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1. POLIOMYELITIS
BY :
MMANTTHAN PUROHIT

2. INTRODUCTION
• Infectious disease
• Epidemic and endemic in nature
• Viral infection of nerve cell in anterior gray horn.
• It can affect cranial nerve nuclei also.
• Cranial nerve nuclei in brain stem if affected leading to many cases
of permanent paralysis of muscles.
• Characteristics of poliovirus : rapidly inactivated by heat.
formaldehyde
chlorine & UV light.

3. PATHOGENESIS

4. POLIO VIRUS
EPITHELIALCELL

5. 1) Bacteria
releases RNA
2)RNA polymerase
enzyme
3)high-jack of ribosome
and formation of new
protein

6. BACTERIA FROM
EPITHELIAL CELL
TO
BLOOD VESSEL

7. Bacteria from
vessels
To brain and brain
stem

8. PATHOGENESIS
ALIMENTRY STAGE VIRAEMIC STAGE NEUTRAL STAGE
AFTER ENTERING INTO THE
NASOPHARYNX OR GIT, THE VIRUS
MULTIPLIES IN THE EPITHELIAL
CELLS OF MUCOSA
VIRUS SPREADS INTO BLOOD
STREAM
VIRUS GOES TO AHC OF THE
SPINAL CORD AND SOMETIMES TO
NERVE CELLS IN THE BRAIN STEM.

9. PATHOGENESIS ( cont…)
• Mouth is the portal entry of the virus.
• Site for primary multiplication : GIT or NASOPHARYNX
• Virus enters into blood stream, invades local lymphoid tissue.
• Virus also infect nuclei in the brain stem, brain, and AHC of spinal
cord.

10. BULBAR POLIO
• Brainstem and medulla involvement.
• Motor nerves : speaking & swallowing
• Motor nerves to diaphragm
• If vagus nerve is affected impairment in breathing is seen.

11. POST-POLIO SYNDROME
• Decades after initial infection
• Because of aging motor neurons die.
• Extensive loss of muscle function.

12. DIFFERENTIAL DIAGNOSIS
POLIOMYELITIS ASYMMETRICAL
LMNL
NO SENSORY LOSS
IMPROVES WITH TIME OR IT IS STATIC.
MYOPATHY USUALLY SYMMETRICAL
LMNL
NO SENSORY LOSS
DETERIORATES WITH TIME
SPINA BIFIDA SYMMETRICAL
MOTOR + SENSORY LOSS
DETERIORATES WITH GROWTH
NEUROPATHY USUALLY BILATERAL
MOTOR + SENSORY LOSS
MAY IMPROVES WITH TREATMENT

13. TREATMENT

14. STAGE OF ONSET
NOT POSSIBLE
TO DIAGNOSE
STAGE OF MAX. PARALYSIS
MAINLY SUPPORTIVE
TREATMENT
STAGE OF RECOVERY
PREVENT DEFORMITY
CORRECTION OF
DEFORMITY
RETRAINING MUSCLE
ENCOURAGE WALKING
RESIDUAL
PARALYSIS
MORE ACTIVE
ORTHO Rx
IS REQUIRED

15. STAGE OF ONSET :
• NOT POSSIBLE TO DIAGNOSE
• If a child is suspected to have a polio , IM injections, and excessive
physical activity should be avoided.

16. STAGE OF MAX.PARALYSIS
• CHILD NEEDS MAINLY SUPPORTIVE TREATMENT.
• Paralytic limbs may be supported by splints to prevent contracture.
• All the joints should be moved through full range of movement.
• A close watch is kept for suggestive of bulbar polio.

17. STAGE OF RECOVERY
• PRINCIPLES OF TREATMENT :
1. Prevention of deformity : by splintage, mobilisation
2. Correction of deformity
3. Retraining of muscles: progress is judged by Ex of motor power
4. Encourage the walking : appliances

18. STAGE OF RESIDUAL PARALYSIS
1. PREVENTION OR CORRECTION OF DEFORMITY :
• Commonly performed operations :
• For hip deformity : SOUTTERS’ RELEASE
• For knee flexion deformity : WILSON’S RELEASE
• For equinus deformity : tendoachilis lengthening
• For cavus deformity : STEINDLER’S RELEASE
• Tendon transfer operations

19. • LEG LENGTH EQUALISATION
when the leg is short by more than 4 cm, a leg lengthening
procedure may be required.

20. MANAGEMENT OF PREPARALYTIC STAGE :
• Rest in bed
• Analgesics
• Heat : in the form of moist pack, for relieving muscle
soreness

21. MANAGEMENT OF PARALYTIC STAGE :
• Splints : removable splints are used, because paralysed muscle may
cause malposition of joints.
• High fluid intake : compulsory in patients who need to be
catheterized, as secondary infection and calcium phosphate calculi
are common.
• Physiotherapy : to prevent contracture, and relaxes muscle.
• Enemas : if abdominal muscles are weak
• Catheterization : may be necessary for few days.

22. CONVALESCENT STAGE :
• Physiotherapy
• Muscle education
• Appropriate corrective appliances
• Orthopaedic surgery
• Rehabilitation of severely paralysed patients

23. COMPLICATIONS
• Aseptic meningitis
• Acute myocarditis
• Hand, foot & mouth diseases

24. PROGNOSIS
• Total number of cases infected with the poliovirus, 50% do not
develop paralysis.
• 40% develop paralysis of varying degree.
• 10% patient die because of respiratory muscle paralysis.

25. ACCORDING TO WHO…
• Most infected people have no symptoms, or very mild symptoms
and usually go unrecognized.
• In others, initial symptoms include fever, fatigue, headache,
vomiting, stiffness in the neck and pain in the LL.
• There is no cure for polio.
• Heat & physiotherapy & antispasmodic drugs are given to relax the
muscles, but it can not reverse the permanent paralysis.

26. • There are 3 types of wild polio virus ( WPV) – types 1, 2 and 3.
• In September 2015, WPV type 2 was officially declared eradicated.
• Since November 2012, WPV type 3 has not been detected.
• WPV type 1 is probably the only WPV which remains in circulation.

27. VACCINATION
• There are total 6 different vaccines :
1. Inactivated polio vaccine (IPV) – protect against types 1, 2, & 3.
2. Trivalent oral polio vaccine (tOPV) – protect against types 1, ,2, & 3
3. Bivalent oral polio vaccine (bOPV) - protect against types 1 & 3
4. Monovalent oral polio vaccine (mOPV1, mOPV2, mOPV3) – protect
against all types.

28. VACCINE ASSOCIATED PARALYTIC
POLIOMYELITIS
• Very rarely it is seen.
• An adverse event followed by live OPV.
• Increased risk in person >18 years and those who are
immunodeficient.

29. QUIZ TIME
1. How many types of vaccines are used in poliomyelitis ??
2. What are the clinical features of poliomyelitis ??
3. While diagnosing from which conditions you will differentiate
poliomyelitis ??
4. Which investigations are needed to diagnose poliomyelitis ??