Nonpolio causes of polio-like paralytic syndromes

In a study of patients with suspected poliomyelitis, but from whom poliovirus was not isolated, a variety of causes of the paralysis was found. Injury of the spinal column sometimes followed by periostitis or osteomyelitis was relatively common. Exotic causes included paralysis due to snake bite, spider bite, scorpion sting, and tick bite and schistosomiasis involving the spinal cord. Chemical poisons, such as arsenic, triorthocresyl phosphate, and organophosphorus insecticides, were responsible for paralysis affecting groups of people. Paralysis in individual patients with porphyria followed the administration of anesthesia and certain drugs. Normal clinicopathologic findings in hospital nurses with Iceland disease suggested a psychological component. The Guillain-Barré syndrome in some patients resulted from virus infection of the nerve tissue, in others it was related to a hyperreactive autoallergic state. Enterovirus infections, especially coxsackieviruses A9 and A23 (echovirus 9) and group B coxsackieviruses, frequently caused meningoencephalitis often associated with transient paralysis. Coxsackievirus A7 infection occasionally resulted in permanent paralysis. Clearly it is important to maintain surveillance of these infections.