakness at follow-up. Good prognostic factors included a pretreatment manual muscle strength test unit score >3, normal F-wave persistence, and EV-D68-negative status. Conclusions. EV-D68 may be one of the causative agents for AFM, while host susceptibility factors such as immune response could contribute to AFM development.",

keywords = "Acute flaccid myelitis, Antiganglioside antibodies, Enterovirus D68, Nationwide survey, Prognostic analysis",

author = "Chong, {Pin Fee} and Ryutaro Kira and Harushi Mori and Akihisa Okumura and Hiroyuki Torisu and Sawa Yasumoto and Hiroyuki Shimizu and Tsuguto Fujimoto and Nozomu Hanaoka and Susumu Kusunoki and Toshiyuki Takahashi and Kazunori Oishi and Keiko Tanaka-Taya and Etsushi Toyofuku and Tetsuhiro Fukuyama and Tatsuharu Sato and Yuya Takahashi and Akane Kanazawa and Masato Hiyane and Takao Fukushima and Taira Toki and Ryoko Hayashi and Sonoko Kubota and Wakako Ishii and Manami Akasaka and Haruna Miyazawa and Mitsuo Motobayashi and Mari Asaoka and Takashi Shiihara and Yoshitaka Miyoshi and Tomohiko Tsuru and Kenta Ikeda and Masaru Matsukura and Ryoko Nakamura and Kengo Moriyama and Yuji Sugawara and Yuichi Takami and Takako Fujita and Tamami Yano and Mariko Kasai and Takashi Uchida and Masashi Fujita and Mitsugu Uematsu and Atsuko Hata and Hideto Ogata and Tomoyuki Miyamoto and Kataharu Sumi and Yu Ishida and Eri Takeshita and Tomoya Kawazoe and Takayoshi Kawabata and Chiharu Miyatake and Akiko Yakuwa and Yu Kakimoto and Hiroshi Terashima and Masaya Kubota and Yuichi Abe and Michiaki Nagura and Hideo Yamanouchi and Satomi Mori and Yukihiko Konishi and Mariko Ikegami and Yuko Tomonaga and Yumiko Takashima and Kazushi Ichikawa and Nobuko Moriyama and Chizu Oba and Mitsuru Kashiwagi and Sosuke Yoshikawa and Kenichi Tanaka and Genrei Ohta and Ayako Hattori and Daisuke Ieda and Sahoko Ono and Tomoshige Tanimura and Kyoko Ban and Nobuyoshi Sugiyama and Nozomi Kouzan and Yuki Yamada and Mika Inoue and Kenichi Sakajiri and Ken Ohyama and Miho Yamamuro and Hidetoshi Ishigaki and Azusa Seino and Shuichi Igarashi and Takahito Nakamoto and Kanae Sugimoto and Mitsuhiro Ochi and Eri Hamanaka and Kazuki Ohi and Hidefumi Kawasaki and Masahiko Nishitani and Hiroshi Uno and Masaru Inoue and Mai Okuyama and Ayako Yamamoto and Ryota Sato and Norihiko Azuma and Sakiko Mabuchi and Yoko Shida and Yu Hashimoto and Motoi Yoshimura and Yuki Matsuhisa and Kotaro Nakano and Yukio Yamashita and Eriko Kikuchi and Asuka Yamamoto and Naru Igarashi and Noboru Yoshida and Shingo Nishiki and Daisuke Yasutomi and Nobuyoshi Kusano and Ryohei Wakahara and Masayuki Furuyama and Hitoshi Mikami and Hiroaki Taniguchi and Yasuhiro Yoshii and Atsushi Narabayashi and Tomofumi Nakamura and Yasuo Kaburagi and Akiko Nagasao and Motoi Kuwahara and Kenichi Kaida",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2017.",

