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iomyelitis
Poliomyelitis
– P o lio m y elitis is an acute viral infectio n d ue to a p o lio virus ( sero ty p es 1 , 2 and 3 ) .
H um an- to - hum an transm issio n is d irect (faecal- o ral) o r ind irect ( ingestio n o f fo o d
and water co ntam inated by sto o l) . H um ans are the o nly reservo ir o f the virus. I n
p rincip le the d isease can be erad icated by m ass vaccinatio n with o ral p o lio vaccine
(O P V ).
– I n end em ic areas, ep id em ics usually affect ch ild ren und er 5 y ears o f age. I n no n-
end em ic areas, where vaccinatio n co verage is lo w, y o ung ad ults are m o st co m m o nly
affected .
Clinical features
– In m o re than 9 0 % o f cases, infectio n is asy m p to m atic.
– Non-paralytic form: a no n-sp ecific febrile illness with m uscle p ain, head ache, vo m iting,
back ache; no neuro lo gical invo lvem ent.
A s sp o ntaneo us reco very usually o ccurs within 1 0 d ay s, d iagno sis is rarely m ad e
o utsid e ep id em ic co ntexts.
– Paralytic form: in less th an 1 % o f cases, after th e no n- sp ecific signs, th e p atient
d evelo p s rap id o nset (fro m the m o rning to the evening) asy m m etrical acute flaccid
p araly sis, p red o m inantly o f th e lo w er lim bs, w ith ascend ing p ro gressio n. Th e
m uscles beco m e so ft with d im inished reflexes. S ensatio n is m aintained . The d isease
is life th reatening if p araly sis invo lves th e resp irato ry m uscles o r m uscles o f
sw allo w ing. I nitial urinary retentio n is co m m o n. G astro intestinal d isturbances
(nausea, vo m iting, d iarrho ea), m uscle p ain and m eningeal sy m p to m s m ay also o ccur.
Laboratory
L o o k fo r th e p o lio virus in sto o l sam p les. Th e virus is excreted fo r o ne m o nth after
infectio n, but o nly interm ittently ; th erefo re, 2 sam p les m ust be co llected w ith an
interval o f 4 8 ho urs.
Treatment
– H o sp italise p atients with th e p araly tic fo rm : rest, p revent bed so res in bed rid d en
p atients, give analgesics (d o no t give I M injectio ns to p atients in the febrile p hase),
ventilate p atients with resp irato ry p araly sis.
– P h y sio th erap y o nce th e lesio ns are stab le to p revent m uscle atro p h y and
co ntractures.
– C are fo r sequelae: p hy sio therap y , surgery and p ro sthetics.
192
Poliomyelitis
– P o lio m y elitis is an acute viral infectio n d ue to a p o lio virus ( sero ty p es 1 , 2 and 3 ) .
H um an- to - hum an transm issio n is d irect (faecal- o ral) o r ind irect ( ingestio n o f fo o d
and water co ntam inated by sto o l) . H um ans are the o nly reservo ir o f the virus. I n
p rincip le the d isease can be erad icated by m ass vaccinatio n with o ral p o lio vaccine
(O P V ).
– I n end em ic areas, ep id em ics usually affect ch ild ren und er 5 y ears o f age. I n no n-
end em ic areas, where vaccinatio n co verage is lo w, y o ung ad ults are m o st co m m o nly
affected .
Clinical features
– In m o re than 9 0 % o f cases, infectio n is asy m p to m atic.
– Non-paralytic form: a no n-sp ecific febrile illness with m uscle p ain, head ache, vo m iting,
back ache; no neuro lo gical invo lvem ent.
A s sp o ntaneo us reco very usually o ccurs within 1 0 d ay s, d iagno sis is rarely m ad e
o utsid e ep id em ic co ntexts.
– Paralytic form: in less th an 1 % o f cases, after th e no n- sp ecific signs, th e p atient
d evelo p s rap id o nset (fro m the m o rning to the evening) asy m m etrical acute flaccid
p araly sis, p red o m inantly o f th e lo w er lim bs, w ith ascend ing p ro gressio n. Th e
m uscles beco m e so ft with d im inished reflexes. S ensatio n is m aintained . The d isease
is life th reatening if p araly sis invo lves th e resp irato ry m uscles o r m uscles o f
sw allo w ing. I nitial urinary retentio n is co m m o n. G astro intestinal d isturbances
(nausea, vo m iting, d iarrho ea), m uscle p ain and m eningeal sy m p to m s m ay also o ccur.
Laboratory
L o o k fo r th e p o lio virus in sto o l sam p les. Th e virus is excreted fo r o ne m o nth after
infectio n, but o nly interm ittently ; th erefo re, 2 sam p les m ust be co llected w ith an
interval o f 4 8 ho urs.
Treatment
– H o sp italise p atients with th e p araly tic fo rm : rest, p revent bed so res in bed rid d en
p atients, give analgesics (d o no t give I M injectio ns to p atients in the febrile p hase),
ventilate p atients with resp irato ry p araly sis.
– P h y sio th erap y o nce th e lesio ns are stab le to p revent m uscle atro p h y and
co ntractures.
– C are fo r sequelae: p hy sio therap y , surgery and p ro sthetics.
192
