Type 2 poliovirus detection after global withdrawal of. A novel outbreak enterovirus d68 strain associated with. All 25 cases of acute flaccid paralysis included in this study met the case definition for diagnosis of acute flaccid myelitis and presented with acute flaccid weakness, anterior horn cell grey matter involvement on mri or emg, and no identified cause. During the diagnostic approach, it is crucial to obtain a detailed case history, including. Effectiveness of immunization against paralytic poliomyelitis. Importance acute flaccid myelitis afm is an emerging poliolike illness of children whose clinical spectrum and associated pathogens are only partially described. Acute flaccid paralysis afp is a clinical syndrome characterized by rapid onset weakness, that many times includes respiratory and bulbar weakness. Virologists were the first to use the metagenomics approach to detect viruses, causing different diseases in humans such as respiratory tract infections, acute flaccid paralysis in children, and gastroenteritis 8, 11, 12. Acute flaccid paralysis with sensory level necessitates a detailed examination of the back and magnetic resonance imaging spine. Aman presents as acute weakness or paralysis without any sensory loss and with reduced or absent reflexes. Help raise awareness and support spinal cord injury research and education for children like julia. When you have a spinal cord injury, life as you know it changes forever.
Longitudinal outcomes in the 2014 acute flaccid paralysis cluster in canada. Acute flaccid paralysis is a clinical emergency and patients require immediate medical attention, and ideally, subspecialty consultation from a neurologist and an infectious disease specialist. The case definition is intentionally encompassing for epidemiologic surveillance to capture all potential afm cases. Poliovirus is highly infectious, with seroconversion rates in susceptible household contacts of children nearly 100% and of adults over 90%. This child presented with sudden onset bilateral lower extremity weakness, normal tone, hyporeflexia, and bladderbowel involvement. Differential diagnosis of acute flaccid paralysis and its role in. It represents an initial manifestation of upper motor neuron lesions involving the central nervous system and spinal cord or a persistent manifestation of lower motor neuron lesions at the level of the. A systematic approach including clinical data and neuroimaging can help establish accurate diagnosis. On these occasions, central nervous system involvement tends to be extensive, and flaccid paralysis is associated with cranial nerve dysfunction including palpebral ptosis, external ophthalmoparesis and facial diparesis.
Chemistry profile, complete blood count with differential, coagulation studies, blood cultures, hiv antibody screening, and serum samples to be stored for acute and convalescent testing should be obtained in all patients table 4. Flaccid paralysis is a neurological condition characterized by weakness or paralysis and reduced muscle tone without other obvious cause e. Patients with acute flaccid myelitis were predominantly children, with a median age of 70. Children have a shorter clinical course than adults. Points to remember acute flaccid paralysis in children is a medical. Up to 30% will develop respiratory muscle weakness requiring ventil. Nstop officers receive additional training so they can plan vaccination campaigns that are critical to stopping polio. Gbs is the most common cause of acute flaccid paralysis in healthy infants and children. It is a neurological emergency which requires immediate and careful investigations to determine the etiology because accurate diagnosis has significant impact on therapy and prognosis. Investigation of acute flaccid myelitis in children, 2014. Acute flaccid paralysis afp is a lower motor neuron lesion. Signs and symptoms severity ranged from complete paralysis to mild weakness, flaccid in nature 2 typically asymmetric 1, 2 ues more commonly affected 2. Flaccid weakness, quadriparesis, polio, hypotonic paralysis, guillainbarre syndrome. Poliomyelitis is a highly infectious disease caused by poliovirus.
This sensitive case definition will capture acute poliomyelitis but also other diseases, including guillainbarre syndrome, transverse myelitis and traumatic. The term flaccid indicates the absence of spasticity or other signs of disordered central nervous system motor tracts such as hyperreflexia, clonus, or extensor plantar responses. Wed like to understand how you use our websites in order to improve them. Diagnosis and management of hemiplegia introduction hemiplegia is paralysis of one half of the bodywhich includes arm, leg and often face on the affected side. Center for spinal cord injury kennedy krieger institute. Afp is a broad clinical entity with an array of diagnostic possibilities. To expand current knowledge on eva71, molecular epidemiologic analysis and genetic characterization of eva71 isolates were performed in this study. It can affect any age, but primarily involves children aged less than 5 years and causes paralysis in one out of every 200 to infected individuals 1, 2. The term flaccid indicates the absence of spasticity. Acute flaccid paralysis in a patient with sacral dimple. Acute flaccid paralysis afp is a clinical syndrome characterized by rapid onset of weakness, including less frequently weakness of the muscles of respiration and swallowing, progressing to maximum severity within several days to weeks. A case of acute flaccid paralysis afp was defined as a child a child with acute flaccid paralysis article pdf available in the indian journal of pediatrics 7910. Hence, we aim to identify nonpolio enteroviruses recovered from the faeces of children diagnosed with afp in nigeria.
