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Children’s Hospital probes link between enterovirus, paralysis

Boston Children’s Hospital is treating four children with muscle weakness or paralysis that began soon after they were sickened by a respiratory virus, doctors said Tuesday.

The Boston cases are similar to those involving 10 children in the Denver area, which Children’s Hospital Colorado began identifying in August. Health officials and doctors in both states said they are investigating whether the cause might be enterovirus D68, which has sickened dozens of children with respiratory infections and has spread to 30 states.

So far in Boston, none of the four patients has tested positive for enterovirus D68, unlike in Colorado, where the virus was detected in nasal swabs from four of the 10 children so far, but not in spinal fluid. Detecting the enterovirus in spinal fluid would be more conclusive.

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“As of now, it is unclear whether there is a connection’’ between the neurological symptoms and the virus, Dr. Mark Gorman, a neurologist at Boston Children’s, said during a press conference.

The failure to detect enterovirus in the spinal fluid or the nose of patients at Boston Children’s does not rule out a connection, because the virus could have been gone from the patients by the time the neurological symptoms appeared, Gorman said.

“It could be a two-part illness,’’ he said.

But he said that even if the virus caused the neurological symptoms, cases of muscle weakness and paralysis are still rare, given the large number of children infected with enterovirus D68 this summer and fall.

Enterovirus D68 is not new, but for unknown reasons it has manifested as a respiratory infection this year and in some children has led to severe asthma and wheezing. There is no vaccine and no treatment targeting the virus.

The US Centers for Disease Control and Prevention sent doctors an alert last week about the poliolike cases and asked them to report patients 21 years old and younger who have developed limb weakness since Aug. 1 and who have had a medical scan showing abnormalities in nerve tissue in the spinal cord. Gorman said Boston Children’s is monitoring two additional patients who meet one of those criteria.

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At Children’s Hospital Colorado, the 10 children have experienced leg and arm weakness and cranial nerve dysfunction, which can manifest as facial droop, difficulty swallowing, and double vision. Six of those patients have gone home, and four remained hospitalized Tuesday.

In Boston, patients have had muscle weakness that resulted in difficulty walking or moving their arms and cranial nerve dysfunction, including double vision. The patients are between 4 and 15 years old. Three are still in the hospital, and one, whose muscle weakness improved, was sent home.

While there is no treatment for the virus, doctors have provided patients with physical therapy and pain management and monitored their neurologic and respiratory status.

Occasional cases of viruses causing paralysis in children have been reported in past years, but little is known about the long-term outcome. Some of those children recovered fully, while others did not, Gorman said.

Doctors and health officials advise parents to make sure their children wash their hands often to avoid transmitting the virus and to call their pediatrician about any unusual symptoms, including muscle weakness.


Liz Kowalczyk can be reached at kowalczyk@globe.com.