Clinical profile of acute flaccid paralysis

Abstract

Background and Aims: As a part of the Global Polio Eradication program by the World Health Organization (WHO, 1988), surveillance of acute flaccid paralysis (AFP) was an important public health activity in many countries. With nearing eradication of poliomyelitis, other causes of AFP are gaining importance in both children and adults. Our study was designed to know the clinical characteristics and differential diagnosis of causes of AFP, including distribution by age, gender, and time. This was a prospective observational study. Methods: AFP cases were diagnosed on history and physical examination. The underlying etiology was ascertained by appropriate laboratory investigations such as arterial blood gas analysis, urinary pH, electrolytes, thyroid profile, electrophysiological studies, cerebrospinal fluid (CSF) analysis, and imaging. Results: Between July 2010 and September 2012, 106 cases of AFP were enrolled in the study. The mean age of males was 40.2 years (standard deviation [SD] 17.1) and the mean age of females was 33.4 years (SD 14.1). Of 106 patients, 61 (57.5%) were male and 45 (42.5%) were female. Out of 106 patients, 58 (54.7%) were suffering from Guillain-Barre' syndrome (GBS), 15 (14.2%) from hypokalemic paralysis, 8 (7.5%) from myasthenia gravis, 8 (7.5%) from thiamine deficiency, 5 (4.7%) from transverse myelitis, and 2 (1.9%) from cord compression. Other diagnoses include acute motor axonal neuropathy 3 (2.8%), acute disseminated encephalomyelitis 2 (1.9%), meningoencephalitis 2 (1.9%), diabetic polyneuropathy 2 (1.9%), and chemotherapy-induced neuropathy 1 (0.9%). Of 106 patients, 42 (39.6%) were admitted during the spring season. Conclusion: GBS was the most common cause of AFP in all age groups. Most AFP cases occurred during the spring season. No case of poliomyelitis was found.