Talk:Acute flaccid myelitis

Nagpur

Has anyone evaluated the cases of acute flaccid paralysis in 2011 in Nagpur, which were negative for polio, for enterovirus D-68? (Ref: [1] [2]) Wnt (talk) 02:01, 25 October 2014 (UTC)

To do list

• Explain flaccidity versus stiffness in acute flaccid myelitis vs. transverse myelitis. The podcast touched on this; none of the other sources so far have. Wnt (talk) 16:27, 26 October 2014 (UTC)

• Consider adding information about links of certain vaccines to contracting AFM 71.35.165.22 (talk) 10:05, 5 November 2016 (UTC)

And when 'considering' the above request to add 'information' supposedly about links between AFM and vaccines, please notice that the link given is for an anti-vaccination group with an ax to grind. UnderEducatedGeezer (talk) 20:06, 9 October 2018 (UTC)

Replace 'non-enhancing' with 'non-enhanced'? (re: image contrast agent) OR NOT!

In the section, 'Signs and symptoms', there is a phrase (relating to findings on MRI imagings), "...consisting of non-enhancing lesions largely restricted to the grey matter.", and the term 'non-enhancing' is linked to wiki page 'Contrast agent' (which page explains the use of a contrast agent when taking a medical image of the body, to make structures better visible, ie, to enhance the image). However, to me the phrase used here, "non-enhancing lesions", suggests that the nature of the lesions found is that they are 'non-enhancing', ie, that the action or behavior of the "non-enhancing lesions" is that they are not 'enhancing' things, not making things worse (or 'better'?), whereas the actual purpose of the contrast agent is to make the image of some structure more clear, ie, enhanced. I would therefore suggest that the phrase "non-enhancing" be changed to 'non-enhanced', to more clearly inform that the lesions can be seen without having to use a contrast agent to make them more visible in the medical image. Does anyone agree or disagree? I'm reluctant to change this without knowledgeable input. (Ditto for second use of the same term in same section.) UnderEducatedGeezer (talk) 19:37, 9 October 2018 (UTC)

I notice that the reference to the text I'm speaking about above is broken, but that a similar report that I found ( https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6340a5.htm?s_cid=mm6340a5_w " does use (or also uses) the term 'nonenhancing', which I still think is mis-leading, but since it's probably in the report cited, then I assume that it can't be changed here. So I guess 'never-mind', unless someone can think of a way to clear up what I think is confusing phrase, 'non-enhancing', that would be non-intrusive to the important narrative. I can't. UnderEducatedGeezer (talk) 20:28, 9 October 2018 (UTC)

AFAIK the term "non-enhancing" is diagnostically significant. Changing the phrase to non-enhanced could be interpreted/misread as "unenhanced" (which means scanned without contrast). I'm surprised that enhancing and non-enhancing are not mentioned/explained at contrast agent, though. I'll see if I can find a WP:MEDRS source and add the definitions over the weekend. Little pob (talk) 13:05, 12 October 2018 (UTC)

I agree with UEGeezer; the readability of the dense jargon (of the science paper blockquote) is very difficult for a lay reader. I offer this [editor's brackets] until better information is forthcoming; adjust as you see fit.24.214.86.222 (talk) 21:18, 28 October 2018 (UTC)

Needs work

Since I lack the background to approach this article with any accuracy, I would instead propose a few changes for those who may be able to approach the subject matter with more skill. First, there are far too many lengthy quotes in the article. WP is supposed to provide a summary of what is out there, not just be a depository for large swaths of quoted material. It would be an improvement if the quotes were instead summarized and melded into the article body. Secondly, almost the entirety of the article is sourced back to information generated in the fall of 2014, and much of it speaks of the information as if it's recent commentary - obviously a side-effect of when the article content was being put together. I'd expect that there is considerable, more current information out there after four years, and particularly considering the renewed interest in this article due to the reports of outbreaks in numerous states now in the fall of 2018, I think the article would be improved by revamping and replacing much of this older information. Just my two cents. Anastrophe (talk) 06:56, 17 October 2018 (UTC)

Thank you, User:Natureium for taking on this task, greatly appreciated. Anastrophe (talk) 22:26, 22 October 2018 (UTC)

