A muscle weakening disease in the child "Poliolike" reappears

A polio-like illness that left more than 100 children in the United States at least partially paralyzed in 2014 is back, and we do not know much more this time around, US center officials said. control and prevention of diseases. The CDC excludes no possible triggers – toxin infections, autoimmune reactions to insect bites.

"We have not found a cause for the majority of these cases," Nancy Messonnier, director of the CDC's National Center for Immunization and Respiratory Diseases, said Wednesday at a press conference. "And I'm frustrated that despite all our efforts, we have not been able to identify the cause of this mysterious disease."

But researchers who have studied the muscle weakening disease – called Acute Flaccid Myelitis (AFM) – say closely that they now understand its root cause well, although they still do not know how to treat the disease or stop the progression.

Scientists from the University of Colorado's School of Medicine infected mice with a virus that was circulating during the 2014 MFA outbreak, as well as during similar peaks of the disease in 2016 and this year . The virus triggered a paralyzing disease in mice that "looked a lot like what we saw in children," says Kenneth Tyler, director of the school's neurology department. Tyler thinks that the virus, called enterovirus D68, has changed since its first identification in 1962, becoming more and more dangerous. He raised mice that develop paralysis after infection with the current version of enterovirus D68, but not by previous strains. He has tested a number of possible treatments on his mice, but has yet found none that can make a significant difference in the course of their disease similar to that of the AFM.

The enterovirus D68 has been associated with some of the human cases of the disease and, although this is not the only cause, it is clearly at the origin of the three recent outbreaks, says Kevin Messacar, a medical specialist. infectious diseases and researcher at the Children's Hospital. Colorado. He and Tyler say the CDC are too cautious not to recognize the role of enterovirus D68 in the disease.

The symptoms of the virus resemble those of the common cold and may include coughing, shortness of breath and other respiratory problems similar to those of asthma. "Many people will contract the infection and very little will contract the neurological disease" which causes paralysis, explains Messacar. In rare cases, about a week after the infection, the child will develop weakness in the arms, legs or muscles of the face or throat, he said. Although there is no definitive diagnosis, doctors can identify AFM from a combination of symptoms and an MRI, which may reveal inflammation of the spine.

CDC's courier, AFM is described as "quite dramatic" and says that the federal agency is reacting more and more to that of previous years. She also points out that it's extremely rare to hit about a child in a million. Parents should not panic, but should consult a doctor if their child has signs of sudden weakness or loss of muscle tone in the arms or legs. Since July, the CDC has confirmed 62 cases of AFM in 22 states and is investigating another 65 cases. A child with AFM died last year. Ninety percent of cases have been in children, she says.

Messonnier did not directly address the enterovirus D68 at the press conference and said that the CDC had not yet had the time to exhaustively analyze this summer's cases and this fall. She added that these cases were in no way caused by the polio virus, which was not detected in any of the stool samples of affected children. There is no evidence of West Nile virus infection transmitted by mosquitoes either, she says, although she still encourages parents to send their children with an insect repellent. Some children with AFM regain strength and movement, usually within a few months, while in others, nerve damage seems permanent, she says.

Mitchel Seruya, a surgeon at Children's Hospital in Los Angeles, said when he had operated on children with AFM, that he was amazed at how much their affected nerves were not responding. He can hit them with an electric shock similar to the touch of a car battery, he says, but they do not move. This suggests to him that the disease can completely erase the nerves. Seruya operated on 15 children whose AFM-induced paralysis lasted at least three months. It redirects the redundant nerves from other parts of the arm or abdomen to replace those lost through the disease. He said he had very good results in 14 of the 15 patients; the girl who did not return to her full function had "a suboptimal result, but [her parents are] happy to have received something in return. But the treatments for the infection remain elusive.

Mark Hicar, a specialist in infectious diseases in children and assistant professor at the University of Buffalo, in the south of the UK, treated two children with AFM, one in 2014 and the Other this year. Both were boys – an age of six, a three year old; everyone was suffering from a cold and had fever about a day before stopping to use a leg. None of the two boys has been tested positive for the enterovirus D68 – or A71, a similar virus also linked to the AFM – but the tests are not definitive, he says. The three-year-old girl improved significantly in the first two days but then reached a plateau and is now back in the hospital on anti-inflammatory treatment, says Hicar, who hopes that these drugs will prevent the immune response of the patient. boy to exacerbate the damage. But the data on the effectiveness of the treatments are so thin that he says that it's not sure whether the therapy is helping the boy or not.

A vaccine against enterovirus D68 would be scientifically feasible, but not economically viable, explains Messacar. Polio is a very similar virus and there is a vaccine to protect against this virus. The Chinese have developed a vaccine against enterovirus A71, but it is not available in the United States, he added. As AFM is very rare and has several potential causes, it would be difficult for a company to make money with a vaccine, explains Messacar.

According to Andrew Pavia, head of the Division of Pediatric Infectious Diseases at the University of Utah, the schema of the disease is very similar to that of the polio outbreak in the 1940s and 1950s, with the exception of its magnitude . While polio infects tens of thousands of children, the AFM hits a little more than 100 every two years. Many people with polio who were children and who have recovered have suffered from muscle weakness again decades later. Studies in mice have not shown whether the symptoms of MAF would return to those affected., Said Tyler.

According to the CDC, there were 120 confirmed cases of MFA in the second half of 2014, 22 in 2015, 149 in 2016 and 33 in 2017. "There is an increase in even years that does not seem to be random," Messacar said. , noting that infections are most common from July to October in the northern states, although they are less seasonal in the south. Research suggests that dew points – a combination of humidity and temperature – appear to affect the transmissibility of the virus, he says.

Pavia recognizes that the enterovirus D68 is the most likely cause of the majority of MFA cases, but "we must wait and see" if the outbreak of this year will follow the same pattern as in 2014 and 2016. The main methods of preventing infection with the virus are as follows: as for any common cold: wash your hands frequently, sneeze into your arm or elbow and avoid close contact with sick people, explains Pavia.

The enterovirus D68 is probably contagious for about a week – about as long as colds, says Messacar. The disease itself develops towards the end of the contagious period and is not spread from person to person.

This was certainly the case in Sarah Pilarowski's family. His eight-year-old son, Liam, caught a horrible cold in 2014 but recovered, but his six-year-old daughter, Lydia, developed a cold and fever that seemed to last forever, says pediatrician Pilarowski. in Denver. When Lydia was not strong enough to hold an ear of corn in her left hand, Pilarowski worried. Lydia was diagnosed with AFM and endured months of professional and physical therapy, followed by psychotherapy to resolve her persistent nightmares and anxieties. She was not tested positive for the D68 enterovirus, but Pilarowski is confident that both of her children were carriers of the virus, which was touring the Denver area last summer.

Although it is unlikely that there will be a specific vaccine or treatment in the near future, researchers can still do something to fight the AFM, such as better tracking the disease. ######################################################################### 39, evolution of enterovirus infections D68 and A71, learn more about the link between viruses and AFM and understand the genetic changes occurred in the enterovirus D68 to make it more dangerous. "Let's start doing something about it. Let's get financing, "he says. "Do not act like this is a surprise if it comes back in 2020, but let's be more prepared."