Severe Acute Flaccid Myelitis Associated With Enterovirus in Children: Two Phenotypes for Two Evolution Profiles?

Melodie Aubart; Cyril Gitiaux; Charles Joris Roux; Raphael Levy; Isabelle Schuffenecker; Audrey Mirand; Nathalie Bach; Florence Moulin; Jean Bergounioux; Marianne Leruez-Ville; Flore Rozenberg; Delphine Sterlin; Lucile Musset; Denise Antona; Nathalie Boddaert; Shen Ying Zhang; Manoelle Kossorotoff; Isabelle Desguerre

doi:10.3389/fneur.2020.00343

Severe Acute Flaccid Myelitis Associated With Enterovirus in Children: Two Phenotypes for Two Evolution Profiles?

Front Neurol. 2020 Apr 28:11:343. doi: 10.3389/fneur.2020.00343. eCollection 2020.

Authors

Melodie Aubart^{1

2}, Cyril Gitiaux^{3

4}, Charles Joris Roux⁵, Raphael Levy⁵, Isabelle Schuffenecker⁶, Audrey Mirand⁷, Nathalie Bach⁸, Florence Moulin⁹, Jean Bergounioux¹⁰, Marianne Leruez-Ville¹¹, Flore Rozenberg¹², Delphine Sterlin¹³, Lucile Musset¹³, Denise Antona¹⁴, Nathalie Boddaert^{4

5}, Shen Ying Zhang², Manoelle Kossorotoff¹, Isabelle Desguerre¹

Affiliations

¹ Department of Paediatric Neurology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France.
² INSERM 1163, Imagine Institute, Paris, France.
³ Department of Paediatric Neurophysiology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France.
⁴ INSERM U955-Team 10, Department of Neurosciences, Mondor Biomedical Research Institute, Paris-Est University, Créteil, France.
⁵ Department of Paediatric Radiology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France.
⁶ Laboratory of Virology, National Reference Center for Enterovirus, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.
⁷ Laboratory of Virology, National Reference Center for Enterovirus Associated Laboratory, CHU Clermont-Ferrand, Clermont-Ferrand, France.
⁸ Paediatric Department, CHU Caen-Normandie, Caen, France.
⁹ Intensive Care Unit, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France.
¹⁰ Intensive Care Unit, CHU Raymond Poincaré, Paris Saclay University, AP-HP, Garches, France.
¹¹ Laboratory of Virology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France.
¹² Laboratory of Virology, Cochin Hospital, University of Paris, AP-HP, Paris, France.
¹³ Laboratory of Immunology, Pitié-Salpétrière Hospital, Sorbonne University, AP-HP, Paris, France.
¹⁴ Direction des maladies infectieuses, Santé publique France, Saint-Maurice, France.

Abstract

Acute flaccid myelitis (AFM) is an acute paralysis syndrome defined by a specific inflammation of the anterior horn cells of the spinal cord. From 2014, worrying waves of life-threatening AFM consecutive to enterovirus infection (EV-D68 and EV-A71) have been reported. We describe 10 children displaying an AFM with an EV infection, the treatments performed and the 1 to 3-years follow-up. Two groups of patients were distinguished: 6 children ("polio-like group") had severe motor disability whereas 4 other children ("brainstem group") displayed severe brainstem weakness requiring ventilation support. Electrodiagnostic studies (n = 8) support the presence of a motor neuronopathy associated to myelitis. The best prognosis factor seems to be the motor recovery after the first 4 weeks of the disease.

Keywords: EV-A71; EV-D68; children; enterovirus; myelitis.