Idaho healthcare providers should consider acute flaccid myelitis (AFM) when evaluating patients presenting with sudden onset of limb weakness, and loss of muscle tone and reflexes. In 2018 to date, CDC has confirmed 62 cases of AFM in 22 states. No cases have been reported in Idaho this year.
At this time, no specific pathogen has been identified as an etiologic agent responsible for the increase in reported AFM in 2018 and all have tested negative for poliovirus. AFM is most commonly associated with poliovirus in other parts of the world, but can be caused by numerous other viral pathogens, including non-polio enteroviruses, flaviviruses, herpesviruses, and adenoviruses.
Most patients with AFM will have sudden onset of limb weakness and loss of muscle tone and reflexes. Some patients, in addition to the limb weakness, will experience facial droop/weakness, difficulty moving the eyes, drooping eyelids, or difficulty with swallowing or slurred speech. In addition to complete neurologic examinations, findings from MRI, EMG and nerve conduction studies, and CSF help in making a diagnosis of AFM.
Reporting
Healthcare providers who suspect AFM should report the case to public health officials. This includes any illness with onset of acute focal limb weakness, AND
- An MRI showing a spinal cord lesion largely restricted to gray matter, and spanning one or more spinal segments, OR
- CSF with pleocytosis (white blood cell count >5 cells/mm3)
To report suspected cases, contact Southwest District Health at 208-455-5442 or the Idaho Bureau of Communicable Disease Prevention Epidemiology Program at 208-334-5939.
It is important to collect specimens for pathogen testing as early in course of illness as possible to increase the chance of identifying an etiologic agent. Specimens to collect include: CSF, serum, stool, and nasopharyngeal (NP) or oropharyngeal (OP) swabs. Specimen collection instructions are available at www.cdc.gov/acute-flaccid-myelitis/hcp/instructions.html. For assistance with specimen submission, please contact the Idaho Bureau of Laboratories at 208-334-2235. No specimens should be submitted to CDC before consultation with an Idaho public health district or state epidemiologist.
Idaho public health officials will request additional information contained in medical records, such as admission and discharge notes, neurology and infectious disease consult notes, MRI report, MRI images, vaccination history, and laboratory test results.
For More Information
Southwest District Health Confidential Reporting Phone (208) 455-5442
Southwest District Health Confidential Reporting Fax (208) 455-5350