急性弛缓性脊髓炎

定义

急性弛缓性脊髓炎 is a rare condition that affects the nervous system. Inflammation of the gray matter in the spinal cord leads to muscle weakness 和 paralysis.

急性弛缓性脊髓炎 (AFM) is usually caused by infection with a virus. While AFM is rare, there has been a slight increase in cases of AFM since 2014. Most new cases have occurred in children or young adults.

选择的名字

急性弛缓性脊髓炎; AFM; Polio-like syndrome; Acute flaccid paralysis; Acute flaccid paralysis with anterior myelitis; Anterior myelitis; Enterovirus D68; Enterovirus A71

原因

AFM usually occurs after a cold, fever, or gastrointestinal illness.

Different kinds of viruses may be the cause of AFM. 这些包括:

• Enteroviruses (poliovirus 和 non-poliovirus)
• West Nile virus 和 similar viruses such as Japanese encephalitis virus 和 Saint Louis encephalitis virus
• 腺病毒

It is unclear why certain viruses trigger AFM, or why some people develop the condition 和 others don't.

Environmental toxins also can cause AFM. In many cases, a cause is never found.

症状

A fever or a respiratory illness is often present before weakness 和 other symptoms begin.

AFM symptoms often start with sudden muscle weakness 和 loss of reflexes in an arm or leg. 症状 may progress rapidly over a few hours to days. 其他症状可能包括:

• 面部下垂或虚弱
• 下垂的眼睑
• 眼睛移动困难
• Slurred speech or difficulty swallowing

有些人可能有:

• 颈部僵硬
• 手臂或腿部疼痛
• 不能排尿

严重症状包括:

• Respiratory failure, when muscles involved in breathing become weak
• Serious nervous system problems, which may lead to death

考试和测试

Your health care provider will take your medical history 和 vaccination history to know if you are up-to-date with your 脊髓灰质炎疫苗s. Unvaccinated individuals who are exposed to poliovirus are at higher risk for acute flaccid myelitis. Your provider also may want to know if within the last 4 weeks you have:

• 旅行
• Had a cold or the flu or a stomach bug
• Had a fever 100°F (38°C) or higher

Your provider will do a physical exam. 可以进行的测试包括:

• 脊柱MRI 和 脑部核磁共振 to view lesions in the gray matter
• 神经传导速度测验
• 肌电图(EMG)
• Cerebrospinal fluid (CSF) analysis to check if white blood cells are elevated

Your provider also may take stool, blood, 和 saliva samples to test.

治疗

There is no specific treatment for AFM. You may be referred to a doctor specializing in disorders of the nerves 和 nervous system (neurologist). The doctor will likely treat your symptoms.

A number of medicines 和 treatments that work on the immune system have been tried but have not been found to help.

You may need physical therapy to help restore muscle function.

前景(预测)

The long-term outlook of AFM is not known.

可能出现的并发症

AFM的并发症包括:

• 肌肉无力和麻痹
• 肢体功能丧失

When to Contact a Medical Professional

Contact your provider right away if you or your child have:

• Sudden weakness in the arms or legs or difficulty moving the head or face
• AFM的其他症状

预防

There is no known way to prevent AFM. 有一个 脊髓灰质炎疫苗 may help reduce the risk of AFM related to the poliovirus.

Take these steps to help avoid viral infections:

• Wash h和s frequently with soap 和 water, especially before eating.
• Avoid close contact with people who have a viral infection.
• Use mosquito repellants when going outdoors to prevent mosquito bites.

To learn more 和 get recent updates, go to the CDC webpage about acute flaccid myelitis at www.疾病预防控制中心.gov / acute-flaccid-myelitis /索引.html.

参考文献

Centers for Disease Control 和 预防 website. 急性弛缓性脊髓炎. www.疾病预防控制中心.gov / acute-flaccid-myelitis /索引.html. 更新于2022年6月21日. 于2022年12月2日生效.

Kapadia RK, Pastula DM, Glaser CA. Parainfectious 和 postinfectious neurologic syndromes. In: Long SS, Prober CG, Fischer M, Kimberlin DW, eds. Principles 和 Practice of Pediatric Infectious Diseases. 6日艾德. Philadelphia, PA: Elsevier; 2023:chap 45.

梅萨卡·K，艾布扎格·MJ. 肠病毒和喉病毒. In: Long SS, Prober CG, Fischer M, Kimberlin DW, eds. Principles 和 Practice of Pediatric Infectious Diseases. 6日艾德. Philadelphia, PA: Elsevier; 2023:chap 236.