{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T02:09:52Z","timestamp":1768270192292,"version":"3.49.0"},"reference-count":26,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,11,28]],"date-time":"2024-11-28T00:00:00Z","timestamp":1732752000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Paediatrics Child Health"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>We report the epidemiology, treatment and outcomes of acute flaccid myelitis (AFM), including the first two cases of enterovirus (EV) D68 myelitis, in Singapore.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective observational study from a paediatric hospital in Singapore, from January 2012 to December 2022. Clinical, laboratory, neuroimaging and outcome data were analysed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eight patients were identified (all male). Median age at presentation was 3 (interquartile range (IQR) 2.2\u201310.0) years. Seven (87.5%) patients were clustered in two time periods (July 2018\u2013January 2019 and April\u2013August 2022). Presenting features were a preceding febrile respiratory illness (<jats:italic>n<\/jats:italic>\u2009=\u20096) or hand\u2010foot\u2010and\u2010mouth disease (<jats:italic>n<\/jats:italic>\u2009=\u20092), upper limb weakness (<jats:italic>n<\/jats:italic>\u2009=\u20095, 62.5%) and neurogenic bladder (3, 37.5%), while the spinal cord lesions were predominantly in the cervical region (7, 87.5%). Five (62.5%) and six (75.0%) patients had elevated cerebrospinal fluid (CSF) white cells (median 7.5\/mm<jats:sup>3<\/jats:sup> (IQR 2.8\u201340.3)) and protein (median 0.6\u2009g\/L (IQR 0.4\u20130.7)), respectively. CSF was negative for pathogens. Two (50%) of four patients with EV detected in respiratory\/rectal swabs had EVD68 (2022 cluster). All received intravenous methylprednisolone, six (75%) had additional intravenous immunoglobulin and either plasma exchange therapy (<jats:italic>n<\/jats:italic>\u2009=\u20091) or intravenous tocilizumab (<jats:italic>n<\/jats:italic>\u2009=\u20091). Median modified Rankin Scale (mRS) at acute illness was 4 (IQR grades 3\u20135), with an improvement (median 2 (IQR 1.8\u20132.3) mRS grades) on follow\u2010up (median duration 3.7 (IQR 1.4\u20134.1) years). One patient (12.5%) had a full recovery and seven (87.5%) have moderate disability (mRS 2\u20133).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Disability risk in AFM is high despite aggressive immunotherapy. We report the first two confirmed cases of EV D68 AFM in Singapore and Southeast Asia.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jpc.16727","type":"journal-article","created":{"date-parts":[[2024,11,29]],"date-time":"2024-11-29T01:20:28Z","timestamp":1732843228000},"page":"160-165","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Childhood acute flaccid myelitis, including the first confirmed cases of enterovirus <scp>D68<\/scp> myelitis, in Singapore and Southeast Asia"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2036-3744","authenticated-orcid":false,"given":"Jillian Ann","family":"Pakiam","sequence":"first","affiliation":[{"name":"General Paediatric Service, Department of Paediatrics KK Women's and Children's Hospital  Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1313-7458","authenticated-orcid":false,"given":"Karen 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