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POLIOMYELITIS

(INFANTILE PARALYSIS; ACUTE ANTERIOR


POLIOMYELITIS; POLIO)
POLIOMYELITIS

is an acute infection caused by poliovirus (an


enterovirus). manifestations include a non specific
minor illness (abortive poliomyelitis), sometimes
aseptic meningitis without paralysis (non paralytic
poliomyelitis), and less often, flaccid weakness of
various muscle groups (paralytic poliomyelitis).
ETIOLOGY/INCUBATION:

Polioviruses
RESERVOIR

humans are the only natural host


MODE OF TRANSMISSION

highly transmittable via direct contact.


PORTAL OF ENTRY & EXIT

can enter in fecal-oral or respiratory route,


PATHOGNOMONIC SIGN

most cases, 70-75%, has no symptoms; classified


as Abortive poliomyelitis, Paralytic, Non-paralytic
poliomyelitis.

ABORTIVE POLIOMYELITIS slight fever in 1-


3days, malaise, headache, sore throat, and
vomiting.

PARALYTIC and NON-PARALYTIC may develop


without a preceding minor illness.
PATHOPHYSIOLOGY

virus enters via the fecal-oral or respiratory tract

then enter the lymphoid tissues of the GI tract.

a primary viremia follows with spread of virus to the reticuloendothelial system. infection may
be contained at this point, or the virus may further multiply and cause several days of
secondary viremia,

culmination of the development of symptoms and antibodies.

continues to paralytic infection

poliovirus enters CNS whether via secondary viremia or peripheral nerves is unclear.

significant damage in the spinal cord and brain; particularly the motor and autonomic
function.

inflammation compounds the damage produced by primary viral invasion.


factors predisposing to serious neurologic damage includes ;

increased age (throughout life)

recent tonsillectomy or intramuscular injection

pregnancy

impairment of b cell function function

physical exertion concurrent with onset of the CNS phase.


DIAGNOSIS

lumbar puncture

viral culture (stool, throat, and CSF)

reverse transcriptase - per of blood or csf

serologic testing for poliovirus serotypes,


enteroviruses, and west nile virus

it usually causes no fever

muscle weakness is symmetric


TREATMENT

supportive care

standard treatment of poliomyelitis is supportive and


includes rest, analgesics, and antipyretics as needed.
specific antiviral therapy is not available.

during active myelitis, precautions to avoid complications of


bed rest (eg, deep venous thrombosis, atelectasis, UTI)
and prolonged immobility (eg, contractures) may be
necessary. respiratory failure may require mechanical
ventilation. mechanical ventilation or bulbar paralysis
requires intensive pulmonary toilet measures.
KEY POINTS

most poliovirus infections are asymptomatic or


cause nonspecific minor illness or aseptic meningitis
without paralysis; < 1% of patients develop the
classic syndrome of flaccid weakness (paralytic
poliomyelitis)

asymmetric flaccid limb paralysis or bulbar palsies


without sensory loss during an acute febrile illness in
a non immunized child or young adult may indicate
paralytic poliomyelitis.
viral culture of throat swabs, stool, and CSF and
reverse transcriptase - PCR or CSF and blood
should be done.

in paralytic poliomyelitis, about two thirds of patients


have residual permanent weakness.

all infants and children should be immunized, but


adults are not routinely vaccinated unless they are
at increased risk (eg, because of travel or
occupation.