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[The differential diagnosis of poliomyelitis and other acute flaccid paralyses]
1Departamento de Neurología, Hospital Infantil de México Federico Gómez, D.F.
Abstract:
Between June 1988 to January 1991 a total of 246 children with acute flaccid paralysis (AFP) were seen at Hospital Infantil de México, Federico Gómez which was the center of study for AFP for the Poliomyelitis Eradication Program of Mexico. Of the 246 children, 42 has poliomyelitis (17%); 156 has Guillain-Barré syndrome (GBS) (63.4%); 16 had traumatic neuritis of the sciatic nerve secondary to IM injections (TNC) (6.5%); five had transverse myelitis (2%); the rest (27) had other diseases misdiagnosed as polio (10.9%). The basic clinical characteristics for the diagnosis of poliomyelitis are: myalgias and fever at the onset AFP, paralysis is asymmetrical, of distal predominance and causes severe muscular atrophy and skeletal deformities; the GBS presents as an ascending, symmetrical, areflexic paralysis of distal predominance. It does not causes atrophy or deformities. TNC presents several days after IM injections with pain and hypothermia in the affected limbs; TM is a flaccid, symmetrical paraparesis with neurogenic bladder and a sensory level. CSF and neurophysiological studies (EMG and NCV) are very useful for diagnosis. Other entities misdiagnosed as poliomyelitis were: osteoarticular trauma, myopathies and dystrophies, viral myositis, acute cerebellitis, retroperitoneal tumors and upper motor neuron syndromes. Viral studies in stool specimens are essential for the diagnosis of poliomyelitis.
Insights
This study analyzed 246 children with acute flaccid paralysis (AFP), finding Guillain-Barré syndrome (GBS) was most common, not poliomyelitis. Accurate diagnosis is crucial for effective treatment and eradication programs.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Epidemiology
Context:
- A tertiary pediatric hospital served as the central hub for acute flaccid paralysis (AFP) diagnosis in Mexico's Polio Eradication Program.
- The study period spanned from June 1988 to January 1991, encompassing 246 pediatric cases presenting with AFP.
Purpose:
- To differentiate poliomyelitis from other causes of acute flaccid paralysis (AFP) in children.
- To evaluate the diagnostic utility of clinical characteristics, cerebrospinal fluid (CSF) analysis, and neurophysiological studies (EMG, NCV).
Summary:
- Out of 246 children with AFP, only 17% had poliomyelitis; 63.4% had Guillain-Barré syndrome (GBS), 6.5% had traumatic neuritis (TNC), and 2% had transverse myelitis (TM).
- Key clinical distinctions include asymmetrical paralysis with atrophy in polio versus ascending symmetrical paralysis in GBS.
- Other misdiagnosed conditions included trauma, myopathies, viral myositis, and neurological syndromes. Stool viral studies are essential for confirming polio.
Impact:
- Highlights the importance of distinguishing GBS from polio, as GBS is the leading cause of AFP in this cohort.
- Emphasizes the need for comprehensive diagnostic approaches, including clinical evaluation and laboratory testing, to ensure accurate diagnosis of AFP.
- Informs public health strategies for polio eradication by identifying challenges in differential diagnosis and the prevalence of other neurological conditions mimicking polio.