Gong Liming, Wang Yilong, Zhang Weiqing, Chen Chen, Yang Xinghui, Xu Lu, Zhao Congying, Jiang Lihua, Yuan Zhefeng, Xia Zhezhi, Jiang Peifang, Ge Qiong, Yan Juying, Sun Yi, Chen Yin, Zhao Zhengyan, Zhang Yanjun, Gao Feng
Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China.
Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Front Neurol. 2020 May 22;11:360. doi: 10.3389/fneur.2020.00360. eCollection 2020.
In July-December 2018, an outbreak of polio-like acute flaccid myelitis (AFM) occurred in Zhejiang province, China. Enterovirus (EV)-D68 infection has been reported to be associated with AFM. This study aimed to investigate the clinical presentation, laboratory findings, and outcomes of AFM patients. We investigated the clinical and virologic information regarding the AFM patients, and real-time PCR, sequencing, and phylogenetic analysis were used to investigate the cause of AFM. Eighteen cases met the definition of AFM, with a median age of 4.05 years (range, 0.9-9 years), and nine (50%) were EV-D68 positive. Symptoms included acute flaccid limb weakness and cranial nerve dysfunction. On magnetic resonance imaging, 11 (61.1%) patients had spinal gray matter abnormalities. Electromyography results of 16 out of 17 patients (94.1%) were abnormal. Cerebrospinal fluid (CSF) pleocytosis was common (94.4%), while CSF protein concentration was normal in all patients. There was little improvement after early aggressive therapy. Phylogenetic analysis revealed that EV-D68 subclade B3 was the predominant lineage circulating in Zhejiang province in 2018.
2018年7月至12月，中国浙江省发生了一起类似脊髓灰质炎的急性弛缓性脊髓炎（AFM）疫情。据报道，肠道病毒（EV）-D68感染与AFM有关。本研究旨在调查AFM患者的临床表现、实验室检查结果及预后。我们调查了AFM患者的临床和病毒学信息，并采用实时荧光定量PCR、测序及系统发育分析来探究AFM的病因。18例符合AFM的定义，中位年龄为4.05岁（范围0.9至9岁），其中9例（50%）EV-D68呈阳性。症状包括急性弛缓性肢体无力和颅神经功能障碍。在磁共振成像检查中，11例（61.1%）患者存在脊髓灰质异常。17例患者中有16例（94.1%）的肌电图结果异常。脑脊液（CSF）细胞增多很常见（94.4%），而所有患者的脑脊液蛋白浓度均正常。早期积极治疗后改善甚微。系统发育分析显示，EV-D68 B3亚分支是2018年在浙江省流行的主要谱系。
