Poliomyelitis, commonly known as polio, is a highly infectious viral disease that mainly affects children under 5 years old. It is caused by poliovirus which spreads through fecal-oral transmission or contaminated food and water. While most cases are asymptomatic, it can cause paralysis in some cases. There are three types of poliovirus and three forms of the disease - spinal, bulbar, and bulbospinal. Treatment focuses on managing symptoms and prevention through vaccination with either the inactivated polio vaccine or oral polio vaccine.

1. POLIOMYELITIS
Ms. Ekta S Patel
II Year MSc
Nursing
MSN (Neurology)

2. Introduction:

3. • Poliomyelitis (polio) is a highly infectious viral disease,
which mainly affects young children. The virus is
transmitted by person-to-person spread mainly through the
faecal-oral route or, less frequently, by a common vehicle
(e.g. contaminated water or food) and multiplies in the
intestine, from where it can invade the nervous system and
can cause paralysis.

4. • Initial symptoms of polio include fever, fatigue, headache,
vomiting, stiffness in the neck, and pain in the limbs. In a
small proportion of cases, the disease causes paralysis,
which is often permanent. There is no cure for polio, it can
only be prevented by immunization.

5. Types of
Poliomyelitis:

6. There are three types of polio as listed below:
•Spinal Polio
It is kind of polio that affects the spine system. The
disease does not affect the brain or the spinal cord. This
is not a severe form of disease. It does not cause any
symptoms in the affected person.

7. Bulbar Polio
• Bulbar polio affects the brainstem or the central nervous
system. It does not cause paralysis of the body.

8. Bulbospinal
• – This form of polio affects the spine as well as the
brainstem. This Poliomyelitis results in Paralysis of the
body parts and results in severe disorders. This disease
is even known as a Paralytic form of polio.

9. AETIOLOGY:

10. • Polio is caused by small RNA viruses. They are members of
the enterovirus group of the Picornavirus family. There are
three types (types 1, 2, and 3) of polio viruses; type I is
responsible for about 85% of all paralytic infections. These
types are antigenically distinct strains of viruses and
infection or immunity to one type does not protect against
the other two types, however, if immunity is established to
one or all of the three strains, immunity is lifelong. The
problem that these viruses cause is the destruction of spinal
cord cells (specifically, the anterior horn cells).

11. • Polio, like smallpox, only infects humans. Polio spreads
by person-to-person contact; the virus lives in the throat
and in the intestines and is spread through contact with
the feces or by droplet spread in a sneeze or cough. It
can also be spread by an infected person who has
contaminated food or fluids by touching or tasting them.
Unfortunately, a person can be infectious and transmit the
virus even before they develop any symptoms.

12. • The greatest risk factor for polio is not being vaccinated.
• People with immunodeficiency (HIV, cancer patients,
chemotherapy patients, for example), very young
individuals, pregnant females, caregivers for polio
patients, travelers to areas were polio is endemic, and lab
personnel who work with live polioviruses are at
increased risk for polio.

13. Pathophysiology:

14. • The virus enters via the fecal-oral or respiratory route,
then enters the lymphoid tissues of the GI tract. A primary
(minor) viremia follows with spread of virus to the
reticuloendothelial system. Infection may be contained at
this point, or the virus may further multiply and cause
several days of secondary viremia, culminating in the
development of symptoms and antibodies.

15. • In paralytic infections, poliovirus enters the CNS—
whether via secondary viremia or via migration up
peripheral nerves is unclear. Significant damage occurs in
only the spinal cord and brain, particularly in the nerves
controlling motor and autonomic function. Inflammation
compounds the damage produced by primary viral
invasion. Factors predisposing to serious neurologic
damage include;

16. • Increasing age (throughout life)
• Recent tonsillectomy or intramuscular injection
• Pregnancy
• Impairment of B-cell function
• Physical exertion concurrent with onset of the CNS phase
• Poliovirus is present in the throat and feces during
incubation and, after symptom onset, persists 1 to 2 wk in
the throat and ≥ 3 to 6 wk in feces; the fecal-oral and
respiratory routes are the usual method of transmission.

17. Sign and symptoms:

18. • It’s estimated that 95 to 99 percent of people who contract
poliovirus are asymptomatic. This is known as subclinical
polio. Even without symptoms, people infected with
poliovirus can still spread the virus and cause infection in
others.

19. Non-paralytic polio:
• Signs and symptoms of non-paralytic polio can last from
one to 10 days. These signs and symptoms can be flu-like
and can include:
• fever
• sore throat
• headache
• vomiting
• fatigue
• meningitis
• Non-paralytic polio is also known as abortive polio.

