Acute Flaccid Paralysis and Neurogenic Respiratory Failure Associated with Enterovirus D68

Both acute flaccid paralysis (AFP) and neurogenic respiratory failure rarely occur before. At the end of 2018, some children with the two symptoms were admitted to our hospital and enterovirus D68 (EV-D68) was detected in the stool sample of one case. In this study, we aimed to assess two typical cases of the children to focus on EV-D68.

The two cases in this study demonstrated AFP and neurogenic respiratory failure caused by severe inflammatory injury mainly to the anterior horn cells of the spinal cord. These conditions are different from ADEM, which mainly involves the white matter of the nervous system. Therefore, the diagnosis of ADEM was ruled out. Two children admitted to our hospital presented with symptoms and imaging results different from those of acute disseminated encephalomyelitis and hand, foot, and mouth disease. Their main symptoms were AFP and neurogenic respiratory failure. The anterior horn cells of the spinal cord were primarily damaged by severe inflammatory inflammation, according to magnetic resonance imaging. Pathogens such as bacteria, TB, cryptococcus, herpes virus, and coxsackie virus were not found in the blood or cerebral fluid samples that were taken. The two cases' nasopharyngeal, blood, and cerebrospinal fluid samples weren't initially examined for EV-D68. About 2 mo later, EV-D68 was detected in the stool sample of one of the cases. The symptom of AFP was caused by injury to the anterior horn cells at levels C5-L5 of the spinal cord, while neurogenic respiratory failure was at levels C3-C5.

EV-D68 maybe causes AFP and neurogenic respiratory failure in some children. We should pay attention to the early detection and diagnosis of EV-D68 and what’s more important is to develop antivirus drugs and vaccines.