Causes and Differential Diagnosis of Acute Flaccid Paralysis
| Infectious | |
| Viral | |
| Enteroviruses | Poliomyelitis, Coxsackie A ( A7, A9; A4, A5, A10), Coxsackie B (B1-B5), echoviruses (6,9; 1-4, 7, 11, 14, 16-18, 30), enterovirus 70 enterovirus 71 |
| Other Viruses | Myxoviruses (mumps virus), toga and arborviruses, Epstein-Barr Virus; human immunodeficiency virus (HIV), Japanese B encephalitis virus, West Nile virus |
| Bacterial | Campylobacter jejuni (leading cause of Guillain-Barre syndrome) |
| Metabolic- transient and periodic paralysis | |
| Hypokalemic | Familial, Sjogren’s Syndrome, hyperthyroidism, gossypol induced (toxic phenolic pigment in the cottonseed), association with barium poisoning, association with hyperaldosteronism |
| Normo- or hyperkalemic Hypophosphatemia | Familial, adynamia episodia hereditaria of Gamstorp |
| Drug Induced | |
| Heroin | |
| Antibiotics | Aminoglycosides, polymyxin B, tetrayclines |
| Organic | |
| Volatile hydrocarbons | Hexane, methyl butyl ketone, carbon disulfide |
| Trecresyl phosphate | Jamaican ginger tonic; contaminant of cooking oil, mustard oil, or flour |
| Other | Cantharidin, diethyltoluamide (DEET), dithiobiuret (rat poison), triethyldodecyl-ammonium bromide (mouse poison) |
| Toxins | |
| Bacterial | Botulinum, diphtheria, tetanus (cephalic form), moraxella |
| Fungal-mycotoxins | Penicillium citrea-viridae, Penicillium islandicum, Penicillium citrinum |
| Insect | Tick paralysis; spider venom; cockroach, beetle; wasp venom; Lepidoptera larvae |
| Parasite/protozoa/dinoflagellates | Paralytic shellfish poisoning-saxitoxin, ichthyotoxism (sardines) |
| Reptiles-snake venom | Cobra, Australian elapid, krait, mamba, Sea snake |
| Plants and plant toxin | Gloriosa superba (daisy) [root], Lathyrus species (sweet pea), Aconitum (monkhood), hemlock (parsley), Karwinskia humboldtiana/coyotillo (buckthorn) [berries], Calliopsis species (daisy), Cassia (bean), Cycas (evergreen), [seeds], Gelsemium [blossoms], Heliotropium (bush tea shrub), Melochia species [stems], Oenanthe species 9parsnips0 |
| Metals | Organic tin compounds, lead |
| Pesticides | EPN, trichlorfon (Dipterex, dichlorvos (DDVP), DEF, isofenphos (Oftanol), leptophos (Phosel) |
| Inherited/congenital/acquired | Werdnig-Hoffmann disease, Wohlfart-Kugelberg-Welander disease, porphyric polyneuropathy |
| Unknown/multiple causes | Guillain-Barre syndrome, China paralytic syndrome, Bell’s palsy, transverse myelitis |
| Asthma | Polio-like Hopkins’ syndrome |
Source: Plotkin, S., Orenstein, W.;Vaccines, 4th edition. p. 657, Table 25-2.; 2004.
