Clinical profile of acute flaccid paralysis

Abstract

Background and Aim: 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. Materials and 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 analysis, and imaging. Results: Between July 2010 and September 2012, 106 cases of AFP were enrolled. The mean age in males was 40.2 years (standard deviation [SD] 17.1) and the mean age in females was 33.4 years (SD 14.1). Males constituted 57.5% (61/106) and females constituted 42.5% (45/106). 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 (AMAN) 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%). Most cases 42/106 (39.6%) were admitted during spring season. Conclusion: GBS was the most common cause of AFP in all age groups. Most AFP cases occurred during spring season. No case of polio myelitis was found.