2328. First Cluster of Acute Flaccid Myelitis Related to Enterovirus D-68 in Argentinean children
Session: Poster Abstract Session: Pediatric Virology
Saturday, October 7, 2017
Room: Poster Hall CD
Background: : Acute flaccid Myelitis(AFM) related to enterovirus D68(EVD68) has been reported as sporadic cases worldwide since the outbreak of respiratory illness in USA in 2014. Objective: To describe the first cluster of AFM by EVD68 in Argentina.

Methods: prospective-observational study in children admitted to Hospital de Niños “Ricardo Gutiérrez” by Acute Flaccid Paralysis(AFP) from April-August 2016. AFM was defined as AFP with MRI lesions affecting the gray matter of the spinal cord as defined by CDC. RT-PCR was used to identify EVD68 in NPS, CSF, stool samples

Results: Nineteen children were admitted by AFP. Six confirmed as AFM: age 40(±22.6) months; 66% female, 50% had history of recurrent wheezing. Prodrome: 100% Upper Respiratory Tract Infection(URTI); 4/6(66%) fever; 1/6(16%) vomiting and abdominal pain. Neurological symptoms appeared 5.2(±6) days after prodrome. All children had acute progressive asymmetric limbs weakness, areflexia, intact sensitivity and severe muscles pain; 5/6(83%) had neck muscles weakness; 3/6(50%) had severe respiratory failure: 2 mechanical ventilation and 1 noninvasive ventilatory assistance; 3/6(50%) needed feeding support; 2/6(33.3%) had cranial nerve dysfunction. None had cognitive disability. CFS findings: 5/6 mononuclear pleocytosis; 2/6 increase of proteins and 1/6 albuminocytological dissociation. Spinal cord lesions in MRI was observed in all patients. EMG showed early signs of denervation and low motor neuron in 5/5 patient. Virology: enterovirus could be identified by RT-nested – PCR and genomic sequencing from nasopharyngeal-swab in 5/6(83%); 4/5 typified as EVD68, in 1/5 viral charge was low for typing. Stool samples: EVD68 was identified in 2/6(33%). CSF samples were negative. Treatment: IV immunoglobulin 5/6(83%) patient; 2/6(33%) systemic corticosteroids; 3/6(50%) required ICU admission. All patients had neurologic motor sequelae; 2/6 remain with chronical ventilatory assistance after 6 months of follow-up. None patient dye.

Conclusion: this is the first cluster reported from South America and support evidence for the association of EVD68 and AFM in children.

Carolina Carballo, MD, Infectious Diseases, Hospital Gutierrez, Buenos Aires, Argentina, Marcela Garcia Erro, MD, Neurology Department, Hospital de Niños "Ricardo Gutiérrez", Buenos Aires, Argentina, Nora Sordelli, MD, Infectious Diseases, Hospital de Niños Ricardo Gutierez, Buenos Aires, Argentina, Gabriel Vazquez, MD, Neurology, FLENI, Buenos Aires, Argentina, Daniel Cisterna, PhD, Neurovirology Laboratory, ANLIS-MALBRAN, Buenos Aires, Argentina, Alicia Mistchenko, MD, Virology Laboratory, Hospital de Niños "Ricardo Gutiérrez", Buenos Aires, Argentina, Claudia Cejas, MD, Radiology, FLENI, Buenos Aires, Argentina, Manlio Rodriguez, MD, Radiology, Hospital de Niños "Ricardo Gutiérrez", Buenos Aires, Argentina, Cecilia Freire, PhD, Neurovirology Laboratory, ANLIS Malbran, Buenos Aires, Argentina, María M Contrini, MD, Infectious Diseases, Hospital de Niños "R. Gutiérrez", Buenos Aires, Argentina and Eduardo L Lopez, MD, Department of Medicine, Hospital de Niños "Ricardo Gutiérrez", Buenos Aires, Argentina


C. Carballo, None

M. Garcia Erro, None

N. Sordelli, None

G. Vazquez, None

D. Cisterna, None

A. Mistchenko, None

C. Cejas, None

M. Rodriguez, None

C. Freire, None

M. M. Contrini, None

E. L. Lopez, None

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