Polio

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POLIOMYELITIS
By VYOM JAIN

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Did You Know.......
• First described by Michael Underwood in 1789.
• First outbreak described in U.S. in 1843.
• More than 21,000 paralytic cases reported in
the U.S. in 1952.
• Global eradication within this decade.

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What is Poliomyelitis?
•The words polio (grey) and myelon (marrow,
indicating the spinal cord) are derived from the
Greek.
•Poliomyelitis is a disease of the anterior horn
motor neurons of the spinal cord and brain
stem caused by poliovirus.

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•Poliomyelitis, literally meaning “grey spinal cord
inflammation
•It is a viral infection
•There are three types of poliovirus and many strains
of each type
•It is contagious: usually spread from person to
person.
•Only harmful to humans
•Virus localized in the anterior horn cells of
the spinal cord and certain brain steam
motor nuclei.

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CAUSES: POLIOVIRUS
GENUS : Enterovirus
SPECIES : poliovirus
STRUCTURE : ssRNA enclosed in a protein capsid.
TYPES : Three types :- PV1, PV2, PV3. diffrentiated by
the type of capsid protein.
SIZE : 30nm in diameter with icosahedral symmetry
PV1 is most common encountered form & the one
most commonly associated with the paralysis.

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• Minimal heterotypic immunity between serotypes
• Rapidly inactivated by heat, formaldehyde, chlorine,
ultraviolet light
All three are extremely virulent & produces the same disease
symptoms.
 Poliomyelitis is a disease caused by infection with the
poliovirus. The virus spreads by:
• Direct person-to-person contact
• Contact with infected mucus or phlegm from the nose or
mouth
• Contact with infected feces

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PATHOGENESIS.......
•Entry into mouth.
•Replication in pharynx, GI tract, Local
Lymphatics.
•Haematologic spread to lymphatic and central
nervous system.
•Viral spread along nerve fibers.
•Destruction of motor neurons.

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CLASSIFICATION.......
On the basis of symptoms:
1. Symptomatic
2. Asymptomatic
• 91%-95% of all cases are generally Asymptomatic.
• 4%-8% cases shows some symptoms i.e. Symptomatic.
Symptomatic are further divided into two types:
• Mild & Abortive Polio called as Non-paralytic Polio.
• Severe Polio called as Paralytic Polio (0.1%-2% of cases)

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Paralytic polio also may be classified as:
1. Spinal polio - attacks motor neurons in the spinal cord
and causes paralysis in arms and legs and breathing
problems
2. Bulbar polio - affects neurons responsible for sight,
vision, taste, swallowing, and breathing
3. Bulbospinal polio - both spinal and bulbar polio.

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SYMPTOMS:-
1. Acute Stage:-
• Generally last for 7 to 10 days.
• Many includes fever , pharyngitis, headache, anorexia,
nausea, and vomiting.
• These patients develop a higher fever & sever
headache with stiffness of the neck and back.
• Paralysis of the respiratory muscles or from cardiac
arrest if the neurons in the medulla oblongata are
destroyed.

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2. Convalescent Stage:-
• From 2 days after the temperature return to normal and
continues for 2 years.
• Muscle power improves.
• Physical therapy is recommended for full recovery.
• Passive stretching exercises and wedging casts can be used
for mild to moderate contractures.
• Surgical release of tight fascia and muscle aponeuroses and
lengthening of tendons may be necessary for contractures
persisting longer than 6 months.
• Orthoses should be used until no further recovery is
anticipated.

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3. Chronic Stage :-
• 24 months after the active illness:
•The goals of treatment include correcting any significant
muscle imbalance and preventing or correcting soft tissue or
bony deformities.
• Static joint instability can be controlled by Orthoses.
•Dynamic joint instability result in a fixed deformity that
cannot be controlled by Orthoses.

