Abstract
Enterovirus D68 (EV-D68), phylogenetic clade B was identified in nasopharyngeal specimens of two cases of severe acute flaccid myelitis. The cases were six and five years-old and occurred in September and November 2014. EV-D68 is increasingly associated with acute flaccid myelitis in children, most cases being reported in the United States. Awareness of this possible neurological complication of enterovirus D68 infection is needed.
Highlights
Enterovirus D68 (EV-D68), phylogenetic clade B was identified in nasopharyngeal specimens of two cases of severe acute flaccid myelitis
EV-D68 is increasingly associated with acute flaccid myelitis in children, most cases being reported in the United States
We report two cases of severe acute flaccid myelitis (AFM) associated with EV-D68 infection that occurred in September and November 2014 in Norway
Summary
Two cases of acute severe flaccid myelitis associated with enterovirus D68 infection in children, Norway, autumn 2014. Viral upper airway infection was suspected, but PCR analysis of a nasopharyngeal specimen was negative for common respiratory viruses, and the patient was discharged. She was readmitted two days later with further deteriorated general condition, general muscle weakness, mainly proximal and more severe in both upper extremities and neck, and weak/ absent deep tendon reflexes. On Day 12, the patient was readmitted with increasing weakness of the left arm, gait difficulties, pain in the neck, left shoulder and both legs, most severely when extended EV-D68 was detected in a nasopharyngeal specimen collected at Day 7, using a generic real-time RT-PCR (ct value < 30 cycles), culture was negative. The sequence from Case 1 was aligned with the sequences of one reported AFM case from 2014 in France as well as other European strains, including the majority of the 16 Norwegian EV-D68 cases identified in autumn 2014 (Figure) [1]
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