year = "2018",

month = mar,

doi = "10.1093/cid/cix860",

language = "English",

volume = "66",

pages = "653--664",

journal = "Clinical Infectious Diseases",

issn = "1058-4838",

publisher = "Oxford University Press",

number = "5",

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Chong, PF, Kira, R, Mori, H, Okumura, A, Torisu, H, Yasumoto, S, Shimizu, H, Fujimoto, T, Hanaoka, N, Kusunoki, S, Takahashi, T, Oishi, K, Tanaka-Taya, K, Toyofuku, E, Fukuyama, T, Sato, T, Takahashi, Y, Kanazawa, A, Hiyane, M, Fukushima, T, Toki, T, Hayashi, R, Kubota, S, Ishii, W, Akasaka, M, Miyazawa, H, Motobayashi, M, Asaoka, M, Shiihara, T, Miyoshi, Y, Tsuru, T, Ikeda, K, Matsukura, M, Nakamura, R, Moriyama, K, Sugawara, Y, Takami, Y, Fujita, T, Yano, T, Kasai, M, Uchida, T, Fujita, M, Uematsu, M, Hata, A, Ogata, H, Miyamoto, T, Sumi, K, Ishida, Y, Takeshita, E, Kawazoe, T, Kawabata, T, Miyatake, C, Yakuwa, A, Kakimoto, Y, Terashima, H, Kubota, M, Abe, Y, Nagura, M, Yamanouchi, H, Mori, S, Konishi, Y, Ikegami, M, Tomonaga, Y, Takashima, Y, Ichikawa, K, Moriyama, N, Oba, C, Kashiwagi, M, Yoshikawa, S, Tanaka, K, Ohta, G, Hattori, A, Ieda, D, Ono, S, Tanimura, T, Ban, K, Sugiyama, N, Kouzan, N, Yamada, Y, Inoue, M, Sakajiri, K, Ohyama, K, Yamamuro, M, Ishigaki, H, Seino, A, Igarashi, S, Nakamoto, T, Sugimoto, K, Ochi, M, Hamanaka, E, Ohi, K, Kawasaki, H, Nishitani, M, Uno, H, Inoue, M, Okuyama, M, Yamamoto, A, Sato, R, Azuma, N, Mabuchi, S, Shida, Y, Hashimoto, Y, Yoshimura, M, Matsuhisa, Y, Nakano, K, Yamashita, Y, Kikuchi, E, Yamamoto, A, Igarashi, N, Yoshida, N, Nishiki, S, Yasutomi, D, Kusano, N, Wakahara, R, Furuyama, M, Mikami, H, Taniguchi, H, Yoshii, Y, Narabayashi, A, Nakamura, T, Kaburagi, Y, Nagasao, A, Kuwahara, M & Kaida, K 2018, 'Clinical features of acute flaccid myelitis temporally associated with an enterovirus D68 outbreak: Results of a nationwide survey of acute flaccid paralysis in Japan, August-December 2015', Clinical Infectious Diseases, vol. 66, no. 5, pp. 653-664. https://doi.org/10.1093/cid/cix860

Clinical features of acute flaccid myelitis temporally associated with an enterovirus D68 outbreak: Results of a nationwide survey of acute flaccid paralysis in Japan, August-December 2015. / Chong, Pin Fee; Kira, Ryutaro; Mori, Harushi その他.
In: Clinical Infectious Diseases, Vol. 66, No. 5, 03.2018, p. 653-664.

研究成果: ジャーナルへの寄稿 › 記事 › 査読

TY - JOUR

T1 - Clinical features of acute flaccid myelitis temporally associated with an enterovirus D68 outbreak

T2 - Results of a nationwide survey of acute flaccid paralysis in Japan, August-December 2015

