title: Acute flaccid paralysis with anterior myelitis - California, June 2012-June 2014.
abstract: In August 2012, the California Department of Public Health (CDPH) was contacted by a San Francisco Bay area clinician who requested poliovirus testing for an unvaccinated man aged 29 years with acute flaccid paralysis (AFP) associated with anterior myelitis (i.e., evidence of inflammation of the spinal cord involving the grey matter including anterior horn cell bodies) and no history of international travel during the month before symptom onset. Within 2 weeks, CDPH had received reports of two additional cases of AFP with anterior myelitis of unknown etiology. Testing at CDPH's Viral and Rickettsial Disease Laboratory for stool, nasopharyngeal swab, and cerebrospinal fluid (CSF) did not detect the presence of an enterovirus (EV), the genus of the family Picornaviridae that includes poliovirus. Additional laboratory testing for infectious diseases conducted at the CDPH Viral and Rickettsial Disease Laboratory did not identify a causative agent to explain the observed clinical syndrome reported among the patients. To identify other cases of AFP with anterior myelitis and elucidate possible common etiologies, CDPH posted alerts in official communications for California local health departments during December 2012, July 2013, and February 2014. Reports of cases of neurologic illness received by CDPH were investigated throughout this period, and clinicians were encouraged to submit clinical samples for testing. A total of 23 cases of AFP with anterior myelitis of unknown etiology were identified. Epidemiologic and laboratory investigation did not identify poliovirus infection as a possible cause for the observed cases. No common etiology was identified to explain the reported cases, although EV-D68 was identified in upper respiratory tract specimens of two patients. EV infection, including poliovirus infection, should be considered in the differential diagnosis in cases of AFP with anterior myelitis and testing performed per CDC guidelines.
authors.forename: Patrick
authors.initials: P
authors.lastname: Ayscue
authors.forename: Keith
authors.initials: K
authors.lastname: Van Haren
authors.forename: Heather
authors.initials: H
authors.lastname: Sheriff
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Waubant
authors.forename: Paul
authors.initials: P
authors.lastname: Waldron
authors.forename: Shigeo
authors.initials: S
authors.lastname: Yagi
authors.forename: Cynthia
authors.initials: C
authors.lastname: Yen
authors.forename: Anna
authors.initials: A
authors.lastname: Clayton
authors.forename: Tasha
authors.initials: T
authors.lastname: Padilla
authors.forename: Chao
authors.initials: C
authors.lastname: Pan
authors.forename: John
authors.initials: J
authors.lastname: Reichel
authors.forename: Kathleen
authors.initials: K
authors.lastname: Harriman
authors.forename: James
authors.initials: J
authors.lastname: Watt
authors.forename: James
authors.initials: J
authors.lastname: Sejvar
authors.forename: William Allan
authors.initials: WA
authors.lastname: Nix
authors.forename: Daniel
authors.initials: D
authors.lastname: Feikin
authors.forename: Carol
authors.initials: C
authors.lastname: Glaser
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000870:Anterior Horn Cells; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009123:Muscle Hypotonia; D009187:Myelitis / Q000175:diagnosis* / Q000453:epidemiology; D010243:Paralysis / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult