clove and Paralysis

Between October 2001 and April 2002, five cases of acute flaccid paralysis (AFP) associated with type 2 vaccine-derived polioviruses (VDPVs) were reported in the southern province of the Republic of Madagascar. To determine viral factors that favor the emergence of these pathogenic VDPVs, we analyzed in detail their genomic and phenotypic characteristics and compared them with co-circulating enteroviruses. These VDPVs appeared to belong to two independent recombinant lineages with sequences from the type 2 strain of the oral poliovaccine (OPV) in the 5'-half of the genome and sequences derived from unidentified species C enteroviruses (HEV-C) in the 3'-half. VDPV strains showed characteristics similar to those of wild neurovirulent viruses including neurovirulence in poliovirus-receptor transgenic mice. We looked for other VDPVs and for circulating enteroviruses in 316 stools collected from healthy children living in the small area where most of the AFP cases occurred. We found vaccine PVs, two VDPVs similar to those found in AFP cases, some echoviruses, and above all, many serotypes of coxsackie A viruses belonging to HEV-C, with substantial genetic diversity. Several coxsackie viruses A17 and A13 carried nucleotide sequences closely related to the 2C and the 3D(pol) coding regions of the VDPVs, respectively. There was also evidence of multiple genetic recombination events among the HEV-C resulting in numerous recombinant genotypes. This indicates that co-circulation of HEV-C and OPV strains is associated with evolution by recombination, resulting in unexpectedly extensive viral diversity in small human populations in some tropical regions. This probably contributed to the emergence of recombinant VDPVs. These findings give further insight into viral ecosystems and the evolutionary processes that shape viral biodiversity.

Topics: Animals; Cells, Cultured; Disease Outbreaks; Enterovirus C, Human; Evolution, Molecular; Feces; Female; Genome, Viral; Genomics; Humans; Madagascar; Male; Mice; Molecular Epidemiology; Paralysis; Poliovirus; Poliovirus Vaccine, Oral; Recombination, Genetic; RNA, Viral; Serotyping

Child meningomyeloradiculitis is a rare complication form of schistosomiasis, even in hyperendemic area. Its diagnosis is very difficult, especially if there are not history or signs of Schistosoma mansoni or hematobium infections. It must be evocated in case of acute flask paralysis occurring in children living in Schistosoma infections endemic area. The authors report a 14-year-old boy's case and suggest etiopathogeny of the disease.

Topics: Adolescent; Anthelmintics; Anti-Bacterial Agents; Anti-Inflammatory Agents; C-Reactive Protein; Diagnosis, Differential; Drug Therapy, Combination; Endemic Diseases; Humans; Lactams; Madagascar; Male; Neuroschistosomiasis; Paralysis; Praziquantel; Prednisone; Urinary Retention

In the framework of the poliomyelitis program eradication, the World Health Organization suggests two markers to survey the circulation of the poliovirus: notification of all cases of acute flask paralysis (AFP) and etiological research of these AFP from two stool samples. The authors reported the case of a AFP, occurring after a polio vaccination in a 5-year-old boy who had later an acute rhinopharyngitis treated by antibiotics and quinine intramuscular injections. A left lower limb AFP justified his hospitalisation. The isolation of a Sabin type 3 poliovirus was a pitfall because clinical and complementary investigations demonstrate a peripheral neuromuscular paralysis. This demonstrative case shows the need for health staff to be trained to perform correctly an usual act like intramuscular drug injections.

Topics: Acute Disease; Anti-Bacterial Agents; Child, Preschool; Diagnosis, Differential; Disease Notification; Feces; Humans; Injections, Intramuscular; Madagascar; Male; Nasopharyngitis; Paralysis; Poliomyelitis; Poliovirus; Poliovirus Vaccine, Oral; Quinine; Sciatic Nerve