Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 16, 2021; 9(14): 3327-3333
Published online May 16, 2021. doi: 10.12998/wjcc.v9.i14.3327
Acute flaccid paralysis and neurogenic respiratory failure associated with enterovirus D68 infection in children: Report of two cases
Yv Zhang, Sheng-Yuan Wang, Da-Zhi Guo, Shu-Yi Pan, Yan Lv
Yv Zhang, Sheng-Yuan Wang, Da-Zhi Guo, Shu-Yi Pan, Yan Lv, Department of Hyperbaric Oxygen, The Sixth Medical Center of PLA General Hospital, Beijing 100048, China
Author contributions: Zhang Y devised the article; Wang SY, Lv Y, and Pan SY treated the two children and collected the information; Zhang Y, Pan SY, and Guo DZ gave intellectual contribution; Zhang Y and Lv Y created the article draft, which was revised by Lv Y.
Informed consent statement: The two patients, or their legal guardian, provided informed written consent for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan Lv, PhD, Attending Doctor, Department of Hyperbaric Oxygen, The Sixth Medical Center of PLA General Hospital, No. 6 Fucheng Road, Haidian District, Beijing 100048, China. zmz3567@sina.com
Received: October 7, 2020
Peer-review started: October 7, 2020
First decision: January 17, 2021
Revised: January 24, 2021
Accepted: March 4, 2021
Article in press: March 4, 2021
Published online: May 16, 2021
Processing time: 188 Days and 17.2 Hours
Abstract
BACKGROUND

Acute flaccid paralysis (AFP) and neurogenic respiratory failure rarely occur in children. At the end of 2018, some children with such symptoms were admitted to our hospital. In this study, we aimed to assess two children with AFP and neurogenic respiratory failure associated with enterovirus D68 (EV-D68).

CASE SUMMARY

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. Magnetic resonance imaging showed severe inflammatory injury mainly to the anterior horn cells of the spinal cord. Blood and cerebrospinal fluid samples were collected to assess for pathogens, including bacteria, tuberculosis, cryptococcus, herpes virus, and coxsackie virus, and the results were negative. At the beginning, the two cases were not assessed for EV-D68 in the nasopharyngeal, blood, and cerebrospinal fluid specimens. 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.

CONCLUSION

We should pay attention to the detection and diagnosis of EV-D68 and make efforts to develop antivirus drugs and vaccines.

Keywords: Infection; Enterovirus D68; Flaccid; Paralysis; Neurogenic; Respiratory failure; Case report

Core Tip: This paper reports two pediatric cases of acute flaccid paralysis (AFP) and neurogenic respiratory failure associated with enterovirus D68 (EV-D68) infection which rarely occur. We found that EV-D68 might have caused inflammatory injury to the anterior horn cells of the spinal cord. AFP was caused at levels C5-L5, while neurogenic respiratory failure was caused at levels C3-C5. Our findings indicate that EV-D68 should be carefully monitored in children and that further research must be carried out to develop special antivirus drugs and vaccines. We believe that our research is of particular interest and use to clinicians and experts in infectious diseases.