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Vaccine-associated paralytic poliomyelitis and BCG-osis in an immigrant child with severe combined immunodeficiency syndrome - Texas, 2013.
[severe combined immunodeficiency]
Poliovirus
transmission
has
been
eliminated
in
most
of
the
world
through
the
use
of
inactivated
poliovirus
vaccine
(
IPV
)
and
live
,
attenuated
oral
poliovirus
vaccine
(
OPV
)
.
In
the
United
States
,
use
of
OPV
was
discontinued
by
the
year
2000
because
of
the
potential
for
vaccine-associated
paralytic
polio
(
VAPP
)
;
an
average
of
eight
cases
were
reported
each
year
in
the
United
States
during
1980
-
2000
.
Polio
eradication
efforts
in
other
parts
of
the
world
continue
to
rely
on
OPV
to
take
advantage
of
transmission
of
poliovirus
vaccine
strains
to
unvaccinated
persons
in
the
population
,
lower
cost
,
and
ease
of
administration
.
In
2013
,
an
infant
aged
7
months
who
recently
immigrated
to
the
United
States
from
India
was
referred
to
a
hospital
in
San
Antonio
,
Texas
.
The
infant
had
fever
,
an
enlarging
skin
lesion
in
the
deltoid
region
with
axillary
lymphadenopathy
,
decreased
activity
,
and
inability
to
bear
weight
on
the
left
leg
,
progressing
to
paralysis
of
the
left
leg
over
a
6
-
week
period
.
Recognition
of
lymphopenia
on
complete
blood
count
led
to
immune
evaluation
,
which
revealed
the
presence
of
severe
combined
immunodeficiency
syndrome
(
SCIDS
)
,
an
inherited
disorder
.
A
history
of
OPV
and
bacille
Calmette-
Guérin
(
BCG
)
vaccination
in
India
led
to
the
diagnoses
of
VAPP
and
BCG-osis
,
which
were
confirmed
microbiologically
.
This
report
demonstrates
the
importance
of
obtaining
a
comprehensive
clinical
history
in
a
child
who
has
recently
immigrated
to
the
United
States
,
with
recognition
that
differing
vaccine
practices
in
other
countries
might
require
additional
consideration
of
potential
etiologies
.
Diseases
Validation
Diseases presenting
"fever"
symptom
22q11.2 deletion syndrome
acute rheumatic fever
alexander disease
allergic bronchopulmonary aspergillosis
canavan disease
carcinoma of the gallbladder
child syndrome
congenital toxoplasmosis
cushing syndrome
cystinuria
dracunculiasis
erdheim-chester disease
esophageal adenocarcinoma
esophageal carcinoma
familial mediterranean fever
focal myositis
hodgkin lymphoma, classical
lamellar ichthyosis
legionellosis
locked-in syndrome
malignant atrophic papulosis
neonatal adrenoleukodystrophy
neuralgic amyotrophy
oculocutaneous albinism
papillon-lefèvre syndrome
pyomyositis
pyruvate dehydrogenase deficiency
scrub typhus
severe combined immunodeficiency
sneddon syndrome
systemic capillary leak syndrome
triple a syndrome
typhoid
waldenström macroglobulinemia
wolf-hirschhorn syndrome
This symptom has already been validated