Table 2.

Distinguishing features of 4 common diagnoses of AFP

	Poliomyelitis	Guillain-Barré Syndrome	Traumatic Neuritis (After Injection)	Transverse Myelitis
Paralysis	Development of paralysis 24- to 48-h onset to full paralysis; descending; reduced or absent muscle tone in affected limbs; decreased or absent deep tendon reflexes; cranial nerve involvement and respiratory insufficiency only when bulbar involvement present	Development of paralysis from hours to 10 d; ascending; global hypotonia; globally absent deep tendon reflexes; cramps; tingling; hypoesthesia of palms and soles; cranial nerve involvement often present, affecting nerves VII, IX, X, XI, XII	Development of paralysis from hours to 4 d; reduced or absent muscle tone in affected limb; decreased or absent deep tendon reflexes; hypothermia in affected limb	Development of paralysis from hours to 4 d; hypotonia in affected limbs; deep tendon reflexes absent in lower limbs early; hyperreflexia late; anesthesia of lower limbs with sensory level
Clinical features	High fever at onset; always present at onset of flaccid paralysis; gone when progression of paralysis stops; severe myalgia; backache	Respiratory insufficiency in severe cases, enhanced by bacterial pneumonia; frequent blood pressure alterations; sweating; blushing; body temperature fluctuations; transient bladder dysfunction	Fever common before, during, and after flaccid paralysis; pain in gluteus	Occasional respiratory insufficiency; autonomic signs and symptoms present; bladder dysfunction
Diagnostic tests	Inflammatory cerebrospinal fluid; abnormal nerve conduction velocity, third week: anterior horn cell disease (normal during first 2 wk); abnormal electromyography at 3 wk	Albumin-cytologic dissociation of cerebrospinal fluid; abnormal nerve conduction velocity; third week: slowed conduction; decreased motor amplitudes	Abnormal nerve conduction velocity, third week: axonal damage	Mild elevation in cells of cerebrospinal fluid
Sequelae at 3 mo and up to 1 y	Severe, asymmetric atrophy; skeletal deformities developing later	Symmetric atrophy of distal muscles	Moderate atrophy; only in affected limbs	Flaccid diplegia; atrophy after years

Adapted from Sutter RW, Kew OM, Cochi SL, et al. 28-Poliovirus vaccine—live, Table 28–3: distinguishing features of four common diagnoses of acute flaccid paralysis. In: Plotkin SA, Orenstein WA, Offit PA, editors. Vaccines (sixth edition). London: W.B. Saunders; 2013. p. 604; with permission.