Most cases are preceded by campylobacter jejuni infection. The more severe the acute weakness, the greater the chance of residual deficits, bulbar squeals are rare. It doesnt usually affect both limbs at the same time. Defining a restrictive, homogenous subpopulation may aid our understanding of this emerging disease. Gastroenteritis is the second leading cause of death among infants and children worldwide. Acute flaccid paralysis afp is a clinical syndrome char acterized by rapid onset of. Journal of acute disease 201516 1 contents lists available at sciencedirect journal of acute disease journal homepage. The term acute flaccid paralysis and the global monitoring program. Clinical subpopulations in a sample of north american. Acute flaccid paralysis and its differential diagnosis in.
There are a plethora of causes that can have similar clinical presentation and some can progress rapidly to involve bulbar or respiratory muscle weakness. Active epidemiological surveillance for acute flaccid paralysis was discontinued in the united states with the eradication of polio. Sacral dimple of more than 5 mm in diameter, lying 2. Pdf acute flaccid paralysis afp is a clinical syndrome characterized by rapid onset weakness, that many times includes respiratory and bulbar. Ninetysix isolates, 95 unidentified and one previously confirmed sabin poliovirus 3 recovered on rd. Most children with acute flaccid paralysis during the 2014 outbreak in the us had a febrile respiratory illness in the 2 weeks preceding the onset of the neurologic symptoms, which often included focal limb weakness and paralysis, and acute cranial nerve dysfunction. A practical approach to acute hemiparesis in children. Analysis of viral diversity in stool samples from infants. Apr, 2012 with virtual elimination of poliomyelitis, gbs has become the most common cause of acute flaccid paralysis in many parts of the world the overall prognosis of gbs is quite good, children with vital capacity approximately one half the normal value for age or. A 2yearold child with acute flaccid paralysis section 1 a 2yearold boy with a history of autism spectrum disorder and speech delay presented with refusal to walk for a day in late december 2014. Acute flaccid paralysis afp is a clinical syndrome characterized by rapid onset of weakness that involves the voluntary muscles and frequently includes respiratory and bulbar muscles. Encephalitis is a condition of inflammation of the brain parenchyma, occurs as a result of infectious or autoimmune causes, and can lead to encephalopathy, seizures, focal neurological deficits, neurological disability, and death. This abnormal condition may be caused by disease or by trauma affecting the nerves associated with the involved muscles. Protocol for afp surveillance certification polio free epidemiology clinical approach to children with afp how to differentiate.
The kennedy krieger foundation is a 501 c 3 nonprofit organization. Acute flaccid myelitis in a 10yearold girl radiology. Evolutionary phylogeography and transmission pattern of. Inclusion criteria for this study were the cdc case definition for confirmed or probable afm.
His history was remarkable for stereotyped episodes of flaccid quadriplegia or hemiplegia, oculomotor abnormalities, and limb or neck posturing, beginning in the first days of life and becoming more frequent and more prolonged over time. Practical approach to the patient with acute neuromuscular. Here is a case with afp presented to highlight the. The classic cause throughout history was poliomyelitis. Children with flaccid paralysis will have reduced muscle tone without any obvious cause such as trauma. A 10monthold with intermittent hypotonia and paralysis. Acute flaccid paralysis is defined as sudden onset of weakness a child less than 15 yrs of age or paralysis in a person of any age in whom polio is suspected. Afp is also associated with a number of other pathogenic agents including enteroviruses other than polio, echoviruses, west nile virus, and adenoviruses, among others. Acute flaccid paralysis afp is a common presentation to the emergency department. Definition sudden onset of weakness or paralysis over a period of 15 days in a patient aged less than 15 years age. In addition to leg weakness, he developed constipation and urinary retention for 2.
Investigation of acute flaccid myelitis in children, 2014 texas department of state health services. Polio outbreak investigation and response in somalia, 20 raoul kamadjeu. The mortality was 5 to 10% in the era of epidemics, and approached 50% for those. Approach to a child with acute flaccid paralysis article pdf available in the indian journal of pediatrics 7910. Acute hemiparesis in children is a clinical syndrome with diverse causes. Upper motor neuron signs of spasticity and hyperreflexia may not be apparent for many weeks. Sporadic cases of acute flaccid paralysis caused by a variety of other enteroviruses including coxsackie b3b4, west nile virus, and enterovirus d71 ev d71 continued to be reported in the literature 4, 5, 6, 7. Recovery is possible, and there is potential to make progress even years after your injury. Pdf approach to a child with acute flaccid paralysis pratibha. Acute flaccid paralysis afp is a clinical syndrome characterized by rapid onset of weakness due to various conditions and the term flaccid indicates lack of corticospinal tract signs on examination spasticity, hyperreflexia, and extensor. Afp is a challenging neurologic emergency in children characterized by abrupt onset of flaccid paralysis in one or more limbs. Acute inflammatory polyneuropathy classified according to symptoms and divided into axonal and demyelinating forms.
