Enterovirus D68 and acute flaccid myelitis—evaluating the evidence for causality

Increased circulation of enterovirus D68 in 2014 and 2016 temporally and geographically coincided with increases in cases of acute flaccid myelitis, an uncommon condition of paralysis due to lesions in the anterior horn of the spinal cord. The identification of enterovirus D68 in respiratory specime...

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Bibliographic Details
Published in:The Lancet infectious diseases 2018-08, Vol.18 (8), p.e239-e247
Main Authors: Messacar, Kevin, Asturias, Edwin J, Hixon, Alison M, Van Leer-Buter, Coretta, Niesters, Hubert G M, Tyler, Kenneth L, Abzug, Mark J, Dominguez, Samuel R
Format: Article
Language:English
Subjects:
19th century
Analysis
Causality
Central Nervous System Viral Diseases - diagnosis
Central Nervous System Viral Diseases - epidemiology
Central Nervous System Viral Diseases - virology
Cerebrospinal fluid
Disease Outbreaks
Encephalitis
Enterovirus D, Human - isolation & purification
Enterovirus Infections - epidemiology
Enterovirus Infections - virology
Enteroviruses
Epidemiology
Guillain-Barre syndrome
Humans
Illnesses
Infectious diseases
Lesions
Medical colleges
Myelitis
Myelitis - diagnosis
Myelitis - epidemiology
Myelitis - virology
Neuromuscular Diseases - diagnosis
Neuromuscular Diseases - epidemiology
Neuromuscular Diseases - virology
Paralysis
Paralysis - etiology
Poliomyelitis
Respiratory diseases
Spinal cord
Viruses
West Nile virus
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Summary:Increased circulation of enterovirus D68 in 2014 and 2016 temporally and geographically coincided with increases in cases of acute flaccid myelitis, an uncommon condition of paralysis due to lesions in the anterior horn of the spinal cord. The identification of enterovirus D68 in respiratory specimens from cases of acute flaccid myelitis worldwide further supports an association, yet the absence of direct virus isolation from affected tissues, infrequent detection in cerebrospinal fluid, and the absence, until recently, of an animal model has left the causal nature of the relationship unproven. In this Personal View we evaluate epidemiological and biological evidence linking enterovirus D68 and acute flaccid myelitis. We applied the Bradford Hill criteria to investigate the evidence for a causal relationship and highlight the importance of comprehensive surveillance and research to further characterise the role of enterovirus D68 in acute flaccid myelitis and pursue effective therapies and prevention strategies.
ISSN:1473-3099
1474-4457
1474-4457
DOI:10.1016/S1473-3099(18)30094-X