7/14/2015

The Great U.S. Polio Panic of 2015




A new virus in the same family as polio may have caused one of the 100 mystery paralysis cases. The panic that’s resulted from this case study is missing the point: No one has polio.

When children come down with an illness that renders them temporarily paralyzed, public health officials tend to want to know why.
In 2014, there was a nationwide outbreak of a viral illness known as enterovirus D68. Part of a family of viruses that often spread during the summer, this particular outbreak caused  in thousands (possibly millions) of children across the country, in many cases quite severe. Around the same time, a number of children were afflicted with some form of paralysis, leading to concern that the two phenomena were connected. This connection was not firmly established at the time, though ultimately over 100 children were affected.
A new case study reported in the journal Emerging Infectious Diseases suggests that a different virus may have been responsible for at least one case of virally-induced paralysis. Researchers from the University of Virginia School of Medicine describe the case of a 6-year-old girl who was admitted to their medical center with weakness of her right arm in fall of last year. These symptoms had been preceded by a mild upper respiratory illness, with low fever, cough, and runny nose. Shortly before she started having trouble moving her right arm, she also had pain in the limb and under the arm.
When a sample taken from the back of her nose was analyzed, it came back positive for the enterovirus C105. Though from the same family as the virus that caused the outbreak of respiratory illnesses last year, this virus is different.
As the authors of the study note, enterovirus C105 was first detected five years ago in patients from both South America and Africa. Though it is newly discovered, thus far most identified infected patients have had some kind of respiratory illness. However, for some patients in the Congo, it was associated with fatal flaccid paralysis.
Though the symptoms some of the paralyzed patients experienced last year were polio-like, and the poliovirus is part of the same family of viruses as this new virus, it is important to note that these patients did not have polio. That illness, which caused paralysis in tens of thousands of patients in the middle of the past century (PDF), is nearing worldwide eradication thanks to a vigilant vaccination campaign. Children who came down with a paralytic illness last year weren’t infected with a vaccine-preventable illness.
In the case of the girl in Virginia, after several months she had made a near-complete recovery. Whether or not enterovirus C105 was responsible for any of the other cases of paralysis in children last year has not been established. However, there also appears to be little evidence linking the outbreak of the respiratory infection to those cases, either. Of 41 patients tested for enterovirus D68, only eight were positive, and no patients were found to have that virus in their spinal fluid. Though the authors cannot totally exclude the possibility that the D68 strain had also infected the patient they describe, they note that there was no outbreak of that illness in Virginia in 2014.
Whatever the cause of the paralytic illness in children last summer, there is no cause for anyone to be alarmed now. While it’s important to determine as best as possible what causes any illness that threatens public health, and the appearance in this country of a virus previously only identified in patients on other continents is an interesting development, it was only confirmed in one patient. While vigorously knocking on wood, I note that this summer has thus far been free of another outbreak of either form of enterovirus.
But even if enterovirus C105 never causes another illness in the United States, it’s good to be closer to an answer as to what paralyzed over 100 children last year. While the Ebola scare dominated the headlines at the time, these illnesses actually affected many more people in this country. This new case report may be an important clue in figuring out why.

Post Polio Litaff, Association A.C _APPLAC Mexico

The Polio Crusade

THE POLIO CRUSADE IN AMERICAN EXPERIENCE A GOOD VIDEO THE STORY OF THE POLIO CRUSADE pays tribute to a time when Americans banded together to conquer a terrible disease. The medical breakthrough saved countless lives and had a pervasive impact on American philanthropy that ... Continue reading..http://www.pbs.org/wgbh/americanexperience/polio/

Erradicación de La poliomielitis

Polio Tricisilla Adaptada

March Of Dimes Polio History

Dr. Bruno

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A 41-year-old man developed an acute illness at the age of 9 months during which, following a viral illness with headache, he developed severe weakness and wasting of the limbs of the left side. After several months he began to recover, such that he was able to walk at the age of 2 years and later was able to run, although he was never very good at sports. He had stable function until the age of 18 when he began to notice greater than usual difficulty lifting heavy objects. By the age of 25 he was noticing progressive difficulty walking due to weakness of both legs, and he noticed that the right calf had become larger. The symptoms became more noticeable over the course of the next 10 years and ultimately both upper as well as both lower limbs had become noticeably weaker.

On examination there was wasting of the muscles of upper and lower limbs on the left, and massively hypertrophied gastrocnemius, soleus and tensor fascia late on the right. The calf circumference on the right exceeded that on the left by 10 cm (figure1). The right shoulder girdle, triceps, thenar eminence and small muscles of the hand were wasted and there was winging of both scapulae. The right quadriceps was also wasted. The wasted muscles were also weak but the hypertrophied right ankle plantar flexors had normal power. The tendon reflexes were absent in the lower limbs and present in the upper limbs, although the right triceps was reduced. The remainder of the examination was normal.

Figure 1

The patient's legs, showing massive enlargement of the right calf and wasting on the left

Questions

1
What is that nature of the acute illness in infancy?
2
What is the nature of the subsequent deterioration?
3
What investigations should be performed?
4
What is the differential diagnosis of the cause of the progressive calf hypertrophy?

Answers

QUESTION 1

An acute paralytic illness which follows symptoms of a viral infection with or without signs of meningitis is typical of poliomyelitis. Usually caused by one of the three polio viruses, it may also occur following vaccination and following infections with other enteroviruses.1 Other disorders which would cause a similar syndrome but with upper motor neurone signs would include acute vascular lesions, meningoencephalitis and acute disseminated encephalomyelitis.

QUESTION 2

A progressive functional deterioration many years after paralytic poliomyelitis is well known, although its pathogenesis is not fully understood.2 It is a diagnosis of exclusion; a careful search for alternative causes, for example, orthopaedic deformities such as osteoarthritis or worsening scoliosis, superimposed neurological disorders such as entrapment neuropathies or coincidental muscle disease or neuropathy, and general medical causes such as respiratory complications and endocrinopathies.3

QUESTION 3

Investigations revealed normal blood count and erythrocyte sedimentation rate and normal biochemistry apart from a raised creatine kinase at 330 IU/l (normal range 60–120 IU/l), which is commonly seen in cases of ongoing denervation. Electromyography showed evidence of denervation in the right APB and FDI with polyphasic motor units and complex repetitive discharges, no spontaneous activity in the left calf and large polyphasic units in the right calf consistent with chronic partial denervation. Motor and sensory conduction velocities were normal. A lumbar myelogram was normal. Magnetic resonance imaging (MRI) scan of the calves is shown in figure2.

Figure 2

Axial T1 weighted MRI scan (TR 588 ms, TE 15 ms) of the calves, showing gross muscle atrophy and replacement by adipose tissue on the left, and hypertrophy of the muscles on the right, with only minor adipose tissue deposition

QUESTION 4

The differential diagnosis of the progressive calf hypertrophy is given in the box.

Causes of calf muscle hypertrophy

Chronic partial denervation

  • radiculopathy

  • peripheral neuropathy

  • hereditary motor and sensory neuropathy

  • spinal muscular atrophy

  • following paralytic poliomyelitis

    Neuromyotonia and myokymia

  • Isaac's syndrome

  • generalised myokymia

  • neurotonia

  • continuous muscle fibre activity due to: chronic inflammatory demyelinating polyradiculopathy, Guillain Barre syndrome, myasthenia gravis, thymoma, thyrotoxicosis, thyroiditis

    Muscular dystrophies

    Myositis

    Infiltration

  • tumours

  • amyloidosis

  • cysticercosis

    Link here