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There are three basic patterns of polio infection: Subclinical
infections, Paralytic, Non-paralytic. Most people have
subclinical infection, and may not have symptoms.
SUBCLINICAL INFECTION SYMPTOMS
• General discomfort or uneasiness (malaise).
• Headache.
• Red Throat.
• Sore Throat.
• Slight Fever.
• Vomiting.

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Exams & Tests.....
The health care provider may find:
• Abnormal reflexes
• Back Stiffness
• Difficulty in lifting head or legs when lying flat on the back
• Stiff neck
• Trouble bending the neck.
Test includes :
• Culture of throat washing, stools or spinal fluids.
• Spinal tap and examination of the spinal fluid using
PCR.
• Test for the level of antibodies for the polio virus.

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Treatment:-
• The goal of the treatment is to control symptoms while the
infection runs its course as there are no specific treatment for the
viral infection.
• Treatment may includes :
• Antibiotic for urinary tract infection.
• Moist heat to reduse pain and muscle spasm
• Pain killer to reduce muscle pain, headache(narcotics are
not given).
• Physical therapy, braces or corrective shoes, or orthopedic
surgeryto help recover muscle strength & function

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Possible complications :
• Aspiration pneumonia
• Cor pulmunale (type of heart failure found on right side of
circulatory system)
• Lack of movement
• Lung problems
• Myocarditis
• Paralytic ileus (loss of intestinal functions)
• Permanent muscle paralysis, disability, deformity.
• Pulmonary edema
• Shock
• Urinary tract infactions.

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In immune individuals, IgA antibodies against poliovirus are
present in the tonsils and gastrointestinal tract, and are able to
block virus replication; IgGand IgM antibodies against PV
can prevent the spread of the virus to motor neurons of the
central nervous system. Infection or vaccination with one
serotype of poliovirus does not provide immunity against the
other serotypes, and full immunity requires exposure to each
serotype.
A rare condition with a similar presentation, nonpoliovirus
poliomyelitis, may result from infections with nonpoliovirus
enteroviruses.

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Post Polio Syndrome.....
Post-polio syndrome is a cluster of disabling signs and symptoms
that affect some people several years — an average of 35 years —
after they had polio. Common signs and symptoms include:
• Progressive muscle or joint weakness and pain
• General fatigue and exhaustion after minimal activity
• Muscle atrophy
• Breathing or swallowing problems
• Sleep-related breathing disorders, such as sleep apnea
• Decreased tolerance of cold temperatures
• Cognitive problems, such as concentration and memory difficulties
• Depression or mood swings

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figure:
Stem cell
therapy
for post
polio
syndrome

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Rehabilitation Program.........
1. Physical Therapy
Physical therapy plays an important role in rehabilitation for
patients with poliomyelitis. Patients with muscle paralysis benefit
from frequent passive range of motion (PROM) and splinting of
joints to prevent contracture and joint ankylosis. Chest physical
therapy (CPT) helps patients with bulbar involvement prevent any
pulmonary complications, such as atelectasis. Frequent
repositioning of paralyzed patients helps to prevent bedsores.
Orthotic treatment for deformities around the knee in
poliomyelitis.

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3. Recreational Therapy
Patients may attend leisure activities to reduce stress and learn
how to get involved in group activities.
2. Occupational Therapy
Patients with paralysis of the extremities may benefit from hand
or arm splints, knee or trochanter rolls, a footboard, or Multi-
Podus boots to prevent foot drop, ulcers, and other deformities.
Hot packs also are helpful to relieve the muscle pain.

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4. Speech Therapy
Patients with cranial nerve involvement may develop swallowing
dysfunction. To protect the airway and prevent aspiration
pneumonia, a speech therapist needs to be involved early to
perform an evaluation of the safety of swallowing. Decisions on
the appropriate consistency of oral foods and use of various
strategies/techniques greatly reduce the risk of aspiration.
Periodic follow up of patient status can be performed with serial
video swallow testing.

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Graph showing the variability in number of patients on different time zones....
Together lets eradicate polio from the world

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Join hands for a polio
free world :)

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Polio

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