The need to investigate the contribution of nonpolio enteroviruses to acute flaccid paralysis afp cannot be over emphasized as we move towards a poliovirus free world. Acute muscle weakness in children is a pediatric emergency. The term acute flaccid paralysis afp is often used to describe a instance with a sudden onset, as might be found with polio afp is the most common sign of acute polio, and used for surveillance during polio outbreaks. Those skills are now supporting the final push against polio. Acute flaccid paralysis represents a syndromic diagnosis and can have an array of diagnostic possibilities. Acute neuromuscular paralysis is a clinical syndrome characterized by rapid onset muscle weakness progressing to maximum severity within several days to weeks. Pdf approach to a child with acute flaccid paralysis. An accurate and early diagnosis of the cause has important bearing on the management and prognosis. Acute flaccid paralysis is defined as sudden onset of weakness the new england journal of medicine. Sunit c singhi department of pediatrics, advanced pediatrics centre, post graduate institute of medical education and research pgimer, chandigarh 160012, india. Acute flaccid paralysis field manual who emro world health. As an umbrella term, it can be difficult to differentiate afm from other neurological disorders because of mimicking symptoms. Symposium on pgimer protocols in neurological emergencies approach to a child with acute flaccid paralysis sunit c.
Longterm followup of these patients is essential, because improvement in motor function may be prolonged, and is often incomplete. The term flaccid indicates the absence of spasticity or other signs of disordered central nervous system motor tracts such as hyperreflexia, clonus, or. Acute flaccid paralysis poliomyelitis medical specialties. Afm may resemble guillainbarre syndrome, acute transverse myelitis, adem, conversion disorder, stroke, tumor, cord compression, or limb injury. Defining acute flaccid paralysis afp is defined as a sudden onset of weakness and floppiness in any child aged under 15 years, or in a person of any age in whom a clinician suspects polio. Acute flaccid paralysis is a clinical syndrome characterized by rapidly evolving weakness, which may include respiratory and bulbar muscles. Total paralysis on one side of the body hemiparesis.
Polio outbreak investigation and response in somalia, 20. Just as critically, they also are trained to monitor for acute flaccid paralysis, a debilitating symptom that signals the presence of polio. The patient was healthy and developmentally normal between. Acute flaccid myelitis investigation, 2014 the texas department of state health services dshs is working with healthcare professionals, local health departments, and the centers for disease control and prevention cdc to. Acute flaccid paralysis afp is a clinical syndrome. Acute encephalitis in immunocompetent adults the lancet. Acute flaccid paralysis and its differential diagnosis in in. Approach to a child with acute flaccid paralysis springerlink.
The immediate priorities in a child who presents with acute progressive. Human coronaviruses cokyaman turgay 1, tekin emine 1, koken ozlem 2, s paksu muhammet 2, a tasdemir haydar 1 1 department of pediatrics, division of pediatric neurology, faculty of medicine, ondokuz mayis university, kurupelit, 559 samsun, turkey 2 department of pediatrics, pediatric intensive care unit, faculty of medicine, ondokuz mayis university. In addition to leg weakness, he developed constipation and urinary retention for 2 days. Twothirds have a history of gastroenteritis or influenzalike illness weeks before onset of neurologic symptoms. Jan 03, 20 the who has defined afp as any child under 15 years of age with acute onset of focal weakness or paralysis including gbs or any person with paralytic illness at any age when polio suspected, characterized by flaccid reduced tone, without other obvious causes e. Afm is categorized as a subtype of acute flaccid paralysis afp.
Longterm followup of these patients is essential, because improvement in motor function may be prolonged, and is often. Acute flaccid paralysis and enteroviral infections. Mar, 2015 guillainbarre syndrome it is an acute idiopathic acquired inflammatory demyelinating polyneuropathy. A 10monthold boy presented with a 1day history of flaccid quadriplegia and dysconjugate gaze. Molecular characterization of enterovirusa71 in children. Jul 12, 2012 acute flaccid paralysis afp is a clinical syndrome characterized by rapid onset weakness, that many times includes respiratory and bulbar weakness. Uttar pradesh 312 bihar 20 haryana 5 uttaranchal 5 madhya pradesh 2 maharashtra 2 chandigarh 1 delhi 1 gujarat 1 jharkhand 1 punjab 1 west bengal 1. Viral causes account for the largest proportion, but in the last decade there has been growing recognition of antineuronal antibody syndromes. Echovirus 14 e14 causes various clinical recognized syndromes, mostly with gastrointestinal syndrome and paralysis. It is defined as a sudden onset of paralysis or weakness in any part of the body of a child less than 15 years of age. Background the number of cases of paralytic poliomyelitis has declined in nigeria since the introduction of newly licensed monovalent oral poliovirus vaccines and new techniques of vaccine delivery.