POLIOMYELITIS

What is it?
Infectious disease by poliovirus type 1, 2 or 3
Can recur in post-polio syndrome
Can cause spinal cord (especially anterior horn cell of spinal cord and cranial
motor nerves) and brainstem paralysis muscle weakness causing inability to
move
Most often involves the leg, but may involve head, neck, diaphragm
Incidence has decreased due to improvement in sanitation, hygiene and polio
vaccines
Pathophysiology
Spread by fecal-oral route and aerosol droplet
Destroy anterior horn cell in spinal cord
Etiology
Acute poliomyelitis is caused by small RNA viruses of the Enterovirus genus of the
Picornaviridae family.
Single stranded RNA core surrounded by capsid with no lipid envelope resistant
to lipid solvent
3 serotypes: type 1, 2, 3
PV1 most commonly associated with paralysis
IP: 7-14 days
Increase risk/severity: immune deficiency, malnutrition, physical activity
immediately after paralysis, skeletal muscle injury due to injection of vaccines,
pregnancy
Clinical features
Abortive Fever, sore throat, myalgia
poliomyelitis Self limiting, short duration
Non-paralytic Features of abortive poliomyelitis + signs of
poliomyelitis meningeal irritation
Complete recovery
Paralytic Increase risk if: male, exercise early in the
poliomyelitis illness, trauma, surgery or IM injection, recent
tonsillectomy
4-5 days after initial illness simulating abortive
poliomyelitis
Meningeal irritation and muscle pain
asymmetric flaccid paralysis without sensory
involvement
Bulbar CN involvement + respiratory muscle paralysis
poliomyelitis Soft palate, pharyngeal and laryngeal muscle
palsies are common
Late cx: aspiration pneumonia, myocarditis,
paralytic ileus, urinary calculi
Diagnosis

Clinical
Absence of sensory involvement, asymmetrical nature of paralysis
 Laboratory confirmation and distinction between wild virus and vaccine strains
achieved by genome detection techniques, virus culture, neutralization and
temperature marker tests.
Treatment Supportive
Bed rest
If muscles of respiration are involved: intermittent + pressure ventilation
Once acute phase has subsided: OT, physiotherapy, surgery for rehabilitation
Prevention and Immunisation decrease the prevalence of the disease
control Inactivated IM poliovirus (IPV) has replaced oral polio vaccine in many countries.