This document appears to be notes from a presentation on Poliomyelitis (Polio). It covers topics such as the causative agent (Poliovirus), modes of transmission (fecal-oral route), risk factors (age, lack of immunization), clinical features (asymptomatic, abortive polio, paralytic forms), diagnosis (cultures, spinal fluid exam), treatment (supportive care, physical therapy), prevention (vaccination schedules), and nursing management considerations. The presentation provides an overview of Polio from its introduction and pathogenesis through clinical presentation, diagnosis, treatment and prevention.

1. CLASS ROOM
TEACHING
P R E S E N T E D T O
M R S . M A H A L A K S H M I M S C ( N )
T U T O R
M M M C O N
P R E S E N T E D B Y
C L I N C Y S P E R C I Y A
M S C ( N ) I Y E A R
M M M C O N

2. Any guess ??

3. Introduction
• Poliomyelitis often called Polio or infantile paralysis is an acute, viral, infectious disease
spread from person to person, primarily via the fecal-oral route.
• The term “Poliomyelitis” derives from the ancient Greek word Polio’s means “grey” and
myelos meaning “marrow” referring to the grey matter of the spinal cord. The suffix itis
denotes inflammation, i.e. inflammation of the spinal cord’s grey matter.
• A severe infection can extend into the brain stream and even higher center resulting in Polio
encephalitis and apnea.

4. Causative Agent
• Poliomyelitis is a communicable disease caused by a virus named Poliovirus
• ENTEROVIRUS

5. MODE OF TRANSMISSION
• Poliovirus is transmitted by the fecal-oral route through ingestion. Inhalation or entry
through conjunctiva of droplets of respiratory secretions may also be possible modes of
entry in close contacts of patients in early stage of disease.
• The virus multiplies initially in the epithelial cells of the alimentary canal and the lymphatic
tissues. It then spreads to the lymph nodes and enters the blood stream.
• After further multiplication in the reticulo-endothelial system, the virus enters the blood
stream again and it is carried to the spinal cord and brain.
• Incubation Period: The time from being infected with the virus to developing symptoms of
disease ranges from 5-35 days(average 7-14 days)

6. DIFFERENT TYPES
• In about 1% of cases, the virus enters the central nervous system, preferentially
infecting and destroying motor neurons leading to muscle weakness and acute
flaccid paralysis. Depending on the nerves involved , Poliomyelitis can be
classified as follows
1) Spinal Polio: It is the most common form characterised by asymmetric paralysis
that most often involves the legs.
2) Bulbar Polio: This leads to weakness of muscles innervated by cranial nerves.
3) Bulbospinal Polio: It is a combination of bulbar and spinal paralysis.

7. RISK FACTOR
• AGE: infant and elderly
• Living with an infected person
• Compromised immune system
• Lack of immunization against polio
• Travelling to an area that has experienced a polio break

8. CLINICAL FEATURES
Inapparent / asymptomatic (90 – 95%)
• 95 % of the cases
• Virus stays in the intestinal tract and does not attack the nerves
• Virus shed in the stools so infected individual is still able to infect others
Apparent / symptomatic ( 5 – 10%)
• Abortive polio
• Non paralytic aseptic meningitis
• Paralytic poliomyelitis
• Polio encephalitis

9. ABORTIVE POLIO
4 – 8 % , does not lead to paralysis
Minor illness
Symptoms
 Low grade fever
 Sore throat
 Vomiting
 Abdominal pain
 Loss of appetite
 Malaise

10. NON – PARALYTIC ASEPTIC MENINGITS
• Occurs in 1- 2 % of polio infection
Symptoms:
Headache
Nausea
Vomitting
Pain and stiffness of neck, back and legs
Complete recovery after 2- 10 days of symptoms

11. PARALYTIC POLIOMYELITIS
0.5 – 1 %
Minor – same as abortive polio
Major – muscle pain, spasm and return of fever
It is of three types
• Spinal paralytic poliomyelitis
• Bulbar poliomyelitis
• Bulbo-spinal poliomyelitis

12. SPINAL PARALYTIC POLIOMYELITIS
• 79 – 80 %
• Attacks motor neurons in the spinal cord and causes paralysis
• Affects muscles of legs , arms and trunk
• Severe cases – quadriplegia , paralysis of trunk, abdominal and
thoracic muscles.

13. Bulbar poliomyelitis
• Affects neurons responsible for sight, vision, taste, swallowing and breathing
• 2% of paralytic polio
• Life threatening
• Affects cranial nerve function
• Primarily inhibits ability to breath, speak and swallow effectively
• Facial asymmetry present

14. Symptoms
• Nasal twang and hoarseness of voice
• Nasal regurgitation
• Dyspnea
• Dysphagia
• Child refuses to feed
• Secretion accumulation
• Shallow and irregular respiration
• Dusky and mottoled skin
• Restless, confused and comatose

15. BULBO SPINAL POLIOMYELITIS
• 19% of paralytic cases
• Affects extremities and cranial nerves
• Leads to severe respiratory involvement
• Combination of spinal paralytic and bulbar polio

16. Polio encephalitis
• Occurs in rare cases
• Causes inflammation of grey matter of brain
• Autonomic dysfunction is common and it has a high mortality
Signs and symptoms
• Agitation
• Confusion
• Stupor
• Coma
• Irritability
• delirium

17. Diagnosis and Tests
• The health care provider may find:-
Abnormal reflexes, Back stiffness, Difficulty in lifting the head or legs when lying
flat or the back stiff neck, trouble bending the neck.
• Tests includes
Cultures of throat washing, stools or spinal fluid, spinal tap and examination of
the spinal fluid (CSF exam.) using PCR. Test for levels of antibodies to the Polio virus.

18. Treatment
• Symptomatic and supportive
The goal of the treatment is to control symptoms
Treatment may includes
Hospitalization (may be required for those individuals who develop paralytic
poliomyelitis)
If the respiratory in involved , long term ventilation is necessary
Catheterization – antibiotic
Moist heat application

19. • Physical therapy
• Braces or corrective shoes
• Orthopaedic surgery to help recover muscle strength and function
• Bed rest
• Optimum position for limbs
• Physio therapy
• Good nursing
• Diet
• Occupational therapy
• Speech therapy

20. Complication
• Myocarditis
• Hypertension
• Pulmonary edema
• Pneumonia
• Urinary tract infections
• Compression neuropathy
• Scoliosis
• Osteoporosis
• Bone fracture
• Skeletal deformities

21. NURSING MANAGEMENT
• NURSING DIAGNOSIS
Imbalanced nutrition
Ineffective thermoregulation
Inefffectice airway clearance
Ineffective breathing pattern
Acute pain
Impaired physical mobility

22. PROGNOSIS
• Non paralytic cases complete recovery
• Paralytic polio – permanent weakness in 2/3rd cases
• Worse – older children, sudden onset of illness with high fever
Post polio syndrome
Affects about 25 – 50% of the polio survivors

23. Prevention
• Vaccination ( IPV & OPV )
ROUTE ORAL
SITE MOUTH
NO OF DOSE 3 DOSES
AGE AT FIRST DOSE 6 WEEKS
MINIMUM INTERVAL
BETWEEN EACH DOSE
4 WEEKS
DOSAGE 2 DROPS
STORAGE TEMPERATURE -15 TO -20 C

24. ??

25. ANY QUESTIONS??

26. THANK YOU!!!