Acute flaccid paralysis

Linus is a 10 year-old boy; he was admitted in our hospital on 24^th May 2011 for acute flaccid paralysis of both lower limbs.

The problem started very suddenly: actually the child had some dullness at the legs the day before the symptoms started, followed by inability to stand the day after.

There was no history of trauma, neither history of previous treatment for a condition similar to this at the past medical history.

The child is well oriented in space.

At the observation of the CNS (central nervous system) the sensory was normal, the deep tendon reflexes were reduced at lower and upper limbs. We have visited him for the motor part of the CNS: the power was grade 2 at the lower limbs and grade 3 at the upper limbs. We have also been thinking of the possibility of a malignancy and we have done an abdominal U/S, thinking of possible abdominal lymphoma. The U/S was normal.

According to the vaccination history the child was fully immunized, and this makes it more unlikely but not impossible to be a case of acute polio.

We have therefore informed the public health authorities about the acute flaccid paralysis. In cases like these we are supposed to report the condition immediately, to collect stool samples and to store them in the fridge at vaccine temperature up to when the officials from the government come to collect them, in order to transport them to Nairobi where vilological tests are performed (Viral culture and typing).

The condition of the patient seems worsening, and since yesterday we have observed quadriparesis. Today Linus shows also weakness of the neck, and of the tongue. It is now very difficult for him to move any part of the body, the breathing is superficial and he is not able to cough. There is high fever reaching up to 39⁰C.

The condition is still unclear to us. To some extent it is similar to what happened to Naomi who became paralyzed in one night, was quadriparetic for a while and then improved again without anyway getting back the possibility of walking.

At the moment I think of poliomyelitis although the history of vaccination seems to prove otherwise: but the history was given orally by the father and we are not sure all the boost doses have been administered. We will wait for the virological tests for a correct diagnosis. For now the most important thing is to keep the boy alive: in fact the ascending trend of the paralysis now involving also the chest and the neck makes him at risk of death due to respiratory arrest.

If it is actually polio we will classify it as paralytic poliomyelitis which is very severe and rare (about 0.5% of infections).

Br. Dr. Giuseppe Gaido