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Member Research and Reports

Columbia: Center for Infection and Immunity Shows New Evidence Points to Viral Culprit in AFM Child Paralysis

Scientists at Center for Infection and Immunity (CII) at Columbia University Mailman School of Public Health, the Centers for Disease Control and Prevention (CDC), and UC San Diego report antibody evidence in cerebrospinal fluid (CSF) that points to enterovirus (EV) infection as a cause for acute flaccid myelitis (AFM), that partially paralyzed more than 560 children in the U.S. since 2014. Results are in the journal mBio.

AFM patients, upwards of 90 percent of whom are children, present with severe weakness in one or more limbs, usually within a month of a respiratory or gastrointestinal illness, leading scientists to posit that a pathogen is behind AFM. A preliminary CDC analysis found that more than 40 percent of children with AFM had evidence of EV RNA in respiratory or fecal samples. Yet in CSF, they found EV in only 4 of 567 total confirmed cases.

In the study, researchers reexamined the CSF of ASM patients for signs of EV. While they found EV RNA in only one adult AFM case and one non-AFM case, there were antibodies to EV peptides in 11 of 14 AFM patients, significantly higher than controls. Also, 6 of 14 CSF and 8 of 11 blood sera from AFM patients were immunoreactive to an EV-D68-specific peptide. The researchers also found no evidence of tick-borne disease pathogens.

“Physicians and scientists have long suspected that enteroviruses are behind AFM, but there has been little evidence to support this,” says co-lead investigator Dr. Nischay Mishra, assistant professor at CII. “These results take us one step closer to understanding the cause of AFM and to developing diagnostic tools and treatments.”

“Pathogen discovery has historically focused on direct detection of infectious agents. Introduction of new methods that allow us to also test for footprints of exposure will lead to new insights into infectious diseases,” says co-senior author Dr. Ian Lipkin, director.

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