Poliomyelitis-1

Poliomyelitis
Long question
• Describe etiology, CF, Ix and Rx of poliomyelitis
Introduction
• Group: ENTEROVIRUS
• There are three antigenic types of polioviruses.
• Type 1: Most common poliovirus
• Type 2
• Type 3
Structure of poliovirus
Antigens of poliovirus:
• The D antigen (dense)
• It is associated with the whole virion.
• Type-specific.
• Anti-D antibodies are protective.
• The C antigen (capsid):
• It is associated with the noninfectious virus.
• Less specific.
• Anti-C antibody does not neutralize virus infectivity.
Pathogenesis
• Mode of transmission:
• Faeco-oral route (most common): Contaminated
water or food.
• Respiratory droplets via inhalation.
• Conjunctival contact: very rare.
• Multiply locally: It multiples in intestinal epithelial
cells, sub mucosal lymphoid tissues, tonsils and
peyer‘s patches.
• Receptor: Viral entry into the host cells is mediated
by binding to CD155 receptors present on the host
cell surface.
Spread to CNS/spinal cord:
• Hematogenous spread (most common):
• Virus spreads to the regional lymph nodes and spills
over to the bloodstream (primary viremia).
• After further multiplying in the reticuloendothelial
system, the virus enters the bloodstream again,
causing secondary viremia.
• Then it is carried to the spinal cord and brain.
Spread to CNS/spinal cord:
• Neural spread:
• Virus may also spread directly through nerves.
• This occurs especially following tonsillectomy where
the virus may spread via glossopharyngeal nerve.
• Site of action:
• The final target site for poliovirus is the motor nerve
ending i.e. anterior horn cells of the spinal cord.
• Neuron degeneration:
• Virus-infected neurons undergo degeneration.
Earliest change in neuron is the degeneration of Nissl
body.
Clinical features
• The incubation period is usually 7-14 days.
• Stages of poliomyelitis:
• Inapparent infection
• Abortive infection
• Nonparalytic poliomyelitis
• Paralytic poliomyelitis
• Inapparent infection:
• Following infection, the majority (91- 96%) of cases
are asymptomatic.
• Abortive infection:
• About 5% of patients develop minor symptoms such
as fever, malaise, sore throat, anorexia, myalgia, and
headache.
• Nonparalytic poliomyelitis:
• It is seen in 1% patients, presented as aseptic
meningitis.
• Paralytic poliomyelllis:
• It is the least common form ( < 1 %) among all the
stages.
• It is characterized by descending asymmetric acute
flaccid paralysis (AFP).
• Proximal muscles are affected earlier than the distal
muscles; paralysis starts at the hip proceeds
towards extremities; which leads to the characteristic
tripod sign (child sits with flexed hip, both arms are
extended towards the back for support).
Paralytic poliomyelllis is subdivided into
following types
• Spinal polio –
• The most common type
• Characterized by asymmetric paralysis that most often
involves the legs.
• Bulbar polio –
• Accounts for 2% of cases
• Leads to weakness of muscles innervated by cranial
nerves.
• Bulbospinal polio –
• It accounts for 19% of cases
• Combination of bulbar and spinal paralysis.
• Risk factors for paralytic polio:
• Older children.
• Pregnant women.
• Following heavy muscular exercise.
• Persons undergoing trauma at time of CNS
symptoms.
• Tonsillectomy
• Intramuscular injections
Investigations
• Virus Culture
• Isolation of virus by cultures, from the stool or
throat swab or cerebrospinal fluid (rare).
• Antibody Detection
• Rising antibody titer in paired sera collected 1-2
weeks interval is recommended.
• Cerebrospinal fluid (CSF) examination
• Increased number of white blood cells
• Mildly elevated protein level in CSF
Management
• Treatment of pain with analgesics.
• Antibiotics for secondary infections.
• Fluid Therapy
• Bed rest (until fever is reduced)
• Adequate diet
• Minimal exertion and exercise
• Hot packs or heating pads (for muscle pain).
• Prolong rehabilitation may be necessary including
braces, splint or surgery.
Management
• Hospitalization (may be required for those
individuals who develop paralytic poliomyelitis).
• If the respiratory is involved, LONG-TERM
VENTILATION is necessary.
• Physiotherapy may be necessary.
• Place the child on firm mattress with support for
feet, change position frequently.
• Encourage oral intake of food and fluid.
• Catheterization of distended bladder may be
necessary.
Prevention
• Ensuring hygiene and encouraging good
sanitation practices.
• Polio vaccine has been developed against all 3
subtypes of the poliovirus
• Two types of vaccine are available:
• An inactivated (killed) polio vaccine (IPV) and
• A live attenuated (weakened) oral polio
vaccine (OPV).
GUIDE ON POLIOMYELITIS
IMMUNIZATION (OPV)
Route Oral
Site Mouth
Number of Dose 3 doses
Age at First Dose 6 weeks after birth
Minimum Intervals 4 weeks
between Doses
Dosage 2 drops
Storage Temperature -15 to -25 °C

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