Acute Flaccid Paralysis (AFP)/ Acute flaccid myelitis (AFM)

AFP/AFM is rare rare but serious neurological condition, which is associated with POLIO infection but has also been linked with other infections (and in the USA they have spikes every 2 yrs last 2020). AFP leads to weakness and paralysis affecting face and limbs but also the respiratory muscles and may lead to respiratory failure.

Epidemiology

AFM (inc. as part of Polio infection) predominantly effect children under 10yrs old. <125% of cases in adults but is likely under recognised in older individuals.

Presentation

Prodrome – Mild cold like illness is commonly reported (fever, cough, rhinorrhea and pharyngitis), GI symptoms are less common.


Symptoms
– Often start within 10days of prodrome

  • Headache, Neck stiffness, and occasionally meningism
  • Limb Pain – often precedes weakness
  • Weakness
    • Upper limbs and proximal muscles more often effected
    • Asymmetric
    • 30% have cranial nerves effected (esp. Facial Nerve)
    • Respiratory Failure requiring ventilation (10-40%)

 

Differentials

 

Management

  • Within ED  management will be symptomatic
    • Referral in to specialty (likely Paeds, Stroke, Medicine)
    • Early ICU referral, may be required if respiratory symptoms found
  • MRI is the best modality for diagnosis of AFM
  • Patients will need formal work up as inpatient inc. stool samples
  • Cases must be reported to UKHSA

References

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