CDC releases interim clinical guidance for AFM treatment

  • Centers for Disease Control and Prevention
  • 14 Nov 2018

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • CDC continues to investigate the significant increase in acute flaccid myelitis (AFM) in children across the US, numbering 252 patients under investigation, and 90 confirmed cases in 27 states as of a November 13 CDC telebriefing.
  • Clinical guidance suggests no preferred treatment or intervention.

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.

Key points

  • 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).
  • Treatment:
    • 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.

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