Thanks. I removed some of the outdated information and I'll try to find more info later. Natureium (talk) 22:40, 22 October 2018 (UTC)

I would add that this is too USA focused, AFM is widespread and increases in incident seen in other countries. Need a rewrite to improve this not just adding in data/information from elsewhere. — Preceding unsigned comment added by 51.6.101.32 (talk) 11:15, 20 December 2018 (UTC)

Calling out enteroviruses in the lead

Doc James - Is there a reason you're removing the bits about Enterovirus 68 and 71 from the lead? I realize you rely pretty heavily on the CDC and that they're being a coy about actually calling out a virus by name, but it seems like most sources have accepted that 68 is the cause (or at least a cause) of AFM. Interestingly, the CDC itself seems to have noted the predominance of 68 in AFM cases. I'm a bit confused by their focus on using CSF to determine etiology. NickCT (talk) 03:16, 22 December 2018 (UTC)

User:NickCT is not a "cause" but potentially a "trigger". There are a bunch of potential triggers though and IMO a detailed discussion of the suspected triggers belongs in the body of the article. Doc James (talk · contribs · email) 04:43, 22 December 2018 (UTC)

Bit confused by your "cause" versus "trigger" distinction. The theory here is direct damage to motor neurons via viral infection, right? Like polio. As poliovirus causes poliomyelitis, so to would enteroviruses cause AFM. Is there a proposed pathogenesis I'm unfamiliar with...? NickCT (talk) 05:31, 22 December 2018 (UTC)

It is more that a viral infection triggers an immune response from what I gather, then direct damage of the motor neuron by the viral infection. Doc James (talk · contribs · email) 12:03, 3 January 2019 (UTC)

@Doc James: - Ah. Ok. So you're saying this is more like an autoimmune neurodegenerative disease, like Amyotrophic lateral sclerosis? That surprises me for two reasons; 1) I think it's pretty well established that Poliovirus directly infects and kills neurons, so I'm not sure why these related viruses wouldn't. 2) I've seen a limited number of sources (e.g. [3]) which seem to suggest that 68 & 71 can directly infect neurons. Do you have sources for the immune response pathology? NickCT (talk) 14:43, 3 January 2019 (UTC)

This ref says "yet the absence of direct virus isolation from affected tissues, infrequent detection in cerebrospinal fluid, and the absence, until recently, of an animal model has left the causal nature of the relationship unproven"[4] Doc James (talk · contribs · email) 16:41, 3 January 2019 (UTC)

User:NickCT the explanation is "Since AFM affects the spinal cord, finding a pathogen (germ) in the fluid that surrounds the spinal cord would be good evidence for a cause. CDC has tested many different specimens from AFM patients for a wide range of pathogens that can cause AFM. We detected coxsackievirus A16, EV-A71, and EV-D68 in the spinal fluid of four AFM cases out of 512 confirmed cases since 2014, which points to the cause of their AFM. For all other patients, no pathogen (germ) has been detected in their spinal fluid. The absence of a pathogen in most AFM cases means we haven’t found the definitive cause yet. There could also be something else triggering the patient’s AFM, such as their immune response to an infection or a genetic factor that may make them more susceptible."[5] Doc James (talk · contribs · email) 12:07, 3 January 2019 (UTC)

I feel like that statement is basically equivalent to saying "If you find a tiger over a carcass, it's good evidence the tiger killed the animal". Then they go on to say "Of 512 carcasses we found, 4 had tigers standing over them".

I don't get the point. If your purpose is to ask "Are tigers killing this group of animals?", it's really unclear whether the 4 out of 512 is intended to support or refute the idea that tigers are responsible.

