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Original article

Vol. 153 No. 2 (2023)

Acute flaccid myelitis in Switzerland – association with enterovirus D68

  • Sandra  Bigi
  • Alban  Ramette
  • Maria Teresa Barbani
  • Andreas Bieri
  • Angelika Hoffmann
  • Christoph Aebi
DOI
https://doi.org/10.57187/smw.2023.40045
Cite this as:
Swiss Med Wkly. 2023;153:40045
Published
08.02.2023

Summary

Poliomyelitis-like acute flaccid myelitis associated with enterovirus D68 (EV-D68) has emerged globally during the past decade. Here we describe the first documented case reported from Switzerland, and a second, suspected case occurring in temporal association. AFM occurs primarily in children, is usually heralded by a febrile, respiratory prodrome followed by acute-onset, usually asymmetrical, limb weakness with some predilection for the upper extremities, and respiratory muscle compromise in one third of reported cases. There is no specific therapy and the majority of cases result in permanent neurological sequelae. A comprehensive diagnostic workup and timely reporting to the health authorities are essential. Surveillance of respiratory and stool samples for EV-D68 and other neurotropic enteroviruses is in place in several European countries and warrants consideration in Switzerland. This could entail the extension of the poliomyelitis surveillance program of the Federal Office of Public Health by monitoring and enteroviral typing of respiratory samples from patients with acute flaccid paralysis.

