title: Longitudinal Outcomes in the 2014 Acute Flaccid Paralysis Cluster in 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.
authors.affiliation: 1 Division of Neurology, The Hospital for Sick Children, Ontario, Canada.
authors.forename: Carmen
authors.initials: C
authors.lastname: Yea
authors.affiliation: 2 Division of Infectious Diseases, The Hospital for Sick Children, Ontario, Canada.|3 Department of Pediatrics, University of Toronto, Ontario, Canada.
authors.forename: Ari
authors.initials: A
authors.lastname: Bitnun
authors.affiliation: 4 Stollery Children's Hospital, University of Alberta, Alberta, Canada.
authors.forename: Joan
authors.initials: J
authors.lastname: Robinson
authors.affiliation: 5 Section of Neurology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Alberta, Canada.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Mineyko
authors.affiliation: 6 Department of Pediatrics, London Health Sciences Centre, Western University, London, Ontario, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Barton
authors.affiliation: 5 Section of Neurology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Alberta, Canada.
authors.forename: Jean K
authors.initials: JK
authors.lastname: Mah
authors.affiliation: 1 Division of Neurology, The Hospital for Sick Children, Ontario, Canada.|3 Department of Pediatrics, University of Toronto, Ontario, Canada.
authors.forename: Jiri
authors.initials: J
authors.lastname: Vajsar
authors.affiliation: 7 Division of Microbiology, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Ontario, Canada.|8 Department of Laboratory Medicine and Pathology, University of Toronto, Ontario, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Richardson
authors.affiliation: 3 Department of Pediatrics, University of Toronto, Ontario, Canada.|9 Division of Nephrology, The Hospital for Sick Children, Ontario, Canada.
authors.forename: Christoph
authors.initials: C
authors.lastname: Licht
authors.affiliation: 10 Division of Infectious Diseases, Children's Hospital of Eastern Ontario, Ontario, Canada.
authors.forename: Jason
authors.initials: J
authors.lastname: Brophy
authors.affiliation: 5 Section of Neurology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Alberta, Canada.
authors.forename: Megan
authors.initials: M
authors.lastname: Crone
authors.affiliation: 11 McMaster Children's Hospital, Ontario, Canada.
authors.forename: Shalini
authors.initials: S
authors.lastname: Desai
authors.affiliation: 12 Division of Pediatric Neurology, British Columbia Children's Hospital, British Columbia, Canada.
authors.forename: Juliette
authors.initials: J
authors.lastname: Hukin
authors.affiliation: 11 McMaster Children's Hospital, Ontario, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Jones
authors.affiliation: 12 Division of Pediatric Neurology, British Columbia Children's Hospital, British Columbia, Canada.
authors.forename: Katherine
authors.initials: K
authors.lastname: Muir
authors.affiliation: 13 Division of Pediatric Infectious Diseases, Department of Pediatrics, McMaster University, Ontario, Canada.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Pernica
authors.affiliation: 14 Public Health Agency of Canada, Ottawa, Ontario, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Pless
authors.affiliation: 15 Pediatric Neurology, Children's Hospital of Eastern Ontario, Ontario, Canada.
authors.forename: Daniela
authors.initials: D
authors.lastname: Pohl
authors.affiliation: 16 Children's Hospital, Winnipeg, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Mubeen F
authors.initials: MF
authors.lastname: Rafay
authors.affiliation: 12 Division of Pediatric Neurology, British Columbia Children's Hospital, British Columbia, Canada.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Selby
authors.affiliation: 15 Pediatric Neurology, Children's Hospital of Eastern Ontario, Ontario, Canada.
authors.forename: Sunita
authors.initials: S
authors.lastname: Venkateswaran
authors.affiliation: 17 Department of Medical Genetics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.|18 Departments of Neurology and Neurosurgery, and Pediatrics McGill University, Montreal, Canada.|19 Child Health and Human Development Program, Research Institute of the McGill University Health Center, Montreal, Canada.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Bernard
authors.affiliation: 1 Division of Neurology, The Hospital for Sick Children, Ontario, Canada.|3 Department of Pediatrics, University of Toronto, Ontario, Canada.
authors.forename: E Ann
authors.initials: EA
authors.lastname: Yeh
mesh_terms: D000200:Action Potentials / Q000502:physiology; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging*; D002170:Canada; D002648:Child; D002675:Child, Preschool; D004576:Electromyography; D030016:Enterovirus D, Human; D004769:Enterovirus Infections / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007223:Infant; D008297:Male; D018482:Muscle, Skeletal / Q000503:physiopathology; D009431:Neural Conduction / Q000502:physiology; D010264:Paraplegia / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy* / Q000821:virology; D010956:Plasmapheresis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous
keywords: North America; enterovirus D68; limb weakness; outbreak; pediatric