Trending Clinical Topics for November 2018

Ryan Syrek


November 30, 2018

Trending Clinical Topic of the Week (November 17-23): Acute Flaccid Myelitis

The continued spread of a polio-like condition across the United States is responsible for this week's top trending clinical topic.

Acute flaccid myelitis (AFM) is a rare condition that causes paralysis, characterized by sudden weakness or loss of muscle tone in the arms or legs. On November 13, the Centers for Disease Control and Prevention (CDC) held a briefing on AFM. They reported that the number of confirmed AFM cases this year had reached 90 across 27 states. No deaths have been reported thus far. Although some patients completely recover from AFM, at least half do not and experience serious sequelae. Attempts to determine a cause have found that about half of the 71 specimens tested were positive for enterovirus (EV) or rhinovirus, including EV-A71 and EV-D68.

Unfortunately, a potential treatment has proven ineffective. The antidepressant fluoxetine did not improve outcomes for children with EV-D68–associated AFM. In fact, the treatment was associated with worsening of the condition in some cases. Steroids, plasma exchange, and antivirals have all been attempted without measurable success. This is possibly because the condition may have more than one cause.

The CDC has made an AFM toolkit for healthcare professionals. It includes important information about the condition, as well as instructions on reporting suspected cases to the health department. The CDC also updates the case count every Monday afternoon. With so many questions still unanswered, AFM is likely to remain a trending clinical topic for quite some time.

For more on one of the potential causes of AFM, read here.


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