Polio

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POLIOMYELITISBy VYOM JAIN

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Did You Know.......• First described by Michael Underwood in 1789.

• First outbreak described in U.S. in 1843.

• More than 21,000 paralytic cases reported in the U.S. in 1952.

• Global eradication within this decade.



What is Poliomyelitis?•The words polio (grey) and myelon (marrow, indicating the spinal cord) are derived from the Greek.

•Poliomyelitis is a disease of the anterior horn motor neurons of the spinal cord and brain stem caused by poliovirus.



•Poliomyelitis, literally meaning “grey spinal cord inflammation•It is a viral infection•There are three types of poliovirus and many strains of each type •It is contagious: usually spread from person to person.•Only harmful to humans•Virus localized in the anterior horn cells of the spinal cord and certain brain steam motor nuclei.





CAUSES: POLIOVIRUSGENUS : EnterovirusSPECIES : poliovirusSTRUCTURE : ssRNA enclosed in a protein capsid.TYPES : Three types :- PV1, PV2, PV3. diffrentiated by the type of capsid protein.SIZE : 30nm in diameter with icosahedral symmetry

PV1 is most common encountered form & the one most commonly associated with the paralysis.



• Minimal heterotypic immunity between serotypes• Rapidly inactivated by heat, formaldehyde, chlorine, ultraviolet light

All three are extremely virulent & produces the same disease symptoms.

Poliomyelitis is a disease caused by infection with the poliovirus. The virus spreads by:• Direct person-to-person contact• Contact with infected mucus or phlegm from the nose or mouth• Contact with infected feces



PATHOGENESIS.......•Entry into mouth.•Replication in pharynx, GI tract, Local Lymphatics.•Haematologic spread to lymphatic and central nervous system.•Viral spread along nerve fibers.•Destruction of motor neurons.





CLASSIFICATION.......On the basis of symptoms:1. Symptomatic2. Asymptomatic• 91%-95% of all cases are generally Asymptomatic.• 4%-8% cases shows some symptoms i.e. Symptomatic.

Symptomatic are further divided into two types:• Mild & Abortive Polio called as Non-paralytic Polio.• Severe Polio called as Paralytic Polio (0.1%-2% of cases)



Paralytic polio also may be classified as:

1. Spinal polio - attacks motor neurons in the spinal cord and causes paralysis in arms and legs and breathing problems

2. Bulbar polio - affects neurons responsible for sight, vision, taste, swallowing, and breathing

3. Bulbospinal polio - both spinal and bulbar polio.



SYMPTOMS:-1. Acute Stage:-• Generally last for 7 to 10 days.• Many includes fever , pharyngitis, headache, anorexia, nausea, and vomiting. • These patients develop a higher fever & sever headache with stiffness of the neck and back.• Paralysis of the respiratory muscles or from cardiac arrest if the neurons in the medulla oblongata are destroyed.





2. Convalescent Stage:-• From 2 days after the temperature return to normal and continues for 2 years.• Muscle power improves. • Physical therapy is recommended for full recovery.• Passive stretching exercises and wedging casts can be used for mild to moderate contractures.• Surgical release of tight fascia and muscle aponeuroses and lengthening of tendons may be necessary for contractures persisting longer than 6 months.• Orthoses should be used until no further recovery is anticipated.





3. Chronic Stage :-

• 24 months after the active illness:•The goals of treatment include correcting any significant muscle imbalance and preventing or correcting soft tissue or bony deformities. • Static joint instability can be controlled by Orthoses.•Dynamic joint instability result in a fixed deformity that cannot be controlled by Orthoses.





There are three basic patterns of polio infection: Subclinical infections, Paralytic, Non-paralytic. Most people have subclinical infection, and may not have symptoms.

SUBCLINICAL INFECTION SYMPTOMS• General discomfort or uneasiness (malaise).• Headache.• Red Throat.• Sore Throat.• Slight Fever.• Vomiting.



Exams & Tests.....The health care provider may find:• Abnormal reflexes• Back Stiffness• Difficulty in lifting head or legs when lying flat on the back• Stiff neck• Trouble bending the neck.

Test includes :• Culture of throat washing, stools or spinal fluids.• Spinal tap and examination of the spinal fluid using PCR.• Test for the level of antibodies for the polio virus.



Treatment:-• The goal of the treatment is to control symptoms while the infection runs its course as there are no specific treatment for the viral infection.• Treatment may includes :

• Antibiotic for urinary tract infection.• Moist heat to reduse pain and muscle spasm• Pain killer to reduce muscle pain, headache(narcotics are not given).• Physical therapy, braces or corrective shoes, or orthopedic surgeryto help recover muscle strength & function



Possible complications :• Aspiration pneumonia• Cor pulmunale (type of heart failure found on right side of circulatory system)• Lack of movement• Lung problems• Myocarditis• Paralytic ileus (loss of intestinal functions)• Permanent muscle paralysis, disability, deformity.• Pulmonary edema• Shock• Urinary tract infactions.



In immune individuals, IgA antibodies against poliovirus are present in the tonsils and gastrointestinal tract, and are able to block virus replication; IgGand IgM antibodies against PV can prevent the spread of the virus to motor neurons of the central nervous system. Infection or vaccination with one serotype of poliovirus does not provide immunity against the other serotypes, and full immunity requires exposure to each serotype.A rare condition with a similar presentation, nonpoliovirus poliomyelitis, may result from infections with nonpoliovirus enteroviruses.





Post Polio Syndrome.....Post-polio syndrome is a cluster of disabling signs and symptoms that affect some people several years — an average of 35 years — after they had polio. Common signs and symptoms include:

• Progressive muscle or joint weakness and pain• General fatigue and exhaustion after minimal activity• Muscle atrophy• Breathing or swallowing problems• Sleep-related breathing disorders, such as sleep apnea• Decreased tolerance of cold temperatures• Cognitive problems, such as concentration and memory difficulties• Depression or mood swings



figure: Stem cell therapy for post polio syndrome



Rehabilitation Program.........1. Physical TherapyPhysical therapy plays an important role in rehabilitation for patients with poliomyelitis. Patients with muscle paralysis benefit from frequent passive range of motion (PROM) and splinting of joints to prevent contracture and joint ankylosis. Chest physical therapy (CPT) helps patients with bulbar involvement prevent any pulmonary complications, such as atelectasis. Frequent repositioning of paralyzed patients helps to prevent bedsores. Orthotic treatment for deformities around the knee in poliomyelitis.



3. Recreational TherapyPatients may attend leisure activities to reduce stress and learn how to get involved in group activities.

2. Occupational TherapyPatients with paralysis of the extremities may benefit from hand or arm splints, knee or trochanter rolls, a footboard, or Multi-Podus boots to prevent foot drop, ulcers, and other deformities. Hot packs also are helpful to relieve the muscle pain.



4. Speech TherapyPatients with cranial nerve involvement may develop swallowing dysfunction. To protect the airway and prevent aspiration pneumonia, a speech therapist needs to be involved early to perform an evaluation of the safety of swallowing. Decisions on the appropriate consistency of oral foods and use of various strategies/techniques greatly reduce the risk of aspiration. Periodic follow up of patient status can be performed with serial video swallow testing.



Graph showing the variability in number of patients on different time zones....

Together lets eradicate polio from the world



Join hands for a polio free world :)






Date post:	13-Apr-2017
Category:	Health & Medicine
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Polio

Health & Medicine