Why this matters
- Expedite neurology, infectious disease consults to coordinate treatment/management considerations.
- Ask about recent fever with/without antecedent respiratory or gastrointestinal symptoms in acute sudden weakness in arms or legs.
- Collect specimens as early as possible for viral testing.
- Confirmed case specimens (from 71 patients) have tested positive for enterovirus (EV)-A71 (29%, n=11), EV-D68 (37%, n=14), and other (34%, n=13).
- Corticosteroids: possibly harmful; balance benefits for spinal cord edema, white matter involvement with possible immunosuppression.
- Intravenous Immune Globulin (IVG): no data indicating human efficacy or harm.
- Plasma Exchange (PLEX): no clear human efficacy; consider procedure-associated risks (especially in small children).
- Fluoxetine: recent data suggest no antiviral benefits against AFM.
- Antivirals: no indication for AFM unless there is clinical suspicion of concomitant herpes virus infection.
- Interferon: potential exists for harm given immunomodulatory effects in setting of possible ongoing viral replication.
- Other immunosuppressive agents, biological modifiers: may have adverse effects in patients.