Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

1136 Parainfluenza Paralytic Poliomyelitis

➣associated with Guillain-Barre syndrome

➣demyelinating syndrome

➣meningitis children/adults

■Immunocompromised host

➣can cause serious and sometimes fatal lower respiratory tract

infections in immunocompromised children+adults

➣Giant – cell pneumonia – SCIDS, AML and s/p BMT

➣Persistent respiratory tract infection has been described in

immunocompromised (e.g., DiGeorge rejection episodes in renal

+liver transplant [type 3])

➣Fever and neutropenia in children

PARALYTIC POLIOMYELITIS

MICHAEL J. AMINOFF, MD, DSc

history & physical

■Weakness of muscles in one or more limbs or the trunk, or supplied

by the lower cranial nerves; may progress for 3–5 days

■Minor GI disturbance, fever, malaise, headache or neck stiffness in

preceding 10 days

■May have been recent recipient or contact of recipient of oral polio

vaccine

■Neck stiffness or other evidence of aseptic meningitis

■Flaccid weakness or paralysis of affected muscles

■No sensory deficit

■Tendon reflexes normal or reduced

tests

■CSF shows pleocytosis & increased protein level

■Poliovirus may be isolated from stool, throat swabs, CSF

■Acute & convalescent serum to detect increase in polio antibody

titers

■EMG evidence of denervation in affected muscles

differential diagnosis

■Infections w/other enteroviruses are distinguished serologically &

by virus isolation studies

■Acute weakness of LMN type due to cord or peripheral nerve disease

is distinguished by the associated clinical deficits; organophosphate