ACUTE FLACCID PARALYSIS

P3 UNIT

Story ends with her…

Jan 13,2011Shahapar village, west bengal

Rukhsar katoon

Poliomyelitis 27-march-2014

“Sudden onset of weakness and floppiness in any part of the body in a child <15 yrs old or paralysis in a person of any age whom polio is suspected.”

-Global polio eradication initiative,41st World health assembly ,may 1988

AFP

DIFFERENTIAL DIAGNOSIS

Muscle disorders

Neuromuscular junction disorders

Neuropathies

Anterior horn cell disorders

Spinal cord disease

MUSCLE DISORDERS

Inflammatory myopathyInfections

hypokalemia

NEUROMUSCULAR JUNCTION DISORDERS

MYASTHENIA GRAVIS

NEUROMUSCULAR JUNCTION DISORDERS

LEMS

NEUROPATHIES

GBS

NEUROPATHIES

POSTDIPHTHERIC NEUROPATHY

PORPHYRIA

VASCULITIS

ANTERIOR HORN CELL DISORDERS

SPINAL CORD DISEASE

COMMON CAUSES

PoliomyelitisGBSTM

Traumatic neuritis

AFP SURVEILLANCE Every case within last 6 month reported

1. Isolated facial palsy 6.Flaccid hemiplegia

2. Isolated bulbar palsy 7.Encephalitis3. unproved hypokalemia 8.Postictal

weakness4. Neck flop 9.Postdiphtheric

polyneuritis5. Floppy baby

AFP SURVEILLANCE

Within 14 days

2 samples

AFP SURVEILLANCE

Voided stool sample

Digital extraction

Postmortem stool collection

AFP SURVEILLANCE

RD cell line

L20B cell line

L20B

Poliomyelitis

Poliovirus-Enterovirus-Picornaviridae

EPIDEMIOLOGY

Seasonal?Route?Reservoir?Endemic?

PATHOGENESISVirus ingested through mouth

Peyer’s patches of ileum

Blood stream

Primary viremia

RES

Blood stream

Secondary viremia

CNS

CLINICAL FEATURES Inapparent : 90-95 %

Abortive polio

Nonparalytic aseptic meningitis

Paralytic poliomyelitis

Polio encephalitis

5-10 %

ABORTIVE POLIO

NON PARALYTIC ASEPTIC MENINGITIS

PARALYTIC POLIOMYELITIS

SPINAL PARALYTIC POLIOMYELITIS

POLIO ENCEPHALITIS

Seizures+

Irritation+ DELIRIUM+

RESIDUAL PARALYSIS

DIAGNOSIS

TREATMENT

OPV VACCINE

TRANSVERSE MYELITIS

?

POLIOMYELITIS TRANSVEERSE MYELITIS

Fever Present Prodromal illness

Symmetry Asymmetric Symmetrical

Sensations Intact Impaired

Resp.insufficiency May be present May be present

Cranial nerves Affected in bulbar & bulbospinal

Not affected

POLIOMYELITIS TRANSVEERSE MYELITIS

Bladder, bowel complaints

Absent Present

Nerve conduction May be abnormal Normal

CSF Lymphocytic pleocytosis, normal or

increased protein

Variable

MRI spine Normal Local enlargement of spinal cord

Definition

Differential diagnosis

AFP surveillance

Poliomyelitis

Transverse myelitis

Thank you