infectious diseases
Poliomyelitis
Diagnosis of Poliomyelitis
Lumbar puncture Viral culture (stool, throat, and cerebrospinal fluid) Reverse transcriptase–polymerase chain reaction of blood or cerebrospinal fluid Serologic testing for poliovirus serotypes, other enteroviruses, and West Nile virus When there are no central nervous system manifestations, symptomatic polio (abortive poliomyelitis) resembles other systemic viral infections and is typically not considered or diagnosed except during an epidemic. resembles other viral meningitides. In such patients, lumbar puncture is usually done; typical cerebrospinal fluid findings are normal glucose, mildly elevated protein, and a cell count of 10 to 500/mcL (predominantly lymphocytes). Detection of the virus in a throat swab, feces, or cerebrospinal fluid or demonstration of a rise in specific antibody titer confirms infection with poliovirus but is usually not needed in patients with uncomplicated Overview of Meningitis . may be suspected in nonimmunized children or young adults who have asymmetric flaccid limb paralysis or bulbar palsies without sensory loss during an acute febrile illness. However, certain group A and B coxsackieviruses (especially A7), several echoviruses, and enterovirus 71 may produce similar findings. Also, cases of focal limb weakness or paralysis have been identified after infection with Acute flaccid myelitis (AFM) . It usually causes no fever. Muscle weakness is symmetric. Sensory deficits occur in 70% of patients Cerebrospinal fluid protein is usually elevated and cerebrospinal fluid cell count is normal. Epidemiologic clues (eg, immunization history, recent travel, age, season) can help suggest the cause. Because identification of poliovirus or another enterovirus as the cause of acute flaccid paralysis is important for public health reasons, suspected cases should be reported to the local or state health department immediately to assist with diagnostic testing. Two sets of throat swabs and whole stool specimens should be taken at least 24 hours apart for viral culture and reverse transcriptase–polymerase chain reaction. Cerebrospinal fluid and blood specimens will likely also be requested. Specific serologic testing for polioviruses, other enteroviruses, and West Nile virus should also be done. 