The document describes a case of poliomyelitis in a 13-year-old patient who wanted to be a dancer. Within two weeks, they lost coordination and 20 pounds and became paralyzed, turning their passion into pain. Poliomyelitis is a highly infectious viral disease that destroys motor neurons and damages the brain and spinal cord, causing muscle weakness and paralysis. It is classified based on symptoms, and while most cases are asymptomatic or mild, some can result in paralysis affecting the legs, breathing, or both.

1. “I wanted to be a dancer, and dancing was
my passion. But at the age of 13, I started
feeling stiff, my joints ached, and over a
two week period, I lost my coordination
and 20 pounds & the saddest of all is I
became paralyzed. My “Passion” thus
became my “Pain”……”
????????..........

2. POLIOMYELITIS
SHEBA SUSAN
BENNY

3. OBJECTIVES
 Students will recall what they have already
learned about Poliomyelitis and will update
their knowledge regarding the topic and
will demonstrate confidence in taking care
of patients with polio and participate
actively in awareness of polio eradication
& vaccination

4. SPECIFIC OBJECTIVES

5. DEFINITION
“ Poliomyelitis is a highly infectious viral
disease, which destructs the motor
neurons and damages brain and spinal
cord and is characterized by muscle
weakness and paralysis”

6. 1580–1350
BC

7. EPIDEMIOLOGY
 This disease is seasonal, occurs
commonly in summer
 The America in 1994, Eastern Pacific
in 2000 & Europe in 2002 are certified
free from circulation of wild polio virus
 Polio is currently reported wildly in
mainly 4 countries- Nigeria, Pakistan,
Afghanistan, Egypt

9. STATUS OF POLIO IN LAST 12
MONTHS

10. CLASSIFICATION
Non-paralytic Paralytic
Asymptomatic Abortive

11. Asymptomatic
 Contribute more than 90% of the cases
 Occurs when the replication of virus is
restricted to gastro-intestinal tract
 This is the case with attenuated vaccine
strain

12. Abortive
 Also known as subclinical
 Around 5% of cases are subclinical
 Affected persons suffers from minor
symptoms starts with febrile disease &
occurs in the first week of infection

13. Non-paralytic
 About 2% cases are experiencing this type
 Severe form of polio
 Starts 3-4 days later to the onset of
infection
 Symptoms last for 2 weeks
 Symptoms are associated with aseptic
meningitis
 Virus progress to brain and infects
meninges

14. Paralytic
 Less than 1% of cases are this type
 This is the most severe form of polio
 About 4 days after the end of first
minor symptoms, virus spread to the
anterior horn cells of the spinal cord
and to the motor cortex of brain
 Degree of paralysis depends upon the
neuron affected & amount of damage
it sustain

15. Spinal
Bulbar
Bulbospinal
TYPES OF PARALYTIC
POLIO

17. ETIOLOGY
 It is caused by 3 poliomyelitis virus types
with different antigenic characteristics
 Brunhilde
 Lansing
 Leon

18. MODE OF SPREAD
 In developing countries- ‘feco oral’
transmission (poor sanitation)
 Industrialized countries- ‘oral
pharyngeal’ transmission
 During outbreaks- ‘oral pharyngeal’
transmission

19. COMMUNICABILITY PERIOD
 As the virus is shed in feces,
transmission is via feco-oral route
through ingestion of contaminated
food or water
 Virus is shed in stools for 6-8 weeks
 Average incubation period is 7-10
days
 Virus spreads rapidly to non-immune
persons
 Humans are the only reservoir of polio
virus and infection is spread from

20. PATHOPHYSIOLOGY
Virus enters the body
through feco-oral route
Reaches digestive tract and
attaches to specific
receptors
Replicates in the intestinal
mucosa

22. Path physiology…..contd
Enters the blood stream
Virus enters the nervous
system through blood
Spread along the axons of
peripheral nerves to CNS

23. Path
physiology…….contd
Progress along the fibers of
motor neuron of brain and
spinal cord
Destroys anterior horn cells
of spinal cord or nerves
within bulbar region
Nerve cell death results in
failure of contraction of
muscles

26. Path
physiology…….contd
Muscle dysfunction results
in respiratory failure and
paralysis of legs
Virus is excreted
through feces and
contributes in further
contamination & spread

27. CLINICAL MANIFESTATIONS
Sub-clinical
Headache Fever
Fatigue
Sore
throat
Vomiting

28. C/M….contd

29. C/M……contd
Paralytic

30. DIAGNOSIS
 It is based on symptoms
 Absence of history of immunization or
presence of an epidemic in a particular
region strengthens the diagnosis

31. Diagnosis……..contd
Lab investigations & findings
 Isolation of polio virus from the stool
 WBC count will be normal or slightly
elevated
 Virus can be detected from onset to
>_8weeks after paralysis
 CSF findings:-
Appearance-clear
Protein-normal initially & rise up to
300mg% in 2-3 weeks after onset

32. DIFFERENTIAL DIAGNOSIS
Most common two are..
 Guillian Barre syndrome
 Transverse myelitis
Other conditions are..
 Traumatic neuritis
 Meningitis
 encephalitis

33. TREATMENT OF POLIO IN EARLY
YEARS

35. TREATMENT
“Treatment should be early and appropriate to
the stage and degree of paralysis”
Acute stage (2-4 weeks)
Strict bed rest to minimize extent of paralysis
Symptomatic relief of muscle tightness & spasm, by
administering analgesics, combined with application of
hot packs for 15-30 mts to affected part, every 4 hours
Parasympathetic stimulant such as Urocholine can be
given for urinary retention
Suitable body alignment in paralytic cases to avoid
skeletal deformity
A firm bed prevents sagging of spine

36. Treatment
Acute stage
contd….
If muscles of foot are involved, feet should be
kept at right angle to the legs
In bulbar poliomyelitis, with pooling of secretion
main concern is airway maintenance & avoid risk
of aspiration. Tracheostomy may be required.

37. Recovery or convalescent (3-6
mnths)
 At this stage, emphasis is on
physiotherapy
 As soon as the pain subsides, passive
movements can be started to prevent joint
stiffness

38. Rehabilitatio
n
Certain patients remain permanently
paralyzed despite vigorous physiotherapy
Severe deformities & contractures require
surgical corrections

39. Any idea who they
are?...

40. VACCINES
 Two types of vaccines are available
world wide
◦ The live attenuated oral polio
vaccine(Salk)
◦ Inactivated or killed poliovirus
vaccine(Sabin)
 Both the vaccines are available as
trivalent preparations containing 3
types of polio virus and both when
used as recommended, provide good
protection from paralytic poliomyelitis
as well as control of disease

41. PROGNOSIS
 Decreased incidence of polio cases
and improved medical care has
resulted in a marked reduction in the
Mortality rate
 Bulbar polio is the most severe form
with relatively poor prognosis
 Estimation was that 10-15% of all
cases of polio results in permanent
paralysis

42. PREVENTION
 Immunization with polio vaccine is the
mainstay in the prevention of polio
 Infant born to mothers with antibodies
are protected naturally against
paralytic disease for a few weeks
 Immunity is acquired through infection
with the wild virus through
immunization
 The Global Polio Eradication Initiative
has significantly reduced the no.of
cases reported

43. OUR ROLE
 Strengthening of routine immunization
 Improve environmental sanitation