Longitudinal Outcomes in the 2014 Acute Flaccid Paralysis Cluster in Canada

Author:

Yea Carmen1,Bitnun Ari23,Robinson Joan4,Mineyko Aleksandra5,Barton Michelle6,Mah Jean K.5,Vajsar Jiri13,Richardson Susan78,Licht Christoph39,Brophy Jason10,Crone Megan5,Desai Shalini11,Hukin Juliette12,Jones Kevin11,Muir Katherine12,Pernica Jeffrey M.13,Pless Robert14,Pohl Daniela15,Rafay Mubeen F.16,Selby Kathryn12,Venkateswaran Sunita15,Bernard Geneviève171819,Yeh E. Ann13

Affiliation:

1. Division of Neurology, The Hospital for Sick Children, Ontario, Canada

2. Division of Infectious Diseases, The Hospital for Sick Children, Ontario, Canada

3. Department of Pediatrics, University of Toronto, Ontario, Canada

4. Stollery Children’s Hospital, University of Alberta, Alberta, Canada

5. Section of Neurology, Department of Pediatrics, Alberta Children’s Hospital, University of Calgary, Alberta, Canada

6. Department of Pediatrics, London Health Sciences Centre, Western University, London, Ontario, Canada

7. Division of Microbiology, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Ontario, Canada

8. Department of Laboratory Medicine and Pathology, University of Toronto, Ontario, Canada

9. Division of Nephrology, The Hospital for Sick Children, Ontario, Canada

10. Division of Infectious Diseases, Children’s Hospital of Eastern Ontario, Ontario, Canada

11. McMaster Children’s Hospital, Ontario, Canada

12. Division of Pediatric Neurology, British Columbia Children’s Hospital, British Columbia, Canada

13. Division of Pediatric Infectious Diseases, Department of Pediatrics, McMaster University, Ontario, Canada

14. Public Health Agency of Canada, Ottawa, Ontario, Canada

15. Pediatric Neurology, Children’s Hospital of Eastern Ontario, Ontario, Canada

16. Children’s Hospital, Winnipeg, University of Manitoba, Winnipeg, Manitoba, Canada

17. Department of Medical Genetics, Montreal Children’s Hospital, McGill University, Montreal, Quebec, Canada

18. Departments of Neurology and Neurosurgery, and Pediatrics McGill University, Montreal, Canada

19. Child Health and Human Development Program, Research Institute of the McGill University Health Center, Montreal, Canada

Abstract

We describe the presenting features and long-term outcome of an unusual cluster of pediatric acute flaccid paralysis cases that occurred in Canada during the 2014 enterovirus D68 outbreak. Children (n = 25; median age 7.8 years) presenting to Canadian centers between July 1 and October 31, 2014, and who met diagnostic criteria for acute flaccid paralysis were evaluated retrospectively. The predominant presenting features included prodromal respiratory illness (n = 22), cerebrospinal fluid lymphocytic pleocytosis (n = 18), pain in neck/back (n = 14) and extremities (n = 10), bowel/bladder dysfunction (n = 9), focal central gray matter lesions found in all regions of the spinal cord within the cohort (n = 16), brain stem lesions (n = 8), and bulbar symptoms (n = 5). Enterovirus D68 was detectable in nasopharyngeal specimens (n = 7) but not in cerebrospinal fluid. Acute therapies (corticosteroids, intravenous immunoglobulins, plasmapheresis) were well tolerated with few side effects. Fourteen of 16 patients who were followed beyond 12 months post onset had neurologic deficits but showed ongoing clinical improvement and motor recovery.

Publisher

SAGE Publications

Subject

Neurology (clinical),Pediatrics, Perinatology and Child Health

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