Enteroviruses Are Likely the Cause of AFM


Enteroviruses are likely the cause of acute flaccid myelitis (AFM), according to new data presented at the 144th Annual Meeting of the American Neurological Association.

Although previous research has suggested a link between AFM and enterovirus D68, uncertainty persists about the role of enteroviruses in AFM.

To further investigate the etiology of AFM, the researchers examined cerebrospinal fluid from 29 pediatric patients with AFM using a pan-viral serologic assay with a programmable phage display in combination with metagenomic next-generation sequencing.

Samples from 71 unmatched pediatric cases of other neurologic diseases that were not known to be caused by enteroviruses were also examined.

Overall, results showed that 21 of 29 AFM cerebrospinal fluid samples specifically enriched enterovirus peptides more than 2500 reads per hundred thousand (rpK), whereas only 7 of the 71 samples from cases of other neurologic diseases had this reaction.

Moreover, metagenomic next-generation sequencing did not detect any additional enterovirus RNA in the cerebrospinal fluid samples.

“Despite the rare detection of [enterovirus] RNA in the [central nervous system] of patients with AFM, our pan-viral serologic assay identified [cerebrospinal fluid] antibodies to the [enterovirus] genus in most patients (21/29) with AFM compared to a minority of pediatric [other neurologic diseases] (7/71),” the researchers wrote.

“Follow-up studies are underway to validate our findings in larger cohorts and to provide [enterovirus] species-level epitope resolution. These results support the hypothesis that [enteroviruses], not other viruses, are associated with AFM.”

—Amanda Balbi


Schubert R, Ramachandran P, Hawes I, et al. Multimodal investigation of the etiology of acute flaccid myelitis. Paper presented at: 144th Annual Meeting of the American Neurological Association; October 13-15, 2019; St. Louis, MO. https://onlinelibrary.wiley.com/doi/10.1002/ana.25587.