Re: India - Acute Flaccid Paralysis 2014
Mosquito-borne virus shows polio-like symptoms
Umesh Isalkar,TNN | Jun 14, 2014, 05.31 AM IST
PUNE: Two months after the country earned its polio-free tag, a mosquito has emerged as a fresh concern. Mosquito-borne West Nile virus has been found to be causing acute flaccid paralysis (AFP), the main symptom of poliomyelitis, for the first time in India. The symptom is the most common sign of acute polio and is used for surveillance during polio outbreaks.
However, unlike polio which is a childhood disease, West Nile induced AFP is seen in adults. So, the finding is not going to undermine the success of polio-free certification, say researchers, but is still reason for concern. Nationwide AFP surveillance is the gold standard to detect polio cases.
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The case reports of three patients, all in the age bracket of 42 to 55 years, have the doctors flummoxed. The three patients were suffering from extreme muscle weakness of limbs, reduced muscle tone, impaired breathing and fever which are primarily the characteristics of polio.
Only after running blood tests and performing a battery of radiology tests that record activity in nerves and in spinal cord cells, did the doctor reach their diagnosis: AFP caused by West Nile virus.
"Previously, severe cases of West Nile had been characterised by meningitis and encephalitis, the brain swelling that is regarded as the most serious consequence of the virus. But the muscle weakness and other problems associated with AFP were not evident," said Arunkumar.
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http://timesofindia.indiatimes.com/...-polio-like-symptoms/articleshow/36517803.cms
CASE REPORT
Year : 2014 | Volume : 17 | Issue : 1 | Page : 85-88
Acute flaccid paralysis due to West nile virus infection in adults: A paradigm shift entity
Boby Varkey Maramattom1, Geetha Philips2, Nittur Sudheesh3, Govindakarnavar Arunkumar3
1 Department of Neurology, Lourdes Hospital, Kochi, Kerala, India
2 Department of Internal Medicine, Lourdes Hospital, Kochi, Kerala, India
3 Manipal Centre for Virus Research (ICMR Virus Diagnostic Laboratory-Grade-I), Manipal University, Madhavnagar, Manipal, Karnataka, India
Date of Submission 22-Jun-2013
Date of Decision 03-Aug-2013
Date of Acceptance 12-Aug-2013
Date of Web Publication 12-Mar-2014
Correspondence Address:
Boby Varkey Maramattom
Department of Neurology, Lourdes Hospital, Kochi, Kerala- 682 006
India
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DOI: 10.4103/0972-2327.128561
PMID: 24753667
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Abstract
Three cases of acute flaccid paralysis (AFP) with preceding fever are described. One patient had a quadriparesis with a florid meningoencephalitic picture and the other two had asymmetric flaccid paralysis with fasciculations at the onset of illness. Magnetic resonance imaging in two cases showed prominent hyperintensitities in the spinal cord and brainstem with prominent involvement of the grey horn (polio-myelitis). Cerebrospinal fluid (CSF) polymerase chain reaction was positive for West Nile virus (WNV) in the index patient. All three cases had a positive WNV immunoglobulin M antibody in serum/CSF and significantly high titer of WNV neutralizing antibody in serum, clearly distinguishing the infection from other Flaviviridae such as Japanese encephalitis. WNV has been recognized in India for many decades; however, AFP has not been adequately described. WNV is a flavivirus that is spread by Culex mosquitoes while they take blood meals from humans and lineage 1 is capable of causing a devastating neuro-invasive disease with fatal consequences or severe morbidity. We describe the first three laboratory confirmed cases of WNV induced AFP from Kerala and briefly enumerate the salient features of this emerging threat.
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Maramattom BV, Philips G, Sudheesh N, Arunkumar G. Acute flaccid paralysis due to West nile virus infection in adults: A paradigm shift entity. Ann Indian Acad Neurol [serial online] 2014 [cited 2014 Jun 14];17:85-8. Available from:
http://www.annalsofian.org/text.asp?2014/17/1/85/128561
