Acute Flaccid Paralysis Linked to West Nile Virus

Acute flaccid paralysis (AFP) syndrome has been associated with the West Nile virus (WNV), according to a series of six cases described in the Sept. 20 issue of the Morbidity and Mortality Weekly Report. Patients presenting with acute weakness should be screened for WNV before beginning treatment for presumed Guillain-Barre syndrome (GBS).

 “Acute WNV infection…has been associated with acute AFP attributed to a peripheral demyelinating process (GBS) or to an anterior myelitis,” write A. Leis, MD, and colleagues from the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.

 “However, the exact etiology of AFP has not been assessed thoroughly with electrophysiologic, laboratory, and neuroimaging data.” In this series of six cases of WNV-associated AFP, clinical, laboratory, and electrophysiologic findings suggest pathology localized to anterior horn cells and motor axons, similar to that seen in acute poliomyelitis. All six patients had acute onset of asymmetrical weakness without pain or sensory loss, and four of five who had cerebrospinal fluid (CSF) analysis had pleocytosis.

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