Poliomyelitis

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Poliomyelitis

• Dept. Of Infectious Disease
• 2nd Affiliated Hospital
• CMU

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Definition

• Poliomyelitis is acute infectious disease caused
  by poliovirus.
• Infantile paralysis.
• Pathologic lesions motor neurons in the gray
  matter in the anterior horn of the spinal cord..
• Clinical feature

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Definition

• Clinical feature fever
• sore throat
• muscle pain
• paralysis

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Etiology

• Causative agent poliovirus
• family Picornaviridae, genus Enterovirus
• single strain RNA
• Resistance Sensitive to heat, oxidant
• ultraviolet rays

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Etiology

• Serotype
• on the basis of neutralization tests.
• Type I
• Type II
• Type III
• no cross immunity

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Epidemiology

• Source of infection
• patients and carriers
• inapparent inf. non-paralytic inf.
• Route of transmission
• air-borne, respiratory tract
• fecal-oral route

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Epidemiology

• Susceptibility
• universal susceptible to polio
• covert infection gt90
• paralytic patientslt1
• lifelong immunity to same type virus
• Epidemiologic features
• children under 5yrs, 6m5yrs
• summer fall

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Pathogenesis
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poliovirus
oral
air
epithelial cells (in pharynx, intestine)
covert infection
regional lymphatics
Ab
blood stream
Ab
abortive infection
first viremia second viremia
blood-brain barrier
CNS
paralytic type
non-paralytic type
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Pathology

• Place of lesion
• all of CNS
• spinal cord, brain stem
• motor neurons in anterior horns of cervical
  lumbar enlargement of spinal cord.

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Pathology

• Pathologic features
• neuron necrosis
• inflammatory infiltrate of leukocyte,lymphocyte.

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Clinical manifestation

• Incubation period 514 days
• Clinical types
• Covert infection gt90
• Abortive poliomyelitis 48
• Non-paralytic poliomyelitis
• Paralytic poliomyelitis 12

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Clinical manifestation

• Paralytic poliomyelitis
• Prodromal period
• preparalytic period
• paralytic period
• convalescent period
• sequela period

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Clinical manifestation

• Prodromal period(14d)
• upper respiratory tact infection
• fever, fatigue, sore throat, headache
• intestinal tract infection
• vomiting, diarrhea, constipation
• abortive poliomyelitis

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Clinical manifestation

• Preparalytic period
• progressing this phase without prodromal phase
• 16days after symptoms of prodromal phase
• without prodromal phase

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Clinical manifestation

• Preparalytic period
• fever two-hump fever(1030)
• symptoms signs of CNS
• severe headache vomiting
• dysphoria or lethargy
• muscle pain

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Clinical manifestation

• Preparalytic period
• symptoms signs of CNS
• cutaneous hyperesthesia
• hyperhidrosis
• meningeal irritations (neck stiffness Kernigs
  Brudzinskis signs positive) 36d , nonparalytic
  poliomyelitis

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Clinical manifestation

• Paralytic period
• paralysis types
• spinal type
• brain stem type
• mixed type
• brain type

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Clinical manifestation

• Paralytic period
• Spinal type most common
• paralysis features
• flaccid (hypomyotonia ,tendon reflexes are weak
  or absent)
• asymmetric distribution
• without sensory loss

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Clinical manifestation

• Paralytic period
• Spinal type most common
• paralysis muscles
• paralysis of extremities leg gtarm proximal gt
  distal
• paralysis of diaphragmatic intercostal muscles
  affects respiratory movement
• paralysis of abdominal muscle -- stubborn
  constipation

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Clinical manifestation

• Paralytic period
• Brain stem type
• cranial nerve paralysis 710, then 912,
• facial paresis
• dysphagia, high-pitched voice
• respiratory center paralysis
• central respiratory failure
• cacorhythmic breathing ect.
• vasomotor center paralysis

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Clinical manifestation

• Paralytic period
• brain type - polio-encephalitis
• high fever, convulsion,
• disturbance of consciousness,
• tonic paralysis
• mixed type
• spinal type brain stem type

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Clinical manifestation

• Convalescent period
• paralytic muscles begin to recover
• distal gt proximal,
• at first 34 month quick recovery, 6 month later
  recovery slowly,the recovery process reaches its
  limit around 18 months

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Clinical manifestation

• Sequela period
• persistent paralysis
• muscular atrophies
• deformities of limbs

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Laboratory Findings

• Cerebrospinal fluid
• aseptic menigitis
• pleocytosis 50500109/L
• protein normal or slightly increase
• albuminocytologic dissociation
• glucose and chloride normal
• virus isolation
  pharynx, feces, blood or CSF,brain.

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Laboratory Findings

• Serological test
• Specific IgM Ab (blood CSF)
• Neutralized Ab
• Complement combining Ab
• four fold rise

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Diagnosis

• Epidemiological data
• Clinical manifestation
• Laboratory findings
• Abortive or non-paralytic polio - isolation
  of virus or serological test
  
• paralytic polio - clinical diagnosis

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Differential Diagnosis

• Guillain-Barre Syndrome
• symmetric, ascending paralysis with loss
• of sensation
• CSF protein elevate with absent or
• minimal pleocytosis,
• albuminocytologic dissociation
• rapid and complete recovery
• Coxsackie or ECHO no epidemic no seqela

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Differential Diagnosis

• Paralysis caused by other enterovirus
• Coxsackie or ECHO viruses
• no epidemic no sequelae

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Treatment

• Prodromal preparalytic P
• isolation rest in bed
• not accept muscular injection operation
• hot moist pack to muscles
• 50GSVitC 12g iv, IFN
• hydrocortison

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Treatment

• Paralytic period
• limb paralysis
• nursing for paralytic limbs
• Put the limbs on function position
• Vit C ATP ivdrop
• Galanthamin or Prostipmin iM

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Treatment

• treatment for respiratory obstacle
• bulbar paralysis
• dysphgia
• keep air way clear (sputum aspiration postural
  drainage )
• tracheal intubation
• tracheotomy tank respirator

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Treatment

• treatment for respiratory obstacle
• respiratory center paralysis
• respiratory stimulant
• tracheotomy tank respirator
• respiratory muscle paralysis
• mild observation
• tank respirator

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Treatment

• Convalescent sequela period
• acupuncture
• massage

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Prevention

• control of source of infection
• isolation 40 days after the onset of illness
• protection of susceptible population
• attenuated live vaccine by oral
• killed virus vaccine