Case

This is a 4-1/2 month old female who presents to the ER with weakness in her
right leg. She is afebrile and does not appear to have any difficulty breathing. Her
right leg appears flaccid and no DTR or Babinski can be elicited although sensation
is intact. The tone, movement, sensation, and reflexes of her other limbs are normal.
Her cardiovascular, respiratory and abdominal examination are normal. Upon
further investigation, her father reports that she had a cough and fever of 38.3 C that
resolved one week prior to presentation. Her father also notes both a normal birth
history and appropriate well baby check ups. Her immunization records are up to
date and at her 4 month visit (2 weeks prior to presentation), she received her 2nd
doses of HiB, DTaP, OPV and pneumococcal vaccine.
CBC and Serum IgG/IgA/IgM are normal and CSF demonstrates elevated
protein with normal glucose. Radiographs of her spine and right lower extremity are
unremarkable. Electrophysiological studies (electromyography and nerve
conduction studies) show absent motor responses to stimulation of her right tibial
nerve. Fecal samples culture the Poliovirus type 3. It is then sent to the CDC where
the poliovirus is identified as a vaccine strain of poliovirus (not the "wild-type"
strain).
She is admitted to the hospital for monitoring. Her immunocompromised
grandfather who changes diapers occasionally is informed about her spinal polio and
encouraged to seek medical attention. During her inpatient care, mechanical
ventilation is not required and she does not experience any urinary or fecal
difficulties. One week after admission, she is discharged with mild residual
weakness of her right leg.

Questions

1. What is the clinical diagnosis in this case?

2. Name other forms of polio infection.
3. Which disease should be differentiated first of all? What is significant in
differentiation?
4. What was incorrect in patient’s vaccination?
5. Name the main treatment guidelines for this case.