Acute flaccid myelitis: not uncommon in rural Uganda?

Author:

Olum Sam12,Scolding Charlotte1234,Omona Venice12,Jackson Kansiime12,Scolding Neil1245ORCID

Affiliation:

1. Department of Internal Medicine, Gulu Medical School, Gulu University , Gulu , Uganda

2. St Mary’s Hospital, Lacor , Gulu , Uganda

3. THS, Faculty of Medicine, University of Bristol , Bristol, BS10 5NB , UK

4. Royal United Hospital , Bath, BA1 3NG , UK

5. Gloucestershire Hospitals NHS Trust , Cheltenham, GL53 7AN , UK

Abstract

Abstract Acute Flaccid Myelitis is a paralytic illness with significant similarities to poliomyelitis, and which affects predominantly children. It was first fully delineated only in 2014 in the USA, occurring in epidemic clusters with a likely overall increasing incidence. It has subsequently rapidly been identified in Europe, the UK, and Australasia and the Far East, confirming it to be an emerging, global, infectious neurological disease. It has, however, been very little studied in low- and middle-income countries—reflecting partly of the global imbalance in science and medical research, and partly the extremely low provision of neurological care in most low- and middle-income countries: Uganda currently has no specialized neurology services outside the capital Kampala. During extended visits over a 2-year period with involvement in acute adult and paediatric internal medicine, one of us (NS) encountered at least six new patients with acute flaccid myelitis, suggesting that both the geographical reach and the frequency of the disorder may be significantly greater than previously thought. Here, these cases are described together with their clinical features and, where available, course and (limited) investigation results. These observations have significant implications concerning the current, and potentially the future geographical spread of the disease, and its clinical phenomenology. In addition, they highlight serious problems concerning the global applicability of the current Acute Flaccid Myelitis diagnostic criteria.

Funder

Burden Trust

Publisher

Oxford University Press (OUP)

Subject

Neurology,Cellular and Molecular Neuroscience,Biological Psychiatry,Psychiatry and Mental health

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