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Polio-like illness - north america: Canada (british columbia)

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  • Polio-like illness - north america: Canada (british columbia)

    ************************************************** ***********
    A ProMED-mail post
    ProMED-mail is a program of the
    International Society for Infectious Diseases

    Date: 30 Sep 2014
    From: Dr. Danuta Skowronski <>
    Among the 8 laboratory-confirmed cases of EV-D68 detected as of [30 Sep 2014] in BC, there were 2 individuals reported to the BC Centre for Disease Control (BCCDC) with paralytic symptoms, including a child aged 5-10 years and a young adult aged 15-20 years. Both are male, previously healthy and had symptom onset in late August 2014. They reside several hundred kilometres apart and are not epidemiologically linked. Unlike other areas affected by EV-D68, a general increase in severe respiratory illness visits to emergency rooms or hospitals has not yet been observed in BC. However, all public primary and secondary schools had been closed in BC due to a teacher's strike that recently ended and with school only having resumed from summer recess on [22 Sep 2014].

    The younger child presented with a 5-day history of fever, cough, rhinorrhea and congestion. Household members, both adult and pediatric, had similar cold-like symptoms. Two days prior to admission, the child experienced headache and neck pain radiating to the left shoulder, worsened by coughing. The child developed sudden onset of left arm weakness. Examination at admission identified left arm flaccid paralysis and areflexia without any sensory findings. CSF examination showed elevated leukocytes consisting of a mix of neutrophils and lymphocytes with slight predominance of the latter, normal glucose and elevated protein (0.5 g/L). MRI identified asymmetric swelling from C2 to T1. Nerve conduction and EMG examination confirmed findings consistent with anterior horn cell involvement but normal sensory findings. CSF was negative for enterovirus RNA but the nasopharyngeal swab was PCR-positive for enterovirus/rhinovirus, subsequently confirmed to be EV-D68 by sequencing of the 5' UTR at the BCCDC. Serology was IgM positive for Mycoplasma pneumoniae but nasopharyngeal swab was PCR-negative. There was no improvement in neurological symptoms during the 9-day course in hospital and the child was discharged with outpatient follow-up. There remains no neurological improvement nearly one-month post-admission.

    The young adult had a prior history of shingles in the late spring and respiratory symptoms over the past 2-3 months. For the current episode, the patient awoke with right arm weakness and presented to hospital with one-day history of flu-like symptoms including mild fever, general aches and fatigue. No other family members had cold-like symptoms. The patient rapidly deteriorated over the ensuing 24 hours with difficulty breathing requiring intubation and mechanical ventilation. CSF specimen showed elevated leukocytes consisting of a mix of neutrophils and lymphocytes with slight predominance of the former, normal glucose and elevated protein (0.63 g/L). CSF was negative for enterovirus and VZV, but tracheal aspirate was positive for enterovirus/rhinovirus, determined by sequencing to be EV-D68 at the BCCDC. MRI showed longitudinal high signal within the cervical cord. Nearly one month post-admission, the patient still requires assistance with ventilation.