• 1.

    Solomon T, Willison H, 2003. Infectious causes of acute flaccid paralysis. Curr Opin Infect Dis 16: 375381.

  • 2.

    Ward NA, Milstien JB, Hull HF, Hull BP, Kim-Farley RJ, 1993. The WHO-EPI initiative for the global eradication of poliomyelitis. Biologicals 21: 327333.

    • Search Google Scholar
    • Export Citation
  • 3.

    Cornblath DR, Hughes RC, 2006. Guillain-Barre syndrome. Kimura J, ed. Handbook of Clinical Neurophysiology. Philadelphia: Elsevier, 695708.

    • Search Google Scholar
    • Export Citation
  • 4.

    Hughes RA, Cornblath DR, 2005. Guillain-Barre syndrome. Lancet 366: 16531666.

  • 5.

    Bahemuka M, 1988. Guillain-Barre syndrome in Kenya: a clinical review of 54 patients. J Neurol 235: 418421.

  • 6.

    Barzegar M, Dastgiri S, Karegarmaher MH, Varshochiani A, 2007. Epidemiology of childhood Guillan-Barre syndrome in the north west of Iran. BMC Neurol 7: 22.

    • Search Google Scholar
    • Export Citation
  • 7.

    Hart DE, Rojas LA, Rosario JA, Recalde H, Roman GC, 1994. Childhood Guillain-Barre syndrome in Paraguay, 1990 to 1991. Ann Neurol 36: 859863.

  • 8.

    Hussain IH, Ali S, Sinniah M, Kurup D, Khoo TB, Thomas TG, Apandi M & Taha AM 2004. Five-year surveillance of acute flaccid paralysis in Malaysia. J Paediatr Child Health 40: 127130.

    • Search Google Scholar
    • Export Citation
  • 9.

    London L, Bourne D, Sayed R, Eastman R, 2004. Guillain-Barre syndrome in a rural farming district in South Africa: a possible relationship to environmental organophosphate exposure. Arch Environ Health 59: 575580.

    • Search Google Scholar
    • Export Citation
  • 10.

    Rocha MS, Brucki SM, Carvalho AA, Lima UW, 2004. Epidemiologic features of Guillain-Barre syndrome in Sao Paulo, Brazil. Arq Neuropsiquiatr 62: 3337.

    • Search Google Scholar
    • Export Citation
  • 11.

    Shafqat S, Khealani BA, Awan F, Abedin SE, 2006. Guillain-Barre syndrome in Pakistan: similarity of demyelinating and axonal variants. Eur J Neurol 13: 662665.

    • Search Google Scholar
    • Export Citation
  • 12.

    Visudtibhan A, Visudhiphan P, Chiemchanya S, Wiengperm M, 1998. Guillain-Barre syndrome in Thai children: retrospective analysis of the clinical and outcome prior to intravenous immune globulin era. J Med Assoc Thai 81: 750756.

    • Search Google Scholar
    • Export Citation
  • 13.

    Arvelo W, ed, 2006. Community household survey to describe healthcare utilization practices and risk factors for diarrheal diseases in the Department of Santa Rosa, Guatemala–2006 (Abstract #988). Proceedings of the 45th Annual Meeting of the Infectious Diseases Society of America; San Diego, CA, October 2007.

    • Search Google Scholar
    • Export Citation
  • 14.

    Kuwabara S, Yuki N, Koga M, Hattori T, Matsuura D, Miyake M, Noda M, 1998. IgG anti-GM1 antibody is associated with reversible conduction failure and axonal degeneration in Guillain-Barre syndrome. Ann Neurol 44: 202208.

    • Search Google Scholar
    • Export Citation
  • 15.

    Green DM, Ropper AH, 2001. Mild Guillain-Barre syndrome. Arch Neurol 58: 10981101.

  • 16.

    Berger AR, Logigian EL, Shahani BT, 1988. Reversible proximal conduction block underlies rapid recovery in Guillain-Barre syndrome. Muscle Nerve 11: 10391042.

    • Search Google Scholar
    • Export Citation

 

 

 

 

Clinical Assessment of Self-Reported Acute Flaccid Paralysis in a Population-Based Setting in Guatemala

View More View Less
  • 1 Division of Viral and Rickettsial Diseases, National Center for Zoonotic and Vector-Borne Diseases (NCZVED), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; Division of Vector-Borne Infectious Diseases, NCZVED, CDC, Atlanta, Georgia; Division of Emerging Infections and Surveillance Services, National Center for Prevention, Detection, and Control of Infectious Diseases, CDC, Atlanta, Georgia; CDC–Universidad del Valle de Guatemala Collaboration, Centro de Estudios en Salud, UVG, Guatemala City, Guatemala; Johns Hopkins School of Public Health, Baltimore, Maryland

Historically, poliovirus infection has been an important cause of acute flaccid paralysis (AFP) worldwide; however, successful elimination of wild-type poliovirus in much of the world has highlighted the importance of other causes of AFP. Despite the evolving etiology, AFP surveillance in most developing countries still focuses on poliovirus detection and fails to detect many AFP cases, particularly among adults. We assessed 41 subjects self-reporting symptoms suggestive of AFP during a population-based health survey in the Department of Santa Rosa, Guatemala. Thirty-five (85%) of the suspected cases were not hospitalized. Most subjects (37) did not have features consistent with AFP or had other diagnoses explaining weakness. We identified two adults who had not received medical attention for a clinical illness consistent with Guillain-Barré syndrome, the most important cause of non-poliovirus AFP. Usual surveillance methods for AFP, particularly in developing countries, may underestimate the true burden of non-poliovirus AFP.

Author Notes

*Address correspondence to James J. Sejvar, CDC, 1600 Clifton Rd., Mailstop A-39, Atlanta, GA 30333. E-mail: zea3@cdc.gov

Authors' addresses: James J. Sejvar and Lawrence B. Schonberger, Division of Viral and Rickettsial Diseases (DVRD) and Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, E-mails: JSejvar@cdc.gov and LSchonberger@cdc.gov. Kim A. Lindblade, Wences Arvelo, Kimberly Pringle, and Norma Padillo, Universidad de Valle de Guatemala, Guatemala City, Guatemala, E-mails: KLindblade@cdc.gov, WArvelo@cdc.gov, kimberly.pringle@gmail.com, and Npadilla@uvg.edu. Erica Dueger, U.S. Naval Medical Research Unit 3 (NAMRU-3), FPO AE 09835-9998, E-mail: erica.dueger@navy.med.mil. Emily Zielinksi-Guttierez, Foothills Campus, Fort Collins, CO, E-mail: EZielinski-Guttierez@cdc.gov. Eileen Farnon, Division of Healthcare Quality Promotion, CDC, Atlanta, GA, E-mail: EFarnon@cdc.gov.

Save