Acute flaccid paralysis surveillance: The need for ruling out polio infection

Afive-year-old, previously well male was admitted to hospital with severe headache after a three-day history of fever, cough and breathing difficulty. The child had not travelled outside of Canada and had received all recommended immunizations. The following day, he developed leg weakness, right-sided calf pain, limited lower extremity movement and decreased lower extremity reflexes bilaterally. Although given a presumptive diagnosis of Guillain-Barre syndrome (GBS) and started on intravenous immunoglobulin, his leg weakness continued to progress. To determine the etiology of his acute flaccid paralysis (AFP), brain and spine magnetic resonance imaging and lumbar puncture were conducted. Because viral culture from stool is the most sensitive test for identifying poliovirus, a stool sample was sent to the National Microbiology Laboratory (NML, Winnipeg, Manitoba) to rule out poliomyelitis. Samples from other sources (eg, nasopharyngeal swab) may be useful for detecting other viruses but stool culture is still recommended for detecting polio. The stool sample was obtained early within the recommended 14 days to ensure the highest probability of poliovirus detection. Results returned after 10 days were negative for poliovirus and further investigations were undertaken. The present case was reported to the local public health unit and the Canadian Paediatric Surveillance Program (CPSP). A 60-day follow-up with the attending physician was scheduled through neurology.