DrHanisah'sNotes

1. ACUTE
FLACCID
PARALYSIS
by Nur Hanisah Zainoren(062)

2. ACUTE
FLACCID
PARALYSIS
Rapid in onset

3. ACUTE
FLACCID
PARALYSIS
Drooping
without spasticity

4. ACUTE
FLACCID
PARALYSIS
Loss of ability to
move a body part

5. What is AFP?

6. What is AFP?
a clinical syndrome

7. What is AFP?
a clinical syndrome
characterized by
rapid onset of weakness including
(less frequently) weakness of the muscles of
respiration & swallowing
progressing to maximum severity within
several days to weeks

8. What is AFP?
In Global Polio Eradication Initiative, AFP is defined as
any case of AFP in a child aged <15 yr
or
any case of paralytic illness in any person
of any age when polio is suspected

9. “Result from
involvement at any point
in the motor unit”
Common causes
of AFP:
Nonpolio
enteroviral
illnesses
Guillain-Barré
syndrome
Poliomyelitis
Transverse
myelitis
Traumatic
neuritis
Postdiphteric
neuropathy

10. “Result from
involvement at any point
in the motor unit”
Common causes
of AFP:
Nonpolio
enteroviral
illnesses
Guillain-Barré
syndrome
Poliomyelitis
Transverse
myelitis
Traumatic
neuritis
Postdiphteric
neuropathy

11. Caused by the destruction of myelin
(demyelination)
Common cause of AFP in children
Guillain-Barré Syndrome

13. “Result from
involvement at any point
in the motor unit”
Common causes
of AFP:
Nonpolio
enteroviral
illnesses
Guillain-Barre
syndrome
Poliomyelitis
Transverse
myelitis
Traumatic
neuritis
Postdiphteric
neuropathy

14. Poliomyelitis
 Highly infectious viral
disease, which mainly
affects young children.
 Viral transmitted mainly
through the faecal-oral
route  multiplies in the
intestine  invade the
nervous system  cause
paralysis.
 There is no cure for polio, it
can only be prevented by
immunization.

15. • Initial symptoms of polio include
 Fever
 Fatigue
 Headache
 Vomiting
 Stiffness in the neck
 Pain in the limbs
 In a small proportion of cases, the disease causes
paralysis, which is often permanent.

16. “Result from
involvement at any point
in the motor unit”
Common causes
of AFP:
Nonpolio
enteroviral
illnesses
Guillain-Barre
syndrome
Poliomyelitis
Transverse
myelitis
Traumatic
neuritis
Postdiphteric
neuropathy

17. Transverse Myelitis
• disorder caused by inflammation of the spinal
cord
• Characterized by symptoms and signs of
neurologic dysfunction in motor and sensory
tracts on both sides of the spinal cord.
• Produce altered sensation, weakness and
sometimes urinary or bowel dysfunction.

18. Transverse Myelitis
• disorder caused by inflammation of the spinal
cord
Characterized by symptoms and signs of
neurologic dysfunction in motor and sen
tracts on both sides of the spinal cord.
duce altered sensation, weakness and
sometimes urinary or bowel dysfunction.

19. • The cause of 60% of TM
cases may remain unknown
• However, the remaining
40% is associated with
autoimmune disorder such
as:
– multiple sclerosis
– neuromyelitis optica
– systemic lupus erythematous
– Sjogren’s syndrome
– sarcoidosis

20. four classic symptoms of transverse myelitis:
• weakness in the arms/legs
• sensory symptoms such as numbness or
tingling
• pain and discomfort
• bladder dysfunction and/or bowel motility
problems

21. “Result from
involvement at any point
in the motor unit”
Common causes
of AFP:
Nonpolio
enteroviral
illnesses
Guillain-Barre
syndrome
Poliomyelitis
Transverse
myelitis
Traumatic
neuritis
Postdiphteric
neuropathy

22. Traumatic neuritis
• Inflammation of a nerve following an injury.
• Sciatic nerve injury leading to paralysis of the foot
and permanent sequelae following intramuscular
injection in the gluteal region has been
recognised since long
• 75% of polio cases have received injections for
fever with paralysis following from 24-48 hours
later.

24. Rationale
Poliomyelitis is targeted for eradication
Highly sensitive surveillance including immediate
case investigation and specimen collection are
critical for the detection of wild poliovirus
circulation
Critical for documenting the absence of poliovirus
circulation for polio-free certification

25.  All patients with acute flaccid paralysis should be reported
to Surveillance Medical Officer of World Health
Organization.
 Every case of AFP within the last 6 months has to be
reported
 Additionally, other conditions which need notification are:
• Isolated facial palsy
• Isolated bulbar palsy
• Unproved hypokalemia
• Neck flop
• Floppy baby
• Flaccid hemiplegia
• Encephalitis
• Postictal weakness (Todd’s paralysis)
• Postdiphretic polyneuritis

26. Cases are investigated
immediately, usually
within 48 hrs of
notification, by a trained
medical officer
Detailed medical history,
examination & investigations are
done :
- Collection & transportation of
stool specimen
- Search for additional cases &
outbreak response in affected
community
- 60 days follow up examination
- Analysis of laboratory result
- Case classsification
AfterconfirmingthecasesasAFP

27. Stool Specimen Collection
• Important aspect of polio eradication strategy
• For every cases of AFP,
2 stool specimen is collected (at least 24 hours apart)
**Ideally within 14 days of onset of paralysis
(optimal time period for detection of polio virus)
**Should also be collected in any late-reported AFP case
upto 60 days from the day of paralysis onset
**>60 days, the likelihood for detecting poliovirus is very low

28. • Voided stool sample is preferred
• Other methods:
– Digital extraction (when child is constipated or dies)
– Postmortem stool collection (contents of large intestine)
– Use of rectal tube
• Each specimen should be 8 g each
• Enema or purgatives is not recommended
•Collected in a clean, dry, screw-capped container
•Labeled and transported in the ‘cold chain’

29. Poliovirus Isolation
• 2 types of cell lines are used:
– RD cell lines (derived from human rhabdomyosarcoma;
favour the growth of all enteroviruses)
– L20B cell lines (favour the growth of only poliovirus)
• If cytopathic effects appears in L20B cell line,
the isolate then goes for neutralization test to
determine the serotype (type 1,2 or 3) of the
poliovirus by using appropriate antisera

30. • If cytopathic effects appears in L20B cell line, the isolate then
goes for neutralization test to determine the serotype (type
1,2 or 3) of the poliovirus by using appropriate antisera
• Intratypic differentiation test is done to determine wether
the particular isolate is wild poliovirus or vaccine poliovirus
• All wild poliovirus isolates also undergo genetic sequencing

31. • A case is classsified as polio if wild poliovirus is
isolated from the stool specimen.
• Cases with inadequate stool specimens and
having residual weakness, who have died or
are lost to followup  undergo additional
investigation & are presented for review by
the National Expert Review Committee
(classifies the case as compatible with polio or discarded as
nonpolio AFP)