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Polio
 

Introduction

     Poliomyelitis is a disorder caused by a viral infection. The virus, known as poliovirus, infects nerves. This infection can lead to temporary paralysis or, in more severe cases, permanent paralysis or death.

Causes

 

  • Virus infection -- the polio virus is transmitted via ingestion of a virus commonly found in human feces and sewage.  In areas where human sewage is allowed to contaminate the drinking water via dumping (pools, lakes, and rivers) the virus can infect older children and adults who come in contact with these waters when swimming, bathing, or ingesting.

  • The virus may enter through the nose or mouth, then invade the intestine, where they move into intestinal cells and multiply into thousands of new virus particles.  These are then excreted through the stool (for weeks), thereby renewing the cycle and endangering the entire community with the risk of infection.

  • Infection is usually mild with only symptoms of Diarrhea and minor discomfort.  The infection resolves on it's own without much damage to the body.  However, in about 1% of all cases, the virions (virus particles or offspring) enter the blood stream and infect the cells of the nervous system, causing more severe problems, such as muscle wasting, paralysis, Comas, or even death.  Most patients often have full or partial improvement of their muscle functions.

Risk Factors

  

  • Children at high risk

  • Especially young children not yet toilet trained

  • Adults who have not been vaccinated

  • Travel to areas where sanitation and hygiene are inadequate and polio is present

  • Low socio-economic (poor, under- privileged) class

  • Regions where flies from infected feces are allowed to contaminate food

  • Infected water sources (near sewage dumping grounds)

  • Low body defenses (immunodeficiency syndromes) such as AIDS and cancer

  • Injections -- intramuscular (e.g., DPT vaccine)

  • Injury

  • Pregnancy

  • Tonsillectomy (removal of tonsils)

  • Emotional or physical stress

Symptoms 

     There are three basic patterns of polio infection: subclinical infections, nonparalytic, and paralytic. Approximately 95% of infections are subclinical infections, which may go unnoticed.

     Clinical poliomyelitis affects the central nervous system (brain and spinal cord), and is divided into nonparalytic and paralytic forms. It may occur after recovery from a subclinical infection.

     SUBCLINICAL INFECTION

   

  • No symptoms, or symptoms lasting 72 hours or less

  • Slight fever  

  • Headache

  • General discomfort or uneasiness (malaise)

  • Sore throat

  • Red throat

  • Vomiting

     NONPARALYTIC POLIOMYELITIS

  • Symptoms last 1 to 2 weeks

  • Moderate fever

  • Headache

  • Vomiting

  • Diarrhea

  • Excessive tiredness, fatigue  

  • Irritability

  • Pain or stiffness of the back, arms, legs, abdomen

  • Muscle tenderness and spasm in any area of the body

  • Neck pain and stiffness

  • Pain front part of neck

  • Back pain or backache

  • Leg pain (calf muscles)

  • Skin rash or lesion with pain

  • Muscle stiffness

     PARALYTIC POLIOMYELITIS

  • Fever, occurring 5 to 7 days before other symptoms

  • Headache

  • Stiff neck and back

  • Muscle weakness, asymmetrical (only on one side or worse on one side)

    • Rapid onset

    • Progresses to paralysis

    • Location depends on where the spinal cord is affected

  • Abnormal sensations (but not loss of sensation) of an area

  • Sensitivity to touch, mild touch may be painful

  • Difficulty beginning to urinate

  • Constipation

  • Bloated feeling of abdomen

  • Swallowing difficulty

  • Muscle pain

  • Muscle contractions or muscle spasms, particularly in the calf, neck, or back

  • Drooling

  • Breathing difficulty

  • Irritability or poor temper control

  • Positive Babinski's reflex

Screening and Diagnostics

  • History of the illness, symptoms, risk factors, and vaccination

  • Medical exam:

    1. Fever

    2. Breathing problems

    3. Difficulty with making faces, swallowing

    4. Muscle wasting

    5. Absent reflexes, such as the knee jerk reflex

    6. Muscle tenderness or stiffness

    7. Neck stiffness or pain

  • Tests:

    1. Collect the secretions from the throat, obtain stool samples, or perform a spinal tap -- and send to laboratory to confirm diagnosis of polio by demonstrating presence of virions.

    2. Spinal tap done by inserting a needle in between the vertebral bones of the spine and removing a small amount of cerebrospinal fluid (CSF) for analysis.

    3. CSF will show increased white blood cells (cells that fight infection), protein, and pressure.

    4. MRI, CAT scan, and X-Rays done if infection, tumor, or other conditions suspected

    5. The physician will consult with an infectious disease physician, a neurologist (nerve and muscle doctor), and notify the local public health officials.

Treatment

  • Is aimed at treating symptoms until the illness runs its course

  • For severe illness or new onset, admit to the hospital

  • Bed rest with frequent turning, good skin care, and a good mattress to prevent development of bed (pressure) sores

  • Tylenol and other medications for pain and fever

  • Avoid use of addictive drugs for pain and spasm

  • Antibiotics may be needed for bacterial infections.

  • Medications for Muscle Spasms, urinary problems, or Constipation

  • Dietary evaluation and good diet is necessary.

  • Mechanical ventilation and oxygen therapy, if needed.

  • Respiratory therapists consulted for those with breathing problems

  • Physical therapy works with weak or wasted (atrophic) muscles and to prevent contractures (freezing in one place) of knees and elbows, or to reduce spasm and pain.

  • Speech therapist may be consulted if there are problems with swallowing.

  • Occupational therapist helps the patient with daily activities of living (i.e. eating, typing, reaching for stuff).

  • Braces, special shoes, walkers, canes, wheel chairs, special safety bars for bathrooms, special toilet seats, special beds, and other devices may be ordered for home use.

  • Therapy and nursing may continue to care for the patient after discharge from hospital.

Prognosis

     The outcome of the disease varies with the form (subclinical, nonparalytic, or paralytic) and the site affected. If the spinal cord and brain are not affected, which is the case more than 90% of the time, complete recovery is likely.

     Brain or spinal cord involvement is a medical emergency that may result in paralysis or death (usually from respiratory difficulties).

     Disability is more common than death. Infection high in the spinal cord or in the brain are associated with greater risk for respiratory difficulty.

Complications   

  • Spread of infection to other non-immunized persons

  • Permanent muscle paralysis, disability, deformity

  • Pulmonary edema

  • Shock

  • Complications of immobility and lung involvement

  • Aspiration pneumonia

  • High blood pressure

  • Urinary tract infections

  • Kidney stones

  • Paralytic ileus (loss of intestinal functioning)

  • Myocarditis

  • Cor pulmonale

Prevention  

     Polio immunization (vaccine) effectively prevents poliomyelitis in most people (immunization is over 90% effective).
 
 

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