Pan-Viral Serology Implicates Enteroviruses in Acute Flaccid Myelitis
LETTERS https://doi.org/10.1038/s41591-019-0613-1 Pan-viral serology implicates enteroviruses in acute flaccid myelitis Ryan D. Schubert 1,2, Isobel A. Hawes1,2,18, Prashanth S. Ramachandran1,2,18, Akshaya Ramesh1,2,18, Emily D. Crawford3,4, John E. Pak3, Wesley Wu3, Carly K. Cheung3, Brian D. O’Donovan5, Cristina M. Tato3, Amy Lyden3, Michelle Tan3, Rene Sit3, Gavin A. Sowa6, Hannah A. Sample5, Kelsey C. Zorn 5, Debarko Banerji2, Lillian M. Khan5, Riley Bove1,2, Stephen L. Hauser1,2, Amy A. Gelfand1,2, Bethany L. Johnson-Kerner1,2, Kendall Nash1,2, Kalpathy S. Krishnamoorthy7, Tanuja Chitnis7,8, Joy Z. Ding9, Hugh J. McMillan9, Charles Y. Chiu 10, Benjamin Briggs11, Carol A. Glaser12, Cynthia Yen13, Victoria Chu 13, Debra A. Wadford13, Samuel R. Dominguez14, Terry Fei Fan Ng 15, Rachel L. Marine 15, Adriana S. Lopez15, W. Allan Nix15, Ariane Soldatos16, Mark P. Gorman17, Leslie Benson17, Kevin Messacar14, Jennifer L. Konopka-Anstadt 15, M. Steven Oberste15, Joseph L. DeRisi3,5 and Michael R. Wilson 1,2* Since 2012, the United States of America has experienced over 500 confirmed cases1–4,8. The nationwide surges in AFM in a biennial spike in pediatric acute flaccid myelitis (AFM)1–6. 2014, 2016 and 2018 have coincided temporally and geographically Epidemiologic evidence suggests non-polio enteroviruses with outbreaks of EV-D68 and EV-A71 infections2,6,9–11. EVs, includ- (EVs) are a potential etiology, yet EV RNA is rarely detected ing poliovirus, are well recognized for their neuroinvasive capac- in cerebrospinal fluid (CSF)2. CSF from children with AFM ity and resultant central nervous system (CNS) pathology, ranging (n = 42) and other pediatric neurologic disease controls from self-resolving aseptic meningitis to fulminant, sometimes (n = 58) were investigated for intrathecal antiviral antibodies, fatal, brainstem encephalitis, and to myelitis leading to permanent using a phage display library expressing 481,966 overlapping debilitating paralysis12.
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