References

  1. U.S. Centers for Disese Control and Prevention Acute neurologic illness with focal limb weakness of unknown etiology in children. CDC Stacks 2014. Available at: https://stacks.cdc.gov/view/cdc/25378
  2. Murphy OC, Messacar K, Benson L, Bove R, Carpenter JL, Crawford T, et al.; AFM working group. Acute flaccid myelitis: cause, diagnosis, and management. Lancet. 2021 Jan;397(10271):334–46. https://doi.org/10.1016/S0140-6736(20)32723-9 DOI: https://doi.org/10.1016/S0140-6736(20)32723-9
  3. Messacar K, Asturias EJ, Hixon AM, Van Leer-Buter C, Niesters HG, Tyler KL, et al. Enterovirus D68 and acute flaccid myelitis-evaluating the evidence for causality. Lancet Infect Dis. 2018 Aug;18(8):e239–47. https://doi.org/10.1016/S1473-3099(18)30094-X DOI: https://doi.org/10.1016/S1473-3099(18)30094-X
  4. Poelman R, Schuffenecker I, Van Leer-Buter C, Josset L, Niesters HG, Lina B; ESCV-ECDC EV-D68 study group. European surveillance for enterovirus D68 during the emerging North-American outbreak in 2014. J Clin Virol. 2015 Oct;71:1–9. https://doi.org/10.1016/j.jcv.2015.07.296 DOI: https://doi.org/10.1016/j.jcv.2015.07.296
  5. Schieble JH, Fox VL, Lennette EH. A probable new human picornavirus associated with respiratory diseases. Am J Epidemiol. 1967 Mar;85(2):297–310. https://doi.org/10.1093/oxfordjournals.aje.a120693 DOI: https://doi.org/10.1093/oxfordjournals.aje.a120693
  6. Blomqvist S, Savolainen C, Råman L, Roivainen M, Hovi T. Human rhinovirus 87 and enterovirus 68 represent a unique serotype with rhinovirus and enterovirus features. J Clin Microbiol. 2002 Nov;40(11):4218–23. https://doi.org/10.1128/JCM.40.11.4218-4223.2002 DOI: https://doi.org/10.1128/JCM.40.11.4218-4223.2002
  7. Duval M, Mirand A, Lesens O, Bay JO, Caillaud D, Gallot D, et al. Retrospective Study of the Upsurge of Enterovirus D68 Clade D1 among Adults (2014-2018). Viruses. 2021 Aug;13(8):1607. https://doi.org/10.3390/v13081607 DOI: https://doi.org/10.3390/v13081607
  8. Kidd S, Yee E, English R, Rogers S, Emery B, Getachew H, et al. National Surveillance for Acute Flaccid Myelitis - United States, 2018-2020. MMWR Morb Mortal Wkly Rep. 2021 Nov;70(44):1534–8. https://doi.org/10.15585/mmwr.mm7044a2 DOI: https://doi.org/10.15585/mmwr.mm7044a2
  9. Kramer R, Sabatier M, Wirth T, Pichon M, Lina B, Schuffenecker I, et al. Molecular diversity and biennial circulation of enterovirus D68: a systematic screening study in Lyon, France, 2010 to 2016. Euro Surveill. 2018 Sep;23(37):1700711. https://doi.org/10.2807/1560-7917.ES.2018.23.37.1700711 DOI: https://doi.org/10.2807/1560-7917.ES.2018.23.37.1700711
  10. Van Haren K, Ayscue P, Waubant E, Clayton A, Sheriff H, Yagi S, et al. Acute Flaccid Myelitis of Unknown Etiology in California, 2012-2015. JAMA. 2015 Dec;314(24):2663–71. https://doi.org/10.1001/jama.2015.17275 DOI: https://doi.org/10.1001/jama.2015.17275
  11. Messacar K, Schreiner TL, Maloney JA, Wallace A, Ludke J, Oberste MS, et al. A cluster of acute flaccid paralysis and cranial nerve dysfunction temporally associated with an outbreak of enterovirus D68 in children in Colorado, USA. Lancet. 2015 Apr;385(9978):1662–71. https://doi.org/10.1016/S0140-6736(14)62457-0 DOI: https://doi.org/10.1016/S0140-6736(14)62457-0
  12. Messacar K, Schreiner TL, Van Haren K, Yang M, Glaser CA, Tyler KL, et al. Acute flaccid myelitis: A clinical review of US cases 2012-2015. Ann Neurol. 2016 Sep;80(3):326–38. https://doi.org/10.1002/ana.24730 DOI: https://doi.org/10.1002/ana.24730