AU - Chong, Pin Fee

AU - Kira, Ryutaro

AU - Mori, Harushi

AU - Okumura, Akihisa

AU - Torisu, Hiroyuki

AU - Yasumoto, Sawa

AU - Shimizu, Hiroyuki

AU - Fujimoto, Tsuguto

AU - Hanaoka, Nozomu

AU - Kusunoki, Susumu

AU - Takahashi, Toshiyuki

AU - Oishi, Kazunori

AU - Tanaka-Taya, Keiko

AU - Toyofuku, Etsushi

AU - Fukuyama, Tetsuhiro

AU - Sato, Tatsuharu

AU - Takahashi, Yuya

AU - Kanazawa, Akane

AU - Hiyane, Masato

AU - Fukushima, Takao

AU - Toki, Taira

AU - Hayashi, Ryoko

AU - Kubota, Sonoko

AU - Ishii, Wakako

AU - Akasaka, Manami

AU - Miyazawa, Haruna

AU - Motobayashi, Mitsuo

AU - Asaoka, Mari

AU - Shiihara, Takashi

AU - Miyoshi, Yoshitaka

AU - Tsuru, Tomohiko

AU - Ikeda, Kenta

AU - Matsukura, Masaru

AU - Nakamura, Ryoko

AU - Moriyama, Kengo

AU - Sugawara, Yuji

AU - Takami, Yuichi

AU - Fujita, Takako

AU - Yano, Tamami

AU - Kasai, Mariko

AU - Uchida, Takashi

AU - Fujita, Masashi

AU - Uematsu, Mitsugu

AU - Hata, Atsuko

AU - Ogata, Hideto

AU - Miyamoto, Tomoyuki

AU - Sumi, Kataharu

AU - Ishida, Yu

AU - Takeshita, Eri

AU - Kawazoe, Tomoya

AU - Kawabata, Takayoshi

AU - Miyatake, Chiharu

AU - Yakuwa, Akiko

AU - Kakimoto, Yu

AU - Terashima, Hiroshi

AU - Kubota, Masaya

AU - Abe, Yuichi

AU - Nagura, Michiaki

AU - Yamanouchi, Hideo

AU - Mori, Satomi

AU - Konishi, Yukihiko

AU - Ikegami, Mariko

AU - Tomonaga, Yuko

AU - Takashima, Yumiko

AU - Ichikawa, Kazushi

AU - Moriyama, Nobuko

AU - Oba, Chizu

AU - Kashiwagi, Mitsuru

AU - Yoshikawa, Sosuke

AU - Tanaka, Kenichi

AU - Ohta, Genrei

AU - Hattori, Ayako

AU - Ieda, Daisuke

AU - Ono, Sahoko

AU - Tanimura, Tomoshige

AU - Ban, Kyoko

AU - Sugiyama, Nobuyoshi

AU - Kouzan, Nozomi

AU - Yamada, Yuki

AU - Inoue, Mika

AU - Sakajiri, Kenichi

AU - Ohyama, Ken

AU - Yamamuro, Miho

AU - Ishigaki, Hidetoshi

AU - Seino, Azusa

AU - Igarashi, Shuichi

AU - Nakamoto, Takahito

AU - Sugimoto, Kanae

AU - Ochi, Mitsuhiro

AU - Hamanaka, Eri

AU - Ohi, Kazuki

AU - Kawasaki, Hidefumi

AU - Nishitani, Masahiko

AU - Uno, Hiroshi

AU - Inoue, Masaru

AU - Okuyama, Mai

AU - Yamamoto, Ayako

AU - Sato, Ryota

AU - Azuma, Norihiko

AU - Mabuchi, Sakiko

AU - Shida, Yoko

AU - Hashimoto, Yu

AU - Yoshimura, Motoi

AU - Matsuhisa, Yuki

AU - Nakano, Kotaro

AU - Yamashita, Yukio

AU - Kikuchi, Eriko

AU - Yamamoto, Asuka

AU - Igarashi, Naru

AU - Yoshida, Noboru

AU - Nishiki, Shingo

AU - Yasutomi, Daisuke

AU - Kusano, Nobuyoshi

AU - Wakahara, Ryohei

AU - Furuyama, Masayuki

AU - Mikami, Hitoshi

AU - Taniguchi, Hiroaki

AU - Yoshii, Yasuhiro

AU - Narabayashi, Atsushi

AU - Nakamura, Tomofumi

AU - Kaburagi, Yasuo

AU - Nagasao, Akiko

AU - Kuwahara, Motoi

AU - Kaida, Kenichi

PY - 2018/3

Y1 - 2018/3

N2 - Background. Acute flaccid myelitis (AFM) is an acute flaccid paralysis syndrome with spinal motor neuron involvement of unknown etiology. We investigated the characteristics and prognostic factors of AFM clusters coincident with an enterovirus D68 (EV-D68) outbreak in Japan during autumn 2015. Methods. An AFM case series study was conducted following a nationwide survey from August to December 2015. Radiographic and neurophysiologic data were subjected to centralized review, and virology studies were conducted for available specimens. Results. Fifty-nine AFM cases (58 definite, 1 probable) were identified, including 55 children