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J Child Neurol. 2017 Mar;32(3):301-307. doi: 10.1177/0883073816680770. Epub 2016 Dec 20.

Longitudinal Outcomes in the 2014 Acute Flaccid Paralysis Cluster in Canada.

Author information

1
1 Division of Neurology, The Hospital for Sick Children, Ontario, Canada.
2
2 Division of Infectious Diseases, The Hospital for Sick Children, Ontario, Canada.
3
3 Department of Pediatrics, University of Toronto, Ontario, Canada.
4
4 Stollery Children's Hospital, University of Alberta, Alberta, Canada.
5
5 Section of Neurology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Alberta, Canada.
6
6 Department of Pediatrics, London Health Sciences Centre, Western University, London, Ontario, Canada.
7
7 Division of Microbiology, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Ontario, Canada.
8
8 Department of Laboratory Medicine and Pathology, University of Toronto, Ontario, Canada.
9
9 Division of Nephrology, The Hospital for Sick Children, Ontario, Canada.
10
10 Division of Infectious Diseases, Children's Hospital of Eastern Ontario, Ontario, Canada.
11
11 McMaster Children's Hospital, Ontario, Canada.
12
12 Division of Pediatric Neurology, British Columbia Children's Hospital, British Columbia, Canada.
13
13 Division of Pediatric Infectious Diseases, Department of Pediatrics, McMaster University, Ontario, Canada.
14
14 Public Health Agency of Canada, Ottawa, Ontario, Canada.
15
15 Pediatric Neurology, Children's Hospital of Eastern Ontario, Ontario, Canada.
16
16 Children's Hospital, Winnipeg, University of Manitoba, Winnipeg, Manitoba, Canada.
17
17 Department of Medical Genetics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
18
18 Departments of Neurology and Neurosurgery, and Pediatrics McGill University, Montreal, Canada.
19
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.

KEYWORDS:

North America; enterovirus D68; limb weakness; outbreak; pediatric

PMID:
28193112
DOI:
10.1177/0883073816680770
[Indexed for MEDLINE]

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