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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