I get that if you're familiar with stats and diagnostics you'd probably be able to interpret this information clearly. The likelihood that members of the press or random netizens (i.e. the people for who this page seems intended) are going to be able to interpret this info seems small. NickCT (talk) 16:46, 3 January 2019 (UTC)

Prevention of AFM DOES NOT include vaccination against polio

Removed the following as it was unsupported by the reference/citation: "Prevention includes polio vaccination and avoiding mosquitoes bites. " It would be best for editors to be able to recognize technical nuances. "AFM-related viruses" is what may be prevented by the polio vaccine and avoiding mosquito bites. This is probably referring to illnesses such as those carried by the WNV or perhaps to St. Louis encephalitis. Nowhere in the source it states that AFMN can be prevented by the polio vaccine. I encourage an editor to be technically precise or use other sources that state that AFM can be prevented with the polio vaccine. Cheers! 71.221.139.97 (talk) 05:13, 2 January 2019 (UTC)

@Doc James: - We need to look at this. The source you're using is really confusing. It seems to say that poliovirus can cause AFM, but doesn't really offer any data to support that. If poliovirus can cause AFM, then I'm confused as to the difference between AFM and poliomyelitis. Almost all the sources I see, other than the one you've used, seem to treat poliovirus and AFM as unrelated. Do you genuinely think the CDC is trying to say they are linked here? NickCT (talk) 17:39, 2 January 2019 (UTC)

Polio is one cause of AFC per "Certain viruses are known to cause AFM including enteroviruses, such as poliovirus and enterovirus A71 (EV-A71), and West Nile virus."[6]

It is just that polio is NOT a cause of the current outbreak in the United States. Doc James (talk · contribs · email) 11:47, 3 January 2019 (UTC)

@Doc James: - I'd read that, thanks. I think you may be relying on the CDC pretty heavily. A whole bunch of non-scholarly sources (e.g. [7], [8], [9]) and scholarly sources (e.g. [10],[11], [12]) seem to pretty explicitly differentiate polio from AFM. There are a small number of sources (e.g. [13]) which seem to suggest poliomyelitis is a subcategory of AFM. I think the person at the CDC who wrote the particular piece you're looking at has adopted the latter viewpoint.

I don't really know or really care which viewpoint is "right". I do know that we shouldn't solely be relying on information from the CDC. NickCT (talk) 14:26, 3 January 2019 (UTC)

The CDC is a fairly well respected source. We of course should not touch the popular press. We should also stick with secondary sources.

So [14] with the others being primary sources.

This is a better known journal though [15]

This review supports the current text [16] Doc James (talk · contribs · email) 16:37, 3 January 2019 (UTC)

You shouldn't turn your nose up at popular press. A lot of news outlets have academics and/or physicians in good standing writting their articles for them. It's worth considering the pieces on a case-by-case basis.

I don't refute the CDC is a well respected source. My point is that it's not the only source.

I also already said there is literature that supports the "polio is a cause of AFM" statement (like the Curr Infect review you point to). Worth noting that the Curr Infect review uses the acronym "AFP" instead of "AFM". Is that an intentional distinction? Or are they just trying to be different?

All this said, in my reading, a majority of sources seem to treat polio/poliomyletisis as being distinct from AFM. I think we ought to reflect that, or at least be ambiguous on the topic. NickCT (talk) 17:06, 3 January 2019 (UTC)

Children

@Doc James: I haven't found any information about this condition occurring in adults. Do you have a source for this? Natureium (talk) 13:39, 20 March 2019 (UTC)

Yes the ref immediately behind the statement in question say "Most cases of AFM have been in children, but it can develop in adults."[17] Doc James (talk · contribs · email) 16:01, 20 March 2019 (UTC)

Thanks. Natureium (talk) 02:01, 21 March 2019 (UTC)

Antivirals do work with this (if your lucky)

I had this illness when i was 4, it caused my legs to lose the ability to remain rigid and straight. When my parents took me to a Baylor hospital, NOT A SINGLE DOCTOR KNEW WHAT WAS HAPPENING TO ME! But after a quick MRI scan and contacting the Children's Hospital in Dallas, it turned out that i had the early stages of this disease early enough to be prescribed antivirals, and get sent home 2-4 days later I was back to normal, and to this day there are no traces of my "Incident". By the way it occurred in 2005. Now how in the hell did I even recover from an almost unheard of disease? I have no damn idea.

• NOTE: Back then, 197 cases were reported in that year(the ones who were actually confirmed to have had it), less than 1/12th of them fully recovered. in 2005 the odds of one getting the illness was 1 in 1,500,101(about the same odds as the chance of being or dying in an aircraft accident).