  13. Knoester M, Helfferich J, Poelman R, Van Leer-Buter C, Brouwer OF, Niesters HG; 2016 EV-D68 AFM Working Group. Twenty-nine Cases of Enterovirus-D68-associated Acute Flaccid Myelitis in Europe 2016: A Case Series and Epidemiologic Overview. Pediatr Infect Dis J. 2019 Jan;38(1):16–21. https://doi.org/10.1097/INF.0000000000002188 DOI: https://doi.org/10.1097/INF.0000000000002188
  14. Midgley SE, Benschop K, Dyrdak R, Mirand A, Bailly JL, Bierbaum S, et al. Co-circulation of multiple enterovirus D68 subclades, including a novel B3 cluster, across Europe in a season of expected low prevalence, 2019/20. Euro Surveill. 2020 Jan;25(2):1900749. https://doi.org/10.2807/1560-7917.ES.2020.25.2.1900749 DOI: https://doi.org/10.2807/1560-7917.ES.2020.25.2.1900749
  15. Stoffel L, Agyeman PK, Keitel K, Barbani MT, Duppenthaler A, Kopp MV, et al. Striking Decrease of Enteroviral Meningitis in Children During the COVID-19 Pandemic. Open Forum Infect Dis. 2021 Apr;8(6):ofab115. https://doi.org/10.1093/ofid/ofab115 DOI: https://doi.org/10.1093/ofid/ofab115
  16. Kuo SC, Tsou HH, Wu HY, Hsu YT, Lee FJ, Shih SM, et al. Nonpolio Enterovirus Activity during the COVID-19 Pandemic, Taiwan, 2020. Emerg Infect Dis. 2021 Jan;27(1):306–8. https://doi.org/10.3201/eid2701.203394 DOI: https://doi.org/10.3201/eid2701.203394
  17. Benschop KS, Broberg EK, Hodcroft E, Schmitz D, Albert J, Baicus A, et al. Molecular Epidemiology and Evolutionary Trajectory of Emerging Echovirus 30, Europe. Emerg Infect Dis. 2021 Jun;27(6):1616–26. https://doi.org/10.3201/eid2706.203096 DOI: https://doi.org/10.3201/eid2706.203096
  18. Medical. Research Council. Aids to the examination of the peripheral nervous system, Memorandum No. 45, London.: Her Majesty's Stationery Office, 1981.
  19. Linsuwanon P, Payungporn S, Samransamruajkit R, Posuwan N, Makkoch J, Theanboonlers A, et al. High prevalence of human rhinovirus C infection in Thai children with acute lower respiratory tract disease. J Infect. 2009 Aug;59(2):115–21. https://doi.org/10.1016/j.jinf.2009.05.009 DOI: https://doi.org/10.1016/j.jinf.2009.05.009
  20. Grädel C, Terrazos Miani MA, Baumann C, Barbani MT, Neuenschwander S, Leib SL, et al. Whole-Genome Sequencing of Human Enteroviruses from Clinical Samples by Nanopore Direct RNA Sequencing. Viruses. 2020 Jul;12(8):841. https://doi.org/10.3390/v12080841 DOI: https://doi.org/10.3390/v12080841
  21. Kroneman A, Vennema H, Deforche K, v d Avoort H, Peñaranda S, Oberste MS, et al. An automated genotyping tool for enteroviruses and noroviruses. J Clin Virol. 2011 Jun;51(2):121–5. https://doi.org/10.1016/j.jcv.2011.03.006 DOI: https://doi.org/10.1016/j.jcv.2011.03.006
  22. Holm-Hansen CC, Midgley SE, Fischer TK. Global emergence of enterovirus D68: a systematic review. Lancet Infect Dis. 2016 May;16(5):e64–75. https://doi.org/10.1016/S1473-3099(15)00543-5 DOI: https://doi.org/10.1016/S1473-3099(15)00543-5
  23. Karelehto E, Koen G, Benschop K, van der Klis F, Pajkrt D, Wolthers K. Enterovirus D68 serosurvey: evidence for endemic circulation in the Netherlands, 2006 to 2016. Euro Surveill. 2019 Aug;24(35):1800671. https://doi.org/10.2807/1560-7917.ES.2019.24.35.1800671 DOI: https://doi.org/10.2807/1560-7917.ES.2019.24.35.1800671
  24. Kamau E, Harvala H, Blomqvist S, Nguyen D, Horby P, Pebody R, et al. Increase in Enterovirus D68 Infections in Young Children, United Kingdom, 2006-2016. Emerg Infect Dis. 2019 Jun;25(6):1200–3. https://doi.org/10.3201/eid2506.181759 DOI: https://doi.org/10.3201/eid2506.181759
  25. Hodcroft EB, Dyrdak R, Andrés C, Egli A, Reist J, García Martínez de Artola D, et al. Evolution, geographic spreading, and demographic distribution of Enterovirus D68. PLoS Pathog. 2022 May;18(5):e1010515. https://doi.org/10.1371/journal.ppat.1010515 DOI: https://doi.org/10.1371/journal.ppat.1010515
