HealthDay News — Enterovirus (EV)-specific antibodies have been identified in the cerebrospinal fluid (CSF) of pediatric cases of acute flaccid myelitis (AFM) versus controls, according to a study published online Oct. 21 in Nature Medicine.

Ryan D. Schubert, MD, from the University of California in San Francisco, and colleagues investigated CSF from 42 children with AFM and 58 controls with other pediatric neurologic disease for intrathecal antiviral antibodies using a phage display library expressing 481,966 overlapping peptides derived from all known vertebrate and arboviruses (VirScan). Metagenomic next generation sequencing (mNGS) was also performed of AFM CSF RNA from 20 cases.

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The researchers found that the viral family significantly enriched by the CSF of AFM cases relative to controls was Picornaviridae using VirScan; the most enriched Picornaviridae peptides belonged to the Enterovirus genus (29 of 42 cases versus four of 58 controls). This finding was confirmed in an EV VP1 enzyme-linked immunosorbent assay (ELISA; 22 of 26 cases versus seven of 50 controls). No additional EV RNA was detected by mNGS.

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“Although continued vigilance for other possible etiologies of AFM is warranted, together the combined mNGS, VirScan, and viral protein ELISA investigation of AFM CSF supports the notion that EV infection probably underlies most AFM cases tested in the present study,” the authors write.

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