Mielitis flácida aguda e infeccion por enterovirus: una enfermedad grave emergente.
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2022
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Sociedad Chilena de Pediatría
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ISSN
2452-6053
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Resumen
La mielitis flácida aguda (MFA) es una enfermedad neuro inflamatoria de la medula espinal caracterizada por la aparición aguda de parálisis flácida asimétrica de predominio proximal y una lesión longitudinal de la sustancia gris de la médula espinal. Afecta principalmente a los niños y se ha descrito desde el año 2014 . Objetivo: Reportar una enfermedad pediátrica neurológica grave emergente en Chile. Casos Clínicos: Tres niños, (2 sexo femenino), rango de edad 4 - 6 años, previamente sanos, que tras infección respiratoria alta febril, presentaron una parálisis aguda asimétrica de predominio proximal en extremidades, que progresó en dos de ellos hacia tetraparesia. En todos se aisló enterovirus en el aspirado nasofaríngeo. En el líquido cefalorraquídeo presentaron pleocitosis, la resonancia magnética demostró hiperintesidad en T2 de la sustancia gris de la médula cervical. Todos ingresaron a cuidados intensivos (UCI) y dos requirieron ventilación mecánica (VM) . La terapia con corticoides, inmunoglobulina y plasmaféresis fue ineficaz. A 12 meses de seguimiento, un paciente permaneció tetrapléjico y dependiente de VM, otro falleció de arritmia ventricular en la UCI, el tercero permanece en rehabilitación con recuperación parcial. Conclusiones: Estos son los primeros reportes de esta enfermedad neurológica emergente en nuestro país. Frente a un niño con una parálisis aguda de extremidades de predominio proximal y asimétrica, los pediatras debemos tener un alto índice de sospecha de una MFA. Dado que puede progresar rápidamente y llevar a una insuficiencia respiratoria, la sospecha de MFA debe ser considerada como una emergencia médica.
Acute flaccid myelitis (AFM) is a neuroinflammatory disease characterized by acute asymmetric weakness of the limbs associated with lesions of the gray matter of the spinal cord. It mainly affects children and has been increasingly identified since 2014. Objective: To describe a severe emerging neurological disease in Chile. Clinical Case: Three children (2 females), previously healthy were included. The age at the onset was between 4 and 6 years. All presented an acute febrile illness associated with upper respiratory symptoms, rapid onset of proximal asymmetric limb weakness, spinal fluid pleocytosis, and enterovirus isolated from nasopharyngeal swab; two patients developed tetraparesis. The MRI of the spinal cord showed T2 hyperintensity of the grey matter. The three patients were admitted to the Pediatric Intensive Care Unit (PICU), and two required mechanical ventilation. No significant improvements were observed after the use of immunomodulatory therapy and plasma exchange. At 12 months of follow-up, one case was quadriplegic and ventilator-dependent; the second died of ventricular arrhythmia in the PICU, and the third one is under rehabilitation with partial recovery. Conclusions: We report the first cases of this severe emerging neurological disease in our country. In a child with predominantly proximal and asymmetric acute limb paralysis, pediatricians must have a high index of suspicion for AFM. Since it can progress rapidly and lead to respiratory failure, suspected AFM should be considered a medical emergency.
Acute flaccid myelitis (AFM) is a neuroinflammatory disease characterized by acute asymmetric weakness of the limbs associated with lesions of the gray matter of the spinal cord. It mainly affects children and has been increasingly identified since 2014. Objective: To describe a severe emerging neurological disease in Chile. Clinical Case: Three children (2 females), previously healthy were included. The age at the onset was between 4 and 6 years. All presented an acute febrile illness associated with upper respiratory symptoms, rapid onset of proximal asymmetric limb weakness, spinal fluid pleocytosis, and enterovirus isolated from nasopharyngeal swab; two patients developed tetraparesis. The MRI of the spinal cord showed T2 hyperintensity of the grey matter. The three patients were admitted to the Pediatric Intensive Care Unit (PICU), and two required mechanical ventilation. No significant improvements were observed after the use of immunomodulatory therapy and plasma exchange. At 12 months of follow-up, one case was quadriplegic and ventilator-dependent; the second died of ventricular arrhythmia in the PICU, and the third one is under rehabilitation with partial recovery. Conclusions: We report the first cases of this severe emerging neurological disease in our country. In a child with predominantly proximal and asymmetric acute limb paralysis, pediatricians must have a high index of suspicion for AFM. Since it can progress rapidly and lead to respiratory failure, suspected AFM should be considered a medical emergency.
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Andes Pediátrica Revista Chilena de Pediatría, Vol. 93, N°4, (2022) p. 552-560.
Palabras clave
Myelitis
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Atribución-NoComercial-CompartirIgual 3.0 Chile (CC BY-NC-SA 3.0 CL)