and 4 adults (median age, 4.4 years). Te AFM epidemic curve showed strong temporal correlation with EV-D68 detection from pathogen surveillance, but not with other pathogens. EV-D68 was detected in 9 patients: 5 in nasopharyngeal, 2 in stool, 1 in cerebrospinal fluid (adult case), and 1 in tracheal aspiration, nasopharyngeal, and serum samples (a pediatric case with preceding steroid usage). Cases exhibited heterogeneous paralysis patterns from 1-to 4-limb involvement, but all definite cases had longitudinal spinal gray matter lesions on magnetic resonance imaging (median, 20 spinal segments). Cerebrospinal fluid pleocytosis was observed in 50 of 59 cases (85%), and 8 of 29 (28%) were positive for antiganglioside antibodies, as frequently observed in Guillain-Barré syndrome. Fifty-two patients showed variable residual weakness at follow-up. Good prognostic factors included a pretreatment manual muscle strength test unit score >3, normal F-wave persistence, and EV-D68-negative status. Conclusions. EV-D68 may be one of the causative agents for AFM, while host susceptibility factors such as immune response could contribute to AFM development.

AB - Background. Acute flaccid myelitis (AFM) is an acute flaccid paralysis syndrome with spinal motor neuron involvement of unknown etiology. We investigated the characteristics and prognostic factors of AFM clusters coincident with an enterovirus D68 (EV-D68) outbreak in Japan during autumn 2015. Methods. An AFM case series study was conducted following a nationwide survey from August to December 2015. Radiographic and neurophysiologic data were subjected to centralized review, and virology studies were conducted for available specimens. Results. Fifty-nine AFM cases (58 definite, 1 probable) were identified, including 55 children and 4 adults (median age, 4.4 years). Te AFM epidemic curve showed strong temporal correlation with EV-D68 detection from pathogen surveillance, but not with other pathogens. EV-D68 was detected in 9 patients: 5 in nasopharyngeal, 2 in stool, 1 in cerebrospinal fluid (adult case), and 1 in tracheal aspiration, nasopharyngeal, and serum samples (a pediatric case with preceding steroid usage). Cases exhibited heterogeneous paralysis patterns from 1-to 4-limb involvement, but all definite cases had longitudinal spinal gray matter lesions on magnetic resonance imaging (median, 20 spinal segments). Cerebrospinal fluid pleocytosis was observed in 50 of 59 cases (85%), and 8 of 29 (28%) were positive for antiganglioside antibodies, as frequently observed in Guillain-Barré syndrome. Fifty-two patients showed variable residual weakness at follow-up. Good prognostic factors included a pretreatment manual muscle strength test unit score >3, normal F-wave persistence, and EV-D68-negative status. Conclusions. EV-D68 may be one of the causative agents for AFM, while host susceptibility factors such as immune response could contribute to AFM development.

KW - Acute flaccid myelitis

KW - Antiganglioside antibodies

KW - Enterovirus D68

KW - Nationwide survey

KW - Prognostic analysis

UR - http://www.scopus.com/inward/record.url?scp=85043579495&partnerID=8YFLogxK

U2 - 10.1093/cid/cix860

DO - 10.1093/cid/cix860

M3 - Article

C2 - 29028962

AN - SCOPUS:85043579495

SN - 1058-4838

VL - 66

SP - 653

EP - 664

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - 5

ER -