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Q: This new polio-like disease has been much talked about lately. Can you help me understand what this involves?
A: Poliomyelitis is caused by a disseminated virus in the stools of infected people (during acute epidemics, it can be transmitted by pharyngeal secretions). Poor sanitary conditions and poor hygiene contribute to its spread.After infection, the virus breeds in the nose. / mucosa of the throat and / or gastrointestinal tract (GI) of the patient.It then invades the lymph nodes and eventually spreads to the blood; in some cases, it can also invade the neurons of the patient's brain and / or spinal cord.
About 90% of those infected with the polio virus have minor non-specific symptoms, such as mild fever, malaise, sore throat and / or headache, and they recover without sequelae. Some people also have symptoms. gastrointestinal symptoms such as nausea, vomiting and / or abdominal pain and, again, a complete cure. About 1% of infected people develop paralytic polio (lesions of muscle nerve neurons), causing muscle weakness (most often in a limb or on one side of the body). may progress to flaccidity (decreased muscle tone) and paralysis. Although paralytic poliomyelitis is not cured, about half of the small percentage of patients who develop this disease recovers completely, a quarter of them have mild residual weakness and about a quarter a severe permanent disability. , the prognosis is better for the youngest. the children. Polio infection is definitely diagnosed by cultures of certain body fluids or blood antibody tests.
Characteristic features of acute flaccid myelitis (AFM) include acute febrile illness, usually with symptoms of the upper respiratory tract (such as a cold), which progressively includes neurological symptoms such as limb weakness and / or other nerve damage. (causing facial, eye, swallowing). There is still no specific test for AFM, although MRI imaging usually shows signs of gray matter involvement in the spinal cord. Blood tests and other tests are usually done to look for other possible causes of symptoms. Therefore, AFM is diagnosed by identifying symptoms of flaccid limb weakness and MRI findings, as well as excluding other possible causes.
The rapid onset of flaccid AFM weakness in one or more limbs is similar to the symptoms of paralytic polio and has been described as "polio-like". However, the underlying pathophysiology of AFM is not (yet) well understood. appears to be caused by a virus, and there are specific suspicious viruses; Enterovirus D68 is a leading candidate (there are many types of enteroviruses, causing more than 10 million infections each year in the United States, usually "colds"). Incomplete understanding of AFM limits the ability to make a specific diagnosis and to identify with confidence. the mode (s) of transmission, as well as the prevention of the development of preventive measures (such as a vaccine) or treatment.
These limitations, as well as the general rarity of the disease (it is estimated that it has caused severe symptoms in less than one in a million Americans), make it difficult to monitor the disease. Despite this, the Centers for Disease Control have followed epidemics of the disease and registered 80 confirmed cases in 26 different states until now in 2018, and several hundred other cases (in 11 more states) have have been reported as suspects for the AFM (there have been outbreaks of AFM in 2014 and 2016, although the 2018 outbreak has been the largest until now). there have already been several deaths from this disease.
Despite the current limited understanding of AFM, some things are known about this disease. AFM appears to cause symptoms most often in young children (most often under the age of 4). fall (July to November). Nearly two-thirds of patients diagnosed with this disease do not regain their strength. The overall mortality due to this disease is not yet known.
Anyone developing acute weakness of a limb, face, eyes, swallowing, speech or any other muscle should seek immediate medical attention. There are many possible causes of these symptoms (for example, several infectious diseases such as poliomyelitis, certain autoimmune diseases, stroke and others) and an assessment to identify the possible causes that can help guide the treatment and care is indicated. The CDC is working to better understand the AFM and, with a better understanding, there may be hope for treatment and prevention (such as an existing polio vaccine).
Jeff Hersh, Ph.D., M.D., can be contacted at [email protected]
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