  26. Grädel C, Ireddy NR, Koch MC, Baumann C, Terrazos Miani MA, Barbani MT, et al. Genome Sequences of Rare Human Enterovirus Genotypes Recovered from Clinical Respiratory Samples in Bern, Switzerland. Microbiol Resour Announc. 2022 Sep;11(9):e0027622. https://doi.org/10.1128/mra.00276-22 DOI: https://doi.org/10.1128/mra.00276-22
  27. Freeman MC, Wells AI, Ciomperlik-Patton J, Myerburg MM, Yang L, Konopka-Anstadt J, et al. Respiratory and intestinal epithelial cells exhibit differential susceptibility and innate immune responses to contemporary EV-D68 isolates. eLife. 2021 Jul;10:10. https://doi.org/10.7554/eLife.66687 DOI: https://doi.org/10.7554/eLife.66687
  28. Brown DM, Hixon AM, Oldfield LM, Zhang Y, Novotny M, Wang W, et al. Contemporary Circulating Enterovirus D68 Strains Have Acquired the Capacity for Viral Entry and Replication in Human Neuronal Cells. MBio. 2018 Oct;9(5):e01954-18. https://doi.org/10.1128/mBio.01954-18 DOI: https://doi.org/10.1128/mBio.01954-18
  29. Schubert RD, Hawes IA, Ramachandran PS, Ramesh A, Crawford ED, Pak JE, et al. Pan-viral serology implicates enteroviruses in acute flaccid myelitis. Nat Med. 2019 Nov;25(11):1748–52. https://doi.org/10.1038/s41591-019-0613-1 DOI: https://doi.org/10.1038/s41591-019-0613-1
  30. Hixon AM, Yu G, Leser JS, Yagi S, Clarke P, Chiu CY, et al. A mouse model of paralytic myelitis caused by enterovirus D68. PLoS Pathog. 2017 Feb;13(2):e1006199. https://doi.org/10.1371/journal.ppat.1006199 DOI: https://doi.org/10.1371/journal.ppat.1006199
  31. Vogt MR, Wright PF, Hickey WF, De Buysscher T, Boyd KL, Crowe JE Jr. Enterovirus D68 in the Anterior Horn Cells of a Child with Acute Flaccid Myelitis. N Engl J Med. 2022 May;386(21):2059–60. https://doi.org/10.1056/NEJMc2118155 DOI: https://doi.org/10.1056/NEJMc2118155
  32. Kane MS, Sonne C, Zhu S, Malhotra A, Van Haren K, Messacar K, et al. Incidence, Risk Factors and Outcomes Among Children With Acute Flaccid Myelitis: A Population-based Cohort Study in a California Health Network Between 2011 and 2016. Pediatr Infect Dis J. 2019 Jul;38(7):667–72. https://doi.org/10.1097/INF.0000000000002276 DOI: https://doi.org/10.1097/INF.0000000000002276
  33. Aliabadi N, Messacar K, Pastula DM, Robinson CC, Leshem E, Sejvar JJ, et al. Enterovirus D68 Infection in Children with Acute Flaccid Myelitis, Colorado, USA, 2014. Emerg Infect Dis. 2016 Aug;22(8):1387–94. https://doi.org/10.3201/eid2208.151949 DOI: https://doi.org/10.3201/eid2208.151949
  34. Schindera C, Kraemer AL, Regamey N, Aebi C, Gorgievski-Hrisoho M, Barbani MT. Immunofluorescence versus xTAG multiplex PCR for the detection of respiratory picornavirus infections in children. J Clin Virol. 2010 Jul;48(3):223–5. https://doi.org/10.1016/j.jcv.2010.04.005 DOI: https://doi.org/10.1016/j.jcv.2010.04.005
  35. Rudy MJ, Frost J, Clarke P, Tyler KL. Neutralizing Antibody Given after Paralysis Onset Reduces the Severity of Paralysis Compared to Nonspecific Antibody-Treated Controls in a Mouse Model of EV-D68-Associated Acute Flaccid Myelitis. Antimicrob Agents Chemother. 2022 Aug;66(8):e0022722. https://doi.org/10.1128/aac.00227-22 DOI: https://doi.org/10.1128/aac.00227-22
  36. Harvala H, Broberg E, Benschop K, Berginc N, Ladhani S, Susi P, et al. Recommendations for enterovirus diagnostics and characterisation within and beyond Europe. J Clin Virol. 2018 Apr;101:11–7. https://doi.org/10.1016/j.jcv.2018.01.008 DOI: https://doi.org/10.1016/j.jcv.2018.01.008

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