Polio will go, AFM will stay – A case report

Abstract

Background: Poliovirus related acute flaccid myelitis (AFM) was one of the most feared diseases. Due to effective vaccines, poliovirus is at the verge of global eradication. However, recent world-wide outbreaks of AFM cases associated with Enterovirus-D68 (EV-D68) are stimulating concerns about a new ‘polio-like’ epidemic, challenging mankind with the devastating outcomes, primarily in children. Case: A previously healthy, 5-year-old boy presented in paediatric ICU with sudden onset upper limbs weakness and breathing difficulty. Two days earlier, he had an upper respiratory illness with mild fever. On examination, he had hypotonia of truncal and limb muscles, with predominant loss of proximal power in the upper limbs. Intubation and mechanical ventilation were required for respiratory failure. MRI spine revealed myelitic changes. Respiratory viral PCR on nasopharyngeal swab was positive for Enterovirus. CSF had mildly raised WCC and proteins but was negative for viruses. EV-D68 was identified from faecal specimens by VP1 region sequencing at the National Enterovirus Reference Laboratory. Despite immunomodulatory therapy and intensive inpatient physiotherapy, the patient had ventilator dependence and a significant residual weakness in his upper limbs. Conclusion: EV-D68 is a neurotropic virus. Increasing awareness amongst clinicians, proper diagnostics and integrating EV-D68 into accessible surveillance systems will be essential to reveal the burden of disease.