Two North Texas children have been paralyzed by a mysterious polio-like illness that has been linked to a common respiratory virus, according to the Texas Department of State Health Services.
The patients, one from Collin County and one from Tarrant County, have tested positive for enterovirus D68, a once-rare virus that has spread across 47 states and infected 1,121 people since mid-August. The outbreak has been winding down as winter approaches.
The Collin County patient is Bryan Sotelo, 11, of Allen, who lost the ability to move his limbs after coming down with a cough and fever in July.
After spending two months in the hospital and several weeks as an inpatient at a rehabilitation center, he was able to reverse 75 percent of his paralysis, his mother, Yadira Garcilazo, told The News in October. She did not respond to a message left for her Friday.
The U.S. Centers for Disease Control and Prevention notified the Texas Department of State Health Services of the most recent enterovirus D68 test result on Tuesday, said Chris Van Deusen, a spokesman for the state health department.
The patients fell ill over the summer, but test results were delayed as the CDC struggled to clear a backlog of cases. The second patient has not been identified.
Enterovirus D68, or EV-D68, typically causes mild cold symptoms. But this summer, the virus led to severe respiratory problems in a small subset of children, requiring physicians to place them on ventilators.
The CDC has also been investigating a possible link between EV-D68 and 88 cases of unexplained limb weakness and spinal cord damage that have been reported in 32 states since Aug. 1. There’s no proof yet that EV-D68 was the direct cause of the two North Texas children’s paralysis.
Dr. Daniel Feikin, a medical epidemiologist at the CDC, said the average age of the patients with sudden paralysis is “about 8 years … but we have seen a few cases in children younger than 1.” Symptoms range from weakness in a single limb to a nearly complete loss of movement.
The majority of patients in the outbreak had a respiratory or febrile illness in the two weeks before they suffered weakness and paralysis.
Feikin said the CDC is working with state health departments to investigate the outbreak but that a cause has not yet been identified.
Dr. Benjamin Greenberg, an expert on pediatric paralysis, suspects the neurological symptoms resulted from a combination of EV-D68 directly damaging the spinal cord and the body’s immune system responding to the virus.
“My sense is we’re seeing something akin to what the polio virus did,” said Greenberg, who works at UT Southwestern Medical Center and at Children’s Medical Center Dallas.
Feikin said: “It’s likely going to be viral, but beyond that, we’re not sure. We’re keeping open the possibility that it’s enterovirus D68. … We are definitely testing for other viruses, as well.”
One factor limiting the ability of lab tests to diagnose the cause of the paralysis is that children are presenting with paralysis days or weeks after the onset of a respiratory or febrile illness. “It’s possible that if it is a virus, that the virus is gone or undetectable by the time they are presenting,” Feikin said.
UT Southwestern is hosting a national data repository of paralysis cases related to this outbreak.
“We are collaborating with universities across the U.S. for them to collate their data into one secure database,” said Greenberg. “We are leading an effort to analyze what were the various ways this outbreak affected children neurologically. Some had paralysis; some had paralysis and changes to their brains. There was a variety of ways that children presented over the summer.”
One of the goals, said Greenberg, is to track which treatments were most and least effective so that doctors can provide better care for children should the outbreak return.
Greenberg and his collaborators are also working to determine if children with paralysis had a different immune response to the virus than children who suffered only cold symptoms. In some cases, the immune system can “go in with the best of intentions” but end up causing more inflammation and damage, he said.
Other researchers are collecting DNA samples from children who did and did not develop neurological problems in an effort to identify a genetic predisposition for spinal cord damage from the virus.
Some institutions are studying whether EV-D68 is capable of directly infecting cells within the spinal cord.
The CDC will continue to track the outbreak into next year, including next summer and fall. “We want to see if we are experiencing a repeat or if this year was a real anomaly,” Feikin said.
Dr. Seema Yasmin, a former epidemiologist at the CDC, is a physician and professor at the University of Texas at Dallas.
akuchment@dallasnews.com; syasmin@dallasnews.com
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