Paralysis was the admitting diagnosis. "Can you review
the child? Could he have polio?" Just six days before admission 3 year old
Tamandani and his mother had been in Mozambique attending his father's funeral.
His father had had a brief, febrile illness, with body pains, headache, gastrointestinal
bleeding, prostration and death. Now less than a week later he was ill too. He
lay on the exam table without moving his arms or legs, unable to hold up his
trunk or head. Olive, the head nurse, coaxed him to take her cell phone in
his left hand and after some time he passed it to his right. When supported under
the arms, with his head held upright, he was able to bear some weight, even
making a clumsy, "dough-boy" step forward desperately trying to escape
my grip to reach his mother. Pushing on
the bottom of his foot back toward his body brought out clonus, a repetitive downward
flapping movement of the foot. Additionally he had hyperactive knee reflexes and his cheeks appeared swollen.
These were signs not of a flaccid paralysis like polio but a spastic
paraparesis. Spastic paralysis has a wide differential; TB, HIV, lymphoma,
herpes, cryptococcus, B12 deficiency. Transverse myelitis, inflammation of the
spinal cord, can be due to a variety of causes including schistosomiasis,
typhoid, and Burkett's lymphoma.
His mother reported he had not urinated all day and would not eat or drink. So a catheter
was placed to drain obstructed urine. The parasite schistosomiasis was not found in the urine, the abdominal ultrasound , CXR and spine films
were normal and an HIV test was negative. In my reading I discovered that typhoid can cause parotitis (swelling of the parotid glands in the cheeks) just like mumps. Typhoid fever occurs when food or water contaminated with feces is ingested. The World Health Organization estimates there are 20 million infections and over 200,000 deaths each year from typhoid. Humans are the only known reservoir.
Treatment included antibiotics, prayer and physical therapy. After a week he was able to hold up his head. Mulungu akumuchilitsa ("God is healing him") I encouraged the mother. A few days later Tamandani was sitting up on his own, then standing up and 2 weeks after admission he was able to walk slowly, holding on to one of his mother's hands.
In John 14: 12 Jesus told his disciples "I tell you the truth anyone who has faith in me will do what I have been doing. He will do even greater things than these..." What a blessing to be the hands and feet of Jesus, a pencil in God's hand as Mother Teresa would have said, through the ministry of healing and pointing people toward God. Thank you for praying for me during my time in Malawi!
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