Differential Diagnosis of Acute Flaccid Paralysis and its Role in Poliomyelitis Surveillance

Marx, Arthur; Glass, Jonathan D.; Sutter, Roland W.

doi:10.1093/oxfordjournals.epirev.a018041

Cited by 148 publications

(154 citation statements)

References 99 publications

(109 reference statements)

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“…21 A number of causes can bring about AFP, and GBS is the most frequently recognized clinical manifestation of AFP onset, particularly after the interruption of wild PV transmission. 23 Here, GBS was confirmed as the most common conclusive diagnosis linked to AFP; this is consistent with other findings reported in Italy 15,21,24 and in other countries such as South Africa and Hong Kong. 25,26 No wild PV were detected during this 4-year study supporting the epidemiological data deriving from AFPS at national level.…”

Section: Discussionsupporting

confidence: 92%

Surveillance of poliomyelitis in Northern Italy: Results of acute flaccid paralysis surveillance and environmental surveillance, 2012–2015

Pellegrinelli

Bubba

Prímache

et al. 2016

Human Vaccines & Immunotherapeutics

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Although in the last years poliovirus (PV) transmission has been reported at the lowest levels ever recorded, the spread of virus from endemic countries endures; the high levels of immigration flows across the Mediterranean Sea jeopardize Italy for PV reintroduction. The World Health Organization (WHO) strategic plan for global poliomyelitis (polio) eradication indicates the nationwide surveillance of Acute Flaccid Paralysis (AFP) as the gold standard for detecting cases of polio. In addition, the Environmental Surveillance (ES), seeking the presence of PV and Non-Polio Enterovirus (NPEV) in sewage, is recognized as a powerful tool to confirm PV circulation in absence of AFP cases, especially in polio-free countries. Here we report the results of AFP surveillance (AFPS) and ES in Lombardy (Northern Italy) from 2012 to 2015.Forty-eight AFP cases were identified during the study period. No AFP case was caused by PV infection. NPEVs were identified in 6.3% (3/48) of AFP cases. The annual AFP incidence rate was 0.87/100 0 000 children <15 y in 2012, 1.42/100 0 000 in 2013, 1.02/100 0 000 in 2014, and 0.47/100 0 000 in 2015; according to WHO indicators, the sensitivity of AFPS was adequate in 2013 and 2014. Completeness of case investigation raised progressively during the study period to achieve the WHO standards in 2014 (92.3%) and 2015 (100%). Completeness of follow-up increased from 72.7% in 2012 to 100% in 2014.In the framework of the ES conducted in Milan, 268 wastewater samples were collected from 2012 to 2015 and no PVs were isolated. In contrast, NPEVs were detected in 65.3% (175/268) of samples. All NPEVs characterized belonged to enterovirus species B: echovirus type 11, 6 and 3 were the most frequently detected viruses, representing 29.1% (41/141), 20.6% (29/141) and 9.2% (13/141) of genotyped NPEVs, respectively.Keeping strong and encouraging both AFPS and ES is crucial to ensure that PV will not return unnoticed in Italy -as well as in other polio-free countries -and, as a final point, to achieve the global polio eradication goal.

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Section: Discussionsupporting

confidence: 92%

Surveillance of poliomyelitis in Northern Italy: Results of acute flaccid paralysis surveillance and environmental surveillance, 2012–2015

Pellegrinelli

Bubba

Prímache

et al. 2016

Human Vaccines & Immunotherapeutics

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“…This fact includes rabies as a differential diagnosis of acute flaccid paralysis, although the disease does not appear in the epidemiological measures according to the Health Ministry. The diagnosis between the different causes of this syndrome is complex, but it is of tremendous importance for the prognosis and treatment of the patient, who may die in the absence of the correct diagnosis 24 .…”

Section: Discussionmentioning

confidence: 99%

Circulation of the rabies virus in non-hematophagous bats in the city of Rio de Janeiro, Brazil, during 2001-2010

Cabral¹,

Morais²,

Dias³

et al. 2012

Rev. Soc. Bras. Med. Trop.

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Introduction: Rabies is one of the most known lethal zoonosis, responsible for 55,000 human deaths per year. It is transmitted to humans mainly by the bite of domestic or wild animals infected with the virus. This paper shows the circulation of this virus in non-hematophagous bats in the City of Rio de Janeiro, Brazil. Methods: A survey was performed on the number of bats that had been sent for diagnosis by the Seção de Virologia of the Instituto Municipal de Medicina Veterinária Jorge Vaitsman and were positive for rabies. The positive animals were identified, and the isolated viruses were sent for antigenic typification with indirect immunofluorescence. The results were compared with the antigenic panel of the Centers for Disease Control and Prevention. Results: During 2001-2010, the laboratory received 555 non-hematophagous bats for rabies diagnosis, with 198 (35.7%) from Rio de Janeiro City. A total of 11 (5.5%) animals were positive for this disease. Antigenic typification revealed the predominance of variant 3 in 9 (81.8%) of the isolated viruses; 1 virus was classified as variant 4 and 1 variant was identified that segregated with the viruses in insectivorous bats. Conclusions: The data obtained in this study showed the presence of the rabies virus in synanthropic populations of non-hematophagous bats in the City of Rio de Janeiro. The circulation of this agent in these animals represents a serious risk to human and animal health and requires attention and control measures by the authorities.

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“…weakness of the muscles of respiration and swallowing, progressing to maximum severity within several days to weeks 1 . It is preferable to use the term "paresis" for slight loss of motor strength and "paralysis" or "plegia" for severe loss of motor strength …”

Section: Introductionmentioning

confidence: 99%

Acute flaccid paralysis: An approach to diagnosis

et al. 2017

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Acute flaccid paralysis (AFP) is a common presentation to the emergency department and can present with paralysis of single to several limbs. Here is a case with AFP presented to highlight the approach to diagnosis. A 25 years male who recently returned from Malaysia presented to the emergency ward with acute onset of paralysis for two days which was progressive and was gradually involving the chest muscles as well. He had a history of loose mucoid stool since 4-5 days but there were no rashes or exanthema in the body. On complete examination, apart from diminished power in all the limbs, there were no other positive findings. He was started on expectant management and no other medications except multivitamins were prescribed. Patient was discharged home on patient party's request and on follow-up after 14 days, patient's had improved.

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Differential Diagnosis of Acute Flaccid Paralysis and its Role in Poliomyelitis Surveillance

Cited by 148 publications

References 99 publications

Surveillance of poliomyelitis in Northern Italy: Results of acute flaccid paralysis surveillance and environmental surveillance, 2012–2015

Surveillance of poliomyelitis in Northern Italy: Results of acute flaccid paralysis surveillance and environmental surveillance, 2012–2015

Circulation of the rabies virus in non-hematophagous bats in the city of Rio de Janeiro, Brazil, during 2001-2010

Acute flaccid paralysis: An approach to diagnosis

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