20. Paralytic polio:
• About 1 percent of polio cases can develop into paralytic
polio. Paralytic polio leads to paralysis in the spinal cord
(spinal polio), brainstem (bulbar polio), or both
(bulbospinal polio).
• Initial symptoms are similar to non-paralytic polio. But
after a week, more severe symptoms will appear. These
symptoms include:

21. • loss of reflexes
• severe spasms and muscle pain
• loose and floppy limbs, sometimes on just one side of the
body
• sudden paralysis, temporary or permanent
• deformed limbs, especially the hips, ankles, and feet
• It’s rare for full paralysis to develop. Less than 1 percent
of all polio cases will result in permanent paralysis. In 5–
10 percent of the polio paralysis cases, the virus will
attack the muscles that help you breathe and cause
death.

22. Post-polio syndrome:
• It’s possible for polio to return even after you’ve
recovered. This can occur after 15 to 40 years. Common
symptoms of post-polio syndrome (pps) are:
• Continuing muscle and joint weakness
• Muscle pain that gets worse
• Becoming easily exhausted or fatigued

23. • Muscle wasting, also called muscle atrophy
• Trouble breathing and swallowing
• Sleep apnea, or sleep-related breathing problems
• Low tolerance of cold temperatures
• New onset of weakness in previously uninvolved muscles
• Depression
• Trouble with concentration and memory

24. Diagnostic evaluation:

25. • poliovirus can be detected in specimens from the throat, and
feces (stool), and occasionally cerebrospinal fluid (CSF), by
isolating the virus in cell culture or by detecting the virus by
polymerase chain reaction (PCR).
• CDC laboratories conduct testing for poliovirus including:
• Culture
• Intratypic differentiation
• Genome sequencing
• Serology

26. Virus Isolation:
• Virus isolation in culture is the most sensitive method to
diagnose poliovirus infection. Poliovirus is most likely to
be isolated from stool specimens. It may also be isolated
from pharyngeal swabs. Isolation is less likely from blood
or CSF.

27. • To increase the probability of isolating poliovirus, collect at
least two stool specimens 24 hours apart from
patients with suspected poliomyelitis. These should be
collected as early in the course of disease as possible
(ideally within 14 days after onset).

28. • Real-time reverse transcription PCR is used to
differentiate possible wild strains from vaccine-like strains
(“intratypic differentiation”), using virus isolated in culture
as the starting material.
• Partial genome sequencing is used to confirm the
poliovirus genotype and determine its likely geographic
origin.

29. Serologic testing:
• Serology may be helpful in supporting the diagnosis of
paralytic poliomyelitis, particularly if a patient is known or
suspected to not be vaccinated. An acute serum
specimen should be obtained as early in the course of
disease as possible, and a convalescent specimen should
be obtained at least three weeks later.

30. CSF analysis:
• Detection of poliovirus in CSF is uncommon. CSF usually
contains an increased number of leukocytes [from 10 to
200 cells/mm3 (primarily lymphocytes)] and a mildly
elevated protein (from 40 to 50 mg/100 ml). These
findings are nonspecific and may result from a variety of
infectious and noninfectious conditions.

31. Treatment for
poliomyelitis:

32. • No drug can kill the virus once an infection has begun, but
it can be prevented with vaccine. Treatment is directed at
controlling the symptoms of the disease. People with
minor poliomyelitis are treated with bed rest and over-the-
counter medicines to control fever and muscle aches.
People with major poliomyelitis may require additional
treatments, including:

33. Physical therapy
• – Therapy helps to minimize damage to paralyzed
muscles and to help people regain mobility as the acute
illness resolves. Treatment for paralysis depends on
which muscles are affected.

34. Measures to prevent urinary tract infections
• – If the bladder muscles do not contract normally, the
bladder may not empty completely. This can lead to
urinary infections. Using catheters to empty the bladder
may be necessary, and long-term use of antibiotics is
recommended in some cases.

35. Mechanical breathing support
• When polio weakens the chest muscles so much that
they cannot move the lungs (cannot breathe), people can
be kept alive by placing a tube into their windpipe (the
trachea). This tube is placed through an opening in the
neck, called a tracheotomy. Breathing is performed by a
machine called a ventilator that moves air in and out of
the lungs.

36. • A catheter attached to a suction motor can remove
excessive mucus through the tracheostomy tube. People
who need artificial respiration long-term must live in a
facility that is staffed by nurses and therapists who are
skilled in respiratory care.

37. • There are two vaccines available to fight polio:
• inactivated poliovirus (IPV)
• oral polio vaccine (OPV)