How much of “poliomyelitis” has always been misdiagnosed?  - SM

Imunization Newsbriefs

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March 16, 2001

 

“Coxsackie Virus A24 Infection Presenting as Acute Flaccid Paralysis” Lancet (www.thelancet.com) (02/24/01) Vol. 357, No. 9256, P. 605;

Chaves, S.S.; Lobo, S.; Kennett, M.; et al.

In regions where the wild-type poliovirus has been eliminated, a significant cause of acute flaccid paralysis (AFP) has been attributed to non-polio enteroviruses that can be associated with outbreaks of a paralytic disease that clinically exhibits like poliomyelitis.  The most common non-polio enteroviruses relative to paralytic disease are coxsackie virus A7 and A9 and enterovirus 71.  Coxsackie virus A24 is not associated with AFP, but is related to the common cold and infantile diarrhea.  Between 1969 and 1970, AFP was known to cause large outbreaks of acute hemorrhagic conjunctivitis in southeast Asia and the Indian subcontinent.  In September 1999, the World Health Organization was alerted to 21 possible cases of AFP over a period of seven months as political changes and violence raged in East Timor.  Thirteen of the cases were of children under five years of age who were in transit from the mountains or western refugee camps or leaving to settle in remote areas.  Because of the instability of this region, it is not possible to document a specific AFP rate for East Timor, and only two cases could be finally confirmed as AFP.  During the same period of time, neighboring Indonesia reported an AFP rate of 0.84 per 100,000 per year.  In January 2000, a four-year old boy with flaccid paralysis of both legs was discovered in central Dili.  The boy had been well until mid-December when he developed non-specific upper respiratory symptoms followed by rapid onset of paralysis.  Ninety days later, the boy had recovered completely without neurological sequelae.  Stool samples taken from the boy collected 24 hours apart three weeks after the onset of paralysis tested negative for polioviruses, but further testing identified the isolates for coxsackie virus A24.  It is not known whether the outbreak of AFP in East Timor is associated with several infectious agents or solely with coxsackie A24, because the unusual population movements in the region would have disseminated the agents.  This was the first discovery of an association of coxsackie A24 and a paralytic disease.  In conclusion, the authors note that “the possibility of an agent such as coxsackie virus A24 causing outbreaks of AFP emphasizes the importance of a better understanding of the epidemiology of paralysis in areas where poliomyelitis has been eradicated.”

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