Acute Flaccid Myelitis
As of August 2014, the CDC was made aware of an increase in the cases of a condition called Acute Flaccid Myelitis (AFM). Although rare, the increase in affected children is becoming alarming. Describe to me what symptoms you might expect to see, how you would diagnosis, what is the cause, how do we treat but most important, how do you prevent? What is its connection to COVID-19?\
Use the article below for references:
Acute Flaccid Myelitis
Acute Flaccid Myelitis (AFM) is a neurologic condition affecting the nervous system, primarily the spinal cord, referred to as gray matter. It leads to weakness in the muscle and body. The condition is more common in children and may invoke respiratory failure and other complications. This paper explores the Acute Flaccid Myelitis (AFM) symptoms, causes, treatment, prevention, and its relationship with COVID 19.
AFM is characterized by significant weakness in legs and arms, loss of reflexes muscles, and difficulty moving the eyes. In addition, the patient may experience facial drooping/weakness, slurred speech, and trouble when swallowing (SRNA, 2020). Pain in the arms, legs, neck, and back may also be present. Sometimes, the patient may experience breathing difficulties due to muscle weakening leading to respiratory failure. It may also be evidenced by life-threatening temperature changes and instability in blood pressure (Murphy et al., 2021). Uncommon symptoms for AFM include the inability to pass urine, numbness, and tingling.
Different approaches may be adopted to diagnose AFM. For instance, Magnetic Resonance Imaging (MRI) of the spinal cord is used to determine complications in the spinal cord functioning due to matter. MRI also helps identify brachial plexus’ swelling and hyperintensity in the affected limbs (Murphy et al., 2021). Non-cerebrospinal fluid (CSF) and central nervous system (CNS) are also critical in diagnosing the causes of AFM. Respiratory oropharyngeal, nasopharyngeal, and rectal swabs are used to determine the prevalence of enterovirus D68 and D71. Reverse transcription-polymerase chain reaction, which is done at early clinical manifestation, is also critical in evaluating the presence of other enterovirus RNA.
Electromyography or nerve conduction studies may be adopted in the early investigation, especially when considering AFM differentia diagnosis such as Guillain-Barre Syndrome. Electromyography may also be critical in diagnosing AFM in situations where MRI is not available or if there is diagnostic uncertainty (Murphy et al., 2021). The studies indicate motor neuropathy mimicking the electrophysiologic changes prevalent in the Guillain-Barre syndrome acute motor axonal neuropathy subtype. If the abnormalities are asymmetrical and proximal, then this is an indication of AFM.
AFM may result from fever which is accompanied by respiratory symptoms. These symptoms are mainly from a viral infection that precedes body weakness. AFM may also be caused by viruses. Enterovirus 68 virus is the main cause of AFM outbreaks in most regions (Murphy et al., 2021). Other enteroviruses, mainly D71 and coxsackievirus strains, may also lead to AFM.
AFM does not have a specific treatment, and thus treatment is recommended based on the specific symptoms presented. Early physical and occupational therapy is a treatment option adopted to restore the functioning of affected limbs while improving daily functioning (CDC, 2021). Providers may also recommend treatments using steroids, immunoglobulin, and antivirals to treat transverse myelitis and other neurological complications. Surgery may also transfer the nerves from the functioning site to the affected area.
AFM does not have specific actions for prevention. However, the disease’s risk may be prevented through scheduled vaccination, staying away from mosquitoes that can transfer the virus, and following good handwashing practices (CDC, 2021). It is essential to minimize physical contact with sick people. This includes sharing eating utensils, straws, water, and cigarettes. Hard surfaces that are frequently touched should be cleaned and disinfected frequently. In addition, coughs should be covered with tissues or upper shirt sleeves (CDC, 2021). Community education may also help in preventing the risk of AFM. The population should be informed on the healthy behaviors critical in the control of AFM. In addition, education will increase awareness of the causes of AFM, which will support the adopted interventions and efforts to reduce the spread of the condition.
Connections to COVID 19
COVID 19 patients face a significant increase in neurological symptoms. These complications are attributed to systematic and metabolic complications, the direct neuro-invasive nature of COVID 19, and post infectious secondary immunogenic hyper reaction (Abdelhady et al., 2020). Furthermore, COVID 19 and AFM lead to respiratory complications such as breathing challenges. In addition, the COVID 19 restrictions such as physical distancing and mask-wearing are also vital in the preventi9on of AFM. However, few cases of AFM are reported in patients with COVID 19.
Abdelhady, M., Elsotouhy, A., & Vattoth, S. (2020). Acute flaccid myelitis in COVID-19. BJR| case reports, 6(3), 20200098. https://doi.org/10.1259/bjrcr.20200098
CDC. (2021, January 26). Prevention for AFM. Centers for Disease Control and Prevention. https://www.cdc.gov/acute-flaccid-myelitis/prevention.html
CDC. (2021, March 30). AFM diagnosis and treatment. Centers for Disease Control and Prevention. https://www.cdc.gov/acute-flaccid-myelitis/diagnosis.html
Murphy, O. C., Messacar, K., Benson, L., Bove, R., Carpenter, J. L., Crawford, T., … & Patel, P. (2021). Acute flaccid myelitis: cause, diagnosis, and management. The Lancet, 397(10271), 334-346. https://doi.org/10.1016/S0140-6736(20)32723-9