PoliomyelitisOften called polio or infantile paralysis, is aninfectious disease caused by a virus.
This virus is a member of the enterovirussubgroup of the Picornaviridae familyand has three serotypes: PV1, PV2 and PV3.
The tissue mostcommonlyaffected is thespinal cord whichleads to theclassicmanifestations ofparalysis.
EpidemiologyAs a result of a massive, global vaccinationcampaign over the past 20 years, polio exists onlyin a few countries in Africa and Asia.In the Philippines, the last polio case wasrecorded in 1993, and in 2000 the Philippines wascertified polio-free (UNICEF, 2005).
TransmissionPerson-to-person spread of poliovirus via thefecal-oral route is the most important route oftransmission, although the oral-oral route mayaccount for some cases.
Compromisedimmmune system Lack of immunization against polio Extreme stress orstrenous activity
Travel to an area that hasexperienced a polio outbreak
PathogenesisThe mouth is the portal of entry of the virus andprimary multiplication of the virus occurs at the site ofimplantation in the pharynx and gastrointestinal tract.The virus is usually present in the throat and in thestools before the onset of illness. One week after onsetthere is little virus in the throat, but virus continues tobe excreted in the stools for several weeks. The virusinvades local lymphoid tissue, enters the blood stream,and then may infect cells of the central nervoussystem. Replication of poliovirus in motor neurons ofthe anterior horn and brain stem results in celldestruction and causes the typical manifestations ofpoliomyelitis.
Paralytic polio is classified into three types... Spinal polio - the most common, and accounted for 79% of paralytic cases from 1969-1979. It is characterized by asymmetric paralysis that most often involves the legs.Bulbar polio - accounts for 2% of cases and leadsto weakness of muscles innervated by cranialnerves.Bulbospinal polio - it accounts for 19% of casesand is a combination of bulbar and spinalparalysis.
Clinical Features The incubation period for poliomyelitis is commonly 6 to 20 days with a range from 3 to 35 days. The response to poliovirus infection is highly variable and has been categorized based on the severity of clinical presentation.
PATHOGNOMONIC SIGNflaccid paralysis, weakness or paralysis andreduced muscle tone.
• PATHOGNOMONIC SIGN• flaccid paralysis, weakness or paralysis and reduced muscle tone.
INAPPARENT INFECTION no manifestation no manifestationABORTIVE • sore throat • upper respiratory • PainPOLIOMYELITIS • abdominal pain tract infection • Fluid Volume • constipation or • fever Deficit diarrhea • Imbalanced • nausea Nutrition: less than body requirement • decreased appetite • Fatigue • HyperthermiaNONPARALYTIC • stiffness of the • PainPOLIOMYELITIS neck, back, and/or • Hyperthermia legsPARALYTIC • severe muscle • loss of superficial • Disturbed bodyPOLIOMYELITIS aches and spasms reflexes image in the limbs or • diminished deep • Risk for Injury back tendon reflexes • Self-Care Deficit • flaccid paralysis • weakened • Impaired breathing breathing pattern • flushed or blotchy skin
DIAGNOSTIC STUDIESVirus CultureThe laboratory diagnosis of polio is confirmed by isolation of virus bycultures, from the stool or throat swab or cerebrospinal fluid (rare). In aninfected person, the virus is most likely to be cultured in stool cultures.Serologic testAcute and convalescent serum sample may be tested for rise in antibodytiter (antibodies to the poliovirus), but the report can be difficult tointerpret as in many cases, the rise in titer may occur prior to paralysis.Cerebrospinal fluid testInfection with polio virus may cause an increased number of white bloodcells and a mildly elevated protein level in cerebrospinal fluid
MANAGEMENT Treatment of pain with analgesics (such as acetaminophen). Antibiotics for secondary infections (none for poliovirus). Fluid Therapy Bed rest (until fever is reduced) Adequate diet Minimal exertion and exercise Hot packs or heating pads (for muscle pain). Prolong rehabilitation may be necessary including braces, splint or surgery.
MANAGEMENTHospitalization (may be required for those individuals who develop paralytic poliomyelitis).If the respiratory is involved, LONG-TERM VENTILATION is necessary.Physiotherapy may be necessary.Place the child on firm mattress with support for feet, change position frequently.Encourage oral intake of food and fluid.Catheterization of distended bladder may be necessary.
PREVENTION• The best preventive measure for poliomyelitis is ensuring hygiene and encouraging good sanitation practices. But, polio prevention begins with polio vaccination. Polio vaccine has been developed against all 3 subtypes of the poliovirus and is very effective in producing protective antibodies that induces immunity against the poliovirus and provides protection from paralytic polio.
Two types of vaccine are available: an inactivated (killed) polio vaccine (IPV) and a live attenuated (weakened) oral polio vaccine (OPV).
ADVANTAGES DISADVANTAGESInactivated Polio Vaccine It is inactivated, so it cannot Requires injection replicate, and cannot be More expensive shed in the stool of a Produces less local vaccinated person. gastrointestinal immunity It cannot cause vaccine Recipients could become associated paralysis, and is infected with wild polio safe to use in virus immunodeficient persons or in household contacts of immunodeficient persons.Oral Polio Vaccine It is very easy to administer May cause vaccine- Less expensive associated paralytic polio Produces excellent intestinal immunity which helps Prevent infection with wild virus
GUIDE ON POLIOMYELITIS IMMUNIZATION (OPV)Route OralSite MouthNumber of Dose 3 dosesAge at First Dose 6 weeks after birthMinimum Intervals 4 weeksbetween DosesDosage 2 dropsStorage Temperature -15 to -25 °C
EVALUATIONPROGNOSIS• The outlook depends on the form of the disease (subclinical, or paralytic) and the body area affected. Most of the time, complete recovery is likely if the spinal cord and brain are not involved.• Brain or spinal cord involvement is a medical emergency that may result in paralysis or death (usually from respiratory problems).• Disability is more common than death. Infection that is located high in the spinal cord or in the brain increases the risk of breathing problems