TABLE. Characteristics of five pediatric patients with acute flaccid myelitis* — Maricopa County, Arizona, October 2016.
| Characteristic | Patient 1 | Patient 2 | Patient 3 | Patient 4 | Patient 5 |
|---|---|---|---|---|---|
| Case status |
Confirmed |
Confirmed |
Confirmed |
Confirmed |
Probable |
| Age at onset (yrs) |
3.5 |
10 |
4 |
9 |
12 |
| Sex |
Boy |
Girl |
Girl |
Girl |
Girl |
| Onset of focal limb weakness |
August 23, 2016 |
August 19, 2016 |
September 15, 2016 |
September 8, 2016 |
August 27, 2016 |
| Onset of preceding respiratory or gastrointestinal illness |
August 21, 2016 (respiratory) |
August 14, 2016 (respiratory) |
September 13, 2016 (respiratory) |
September 6, 2016 (gastrointestinal) |
August 17, 2016 (respiratory) |
| Presence of fever (tactile† or measured) |
Yes |
No |
Yes |
Yes |
No |
| Limbs affected (region) |
1 (LUE) |
4 |
3 (BUE, RLE) |
4 |
1 (LUE) |
| Cranial nerve features and timing |
None |
Facial droop subsequent to onset of limb weakness |
Facial droop subsequent to onset of limb weakness |
Facial droop before onset of limb weakness |
Diplopia concurrent with limb weakness |
| Patient and family history of asthma |
Asthma and family history of asthma |
Asthma |
None |
Family history of asthma |
Mild asthma, seasonal allergies, food allergies, eczema |
| Corticosteroid history |
Maintenance inhaled fluticasone; oral budesonide for asthma exacerbation August 15–19 |
Maintenance inhaled fluticasone; oral prednisolone for asthma exacerbation beginning August 14 |
None |
Oral prednisolone for treatment of Bell’s palsy beginning September 5 |
Maintenance inhaled fluticasone |
| Magnetic resonance imaging (MRI) findings |
T2 signal abnormalities in anterior and posterior columns of the central gray cervical cord |
T2 signal abnormality with anterior and posterior involvement, contiguous through multiple levels of the cord |
T2 signal abnormality in the anterior horn of the central gray cord |
Anterior horn signal abnormality extending four cervical levels |
Normal MRI result |
| Cerebrospinal fluid/white blood cell/mm3 |
50 |
150 |
207 |
115 |
7 |
| Nasopharyngeal swab polymerase chain reaction results from TGen |
Positive for EV-D68 |
Positive for EV-D68 |
Positive for EV-D68 |
Unavailable |
Unavailable |
| Stool specimen testing results | Negative enterovirus/parechovirus by RT-PCR | Negative viral culture and enterovirus/parechovirus by RT-PCR | Negative viral culture and enterovirus/parechovirus by RT-PCR | Positive for coxsackievirus A10 by Sanger sequencing of the VP1 region | Unavailable |
Abbreviations: BUE = bilateral upper extremities; EV = enterovirus; LUE = left upper extremity; RLE = right lower extremity; RT-PCR = reverse transcription–polymerase chain reaction; T2 = T2 weighted image; TGen = Translational Genomics Research Institute (Flagstaff, Arizona); VP1 = viral protein 1.
* Four with confirmed cases and one with a probable case.
† Felt warm to the touch, according to parent.