CLINICAL AND ETIOLOGICAL PROFILE OF ACUTE FLACCID PARALYSIS IN CHILDREN
DOI:
https://doi.org/10.22159/ajpcr.2023.v16i7.46797Keywords:
Acute flaccid paralysis, Guillain-Barré syndrome, Nerve conduction velocityAbstract
Objective: This study was conducted to determine the clinical characteristics and differential diagnosis of individual cases of acute flaccid paralysis (AFP) reporting to tertiary care teaching hospital of Jaipur.
Methods: This prospective observational study was conducted among patients attending outdoor, indoor, and neurology clinics with provisional diagnosis of AFP. The diagnosis was based on the available clinical data, vaccination status, and laboratory results (stool examination, arterial blood gas analysis, thyroid profile, serum electrolytes, electrophysiological studies, cerebrospinal fluid analysis, urinary pH, and imaging).
Results: A total of 60 patients were evaluated over a study duration of 1 year. About 81.7% were male. Most common presenting complaint was lower-limb weakness (100%). None of the cases were identified as acute poliomyelitis or polio-compatible. Guillain–Barré syndrome (GBS) was the most common cause of non-poliovirus AFP (75%). Most common nerve conduction velocity findings in our study were bilateral motor axonal affection of common peroneal nerve (55%).
Conclusion: The most common cause of AFP was GBS in all age groups. No case was diagnosed as poliomyelitis. All of the patients of GBS had progressive muscle weakness in a roughly symmetrical distribution, with areflexia of lower limbs.
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References
World Health Organization. Acute Onset Flaccid Paralysis. WHO/ MNH/EPI/93.3. Geneva: World Health Organization; 1993.
Marx A, Glass JD, Sutter RW. Differential diagnosis of acute flaccid paralysis and its role in poliomyelitis surveillance. Epidemiol Rev 2000;22:298-316. doi: 10.1093/oxfordjournals.epirev.a018041, PMID 11218380
Ahmad A, Rehman A. One year surveillance data of acute flaccid paralysis at Bahwal Victoria Hospital Bahawalpur. Pak J Med Sci 2007;23:308-12.
Alcalá H. The differential diagnosis of poliomyelitis and other acute flaccid paralyses. Bol Med Hosp Infant Mex 1993;50:136-44. PMID 8442872
Hussain IH, Ali S, Sinniah M, Kurup D, Khoo TB, Thomas TG, et al. Five-year surveillance of acute flaccid paralysis in Malaysia. J Paediatr Child Health 2004;40:127-30. doi: 10.1111/j.1440-1754.2004.00312.x, PMID 15009577
Morris AM, Elliott EJ, D’Souza RM, Antony J, Kennett M, Longbottom H. Acute flaccid paralysis in Australian children. J Paediatr Child Health 2003;39:22-6. doi: 10.1046/j.1440-1754.2003.00065.x, PMID 12542807
Fawole OI. Acute Flaccid Paralysis. In: A Proceeding of Oluwaseun Physiotherapy Forum, Ibadan, Nigeria; 2003.
Jasem JA, Marof K, Nawar A, Khalaf Y, Al-Hamdani F, Ali S, et al. An epidemiological analysis of acute flaccid paralysis and its surveillance system in Iraq, 1997-2011. BMC Infect Dis 2014;14:448. doi: 10.1186/1471-2334-14-448, PMID 25141887
Van Haren K, Ayscue P, Waubant E, Clayton A, Sheriff H, Yagi S, et al. Acute flaccid myelitis of unknown etiology in California, 2012- 2015. JAMA 2015;314:2663-71. doi: 10.1001/jama.2015.17275, PMID 26720027
Messacar K, Schreiner TL, Van Haren K, Yang M, Glaser CA, Tyler KL, et al. Acute flaccid myelitis: A clinical review of US cases 2012-2015. Ann Neurol 2016;80:326-38. doi: 10.1002/ana.24730, PMID 27422805
Chong PF, Kira R, Mori H, Okumura A, Torisu H, Yasumoto S, et al. Clinical features of acute flaccid myelitis temporally associated with an enterovirus D68 outbreak: Results of a nation-wide survey of acute flaccid paralysis in Japan, August-December 2015. Clin Infect Dis 2018;66:653-64. doi: 10.1093/cid/cix860, PMID 29028962
Knoester M, Helfferich J, Poelman R, Van Leer-Buter C, Brouwer OF, Niesters HG, et al. Twenty-nine cases of enterovirus-D68 associated acute flaccid myelitis in Europe 2016: A case series and epidemiologic overview. Pediatr Infect Dis J 2019;38:16-21. doi: 10.1097/INF.0000000000002188, PMID 30234793
Ali S, Rehman MZ, Sultan T. Spectrum of acute flaccid paralysis in children. Pak J Neurol Sci 2016;14:8-11.
Shah FU, Salih M, Malik IA. Clinical evaluation of patients with acute flaccid motor weakness. Pak J Med Res 2002;41:58-63.
Sharma KS, Singh R, Shah GS. Guillain Barre syndrome: Major cause of acute flaccid paralysis in children and adolescents of Nepal. J Nepal Paediatr Soc 2011;31:93-7. doi: 10.3126/jnps.v31i2.4065
Jasem J, Marof K, Nawar A, Khalaf Y, Aswad S, Hamdani F, et al. Guillain-Barre Syndrome as a cause of acute flaccid paralysis in Iraqi children: A result of 15 years of nation-wide study. BMC Neurol 2013;13:195. doi: 10.1186/1471-2377-13-195, PMID 24325332
Dave H, Parikh N, Makwana AM. Clinical profile and outcome of “Acute Flaccid Paralysis’ in children admitted to K.T. Children Hospital, Rajkot. IOSR J Dent Med Sci (IOSR-JDMS) 2018;17:32-6.
Sutay NR, Sawant TL. Clinicoetiological study of acute flaccid paralysis in children under 15 years age group. J Med Sci Clin Res 2019;7:980-4. doi: 10.18535/jmscr/v7i7.173
Mohsin N, Asimi R. Clinical profile of acute flaccid paralysis: A study from a tertiary care centre in Kashmir, India. Ann Niger Med 2016;10:24-9. doi: 10.4103/0331-3131.189805
Saraswathy TS, Zahrin HN, Apandi MY, Kurup D, Rohani J, Zainah S, et al. Acute flaccid paralysis surveillance: Looking beyond the global poliomyelitis eradication initiative. Southeast Asian J Trop Med Public Health 2008;39:1033-9. PMID 19062691
Memon IA, Jamal A, Arif F, Murtaza G. Causes of non-polio AFP in children residing in the province of Sindh. Med Channel 2010;16:357-61.
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