In Germany in the summer and autumn of 2016, several cases of illness in children were observed that were accompanied by acute flaccid paralysis. For the entire year 2016, 16 of such polio-like cases were registered with the Robert Koch-Institute. In an article in the current issue of Deutsches Ärzteblatt International (Dtsch Arztebl Int 2017; 114: 550-6), Johannes Hübner et al. describe this disease on the basis of two case reports, in which the neurological symptoms ranged from flaccid paralysis of the arm to tetraplegia requiring intubation and ventilation.
In the children under study, the main characteristic was damage to the anterior horn of the spinal cord as confirmed on MRI or lesions as a sign of motor neuron injury as confirmed electrophysiologically. A pathogen could almost never be detected in cerebrospinal fluid, but epidemiological associations and confirmation of viruses from stool specimens or respiratory secretions pointed at enteroviruses as the likely pathogen. The prognosis of such polio-like disease with flaccid paralysis of differing severity cannot be estimated at the beginning—it ranges from hardly detectable impairment of the arm movement to care dependency in permanent severe symptoms. Targeted therapeutic measures are not available. No sufficient evidence currently exists for the effectiveness of corticosteroids, immunoglobulins, plasmapheresis, or antiviral medications.
The authors express concern that since 2012, several cases of severe flaccid paralysis have been observed in several countries, which closely resemble the symptoms of poliomyelitis, but which are caused be different pathogens that are often not identifiable. The term "acute flaccid paralysis with anterior myelitis" has been adopted, in order to distinguish the symptoms from those of classic poliomyelitis.