A Detailed Awareness Campaign On Poliomyelitis

Poliomyelitis is an acute infectious disease that is caused by one of three types of poliovirus and is characterized by the large range of clinical forms (from abortive to paralytic one).

Etiology: an agent is the poliovirus from the Picornaviridae family, sort of enterovirus.

Epidemiology:

·  the source of infection are patients, viral carriers;

·  the mechanism of transmission is droplet, fecal-oral

·  receptivity is high, especially at the children up to 3 years.

Pathogenesis

1.     Inoculation and reproduction of virus in the intestinal or upper respiratory tract epithelium.

2.     lymphogenic distribution of virus.

3.     Reproduction in organs and tissues.

4.     Fixation in nervous tissues, damage of motoneurons.

Classification

Forms of poliomyelitis without the CNS damage:

I. Innaparant (virus carrying).

ІІ. Abortive (small illness).

Forms of poliomyelitis with the CNS damage:

І. nonparalytic or meningeal.

ІІ. Paralytic:

1.     Spinal (neck, pectoral, lumbar, limited or widespread).

2.     pontinus.

3.     Bulbar.

4.     Pontospinal.

5.     Bulbospinal.

6.     Bulbopontospinal.

Diagnostic criteria of several poliomyelitis forms

Meningeal:

·        latent period is 5-35 days;

·        severe toxicsyndrome;

·        meningeal syndrome;

·        CSF changes, as at serous meningitis (on 4-5 day);

·        pain in extremities, neck, back;

·        horizontal nistagmus (in half of patients);

·        complete recovery in 3-4 weeks.

Paralytic:

Preparalytic period (lasts for 2-3 days):

·        high fever, intoxication;

·        insignificant catarrhal phenomena;

·        dyspepsia syndrome;

·        pain in a neck, back, extremities;

·        hyperesthesia;

·        positive tension symptoms;

·        typical «trypod» position of a patient

·        CSF changes (as at serous meningitis).

Paralytic period (1 day - 2 weeks):

·        development of languid (peripheral) paralyses and paresis.

·        someximes secondary increasment of the temperature

·        damage of lower limbs (80%), or upper limbs, trunk or neck muscles

·        muscular tonus is decreased

·        tendon rephlexes are absent

Period of rehabilitation (to 1 year):

·        renewal of least staggered motoneurons function.

Residual period

·        Increasing muscular atrophies, contractures, osteoporosis, bone deformations.

  

Spinal form of poliomyelitis

Spinal form of poliomyelitis

  

Pontinus form of poliomyelitis

Specific confirmation of diagnosis:

·        virology research of excrements, pharyngeal mucus, CSF;

·        serologic research (NR, CBR) of paired sera.

Diagnosis example: Poliomyelitis, paralytic pontospinal form, period of rehabilitation

Differential diagnosis

1.     The Spinal form is differentiated with orthopedic pathology, myelitis, poliradiculoneuritis.

2.     Pontinus form - with neuritis of facial nerve.

3.     Meningeal form - with serous meningitis of tubercular, meningeal, measles, varicella, measles, enterovirus origin.

 Poliomyelitis need to be differentiated from neurologic diseases as polyradiculoneuritis, myelitis,  congenital myotonia, facial neuritis of other etiology. Meningeal form need to be differentiated with serous meningitis caused by Coxacie or ECHO-viruses.

Differential diagnostics of poliomyelitis with similar forms of enterovirus infection

Signs	poliomyelitis	poliomyelitis like forms of enterovirus infection
Latent period	5-35 days	2-10 days
Toxic syndrome	severe	Mild or moderate
fever	high	moderate
Catarrhal signs	mild	typical (herpangina)
Preparalytic period duration	2-3 days	5-7 days
Skin rashes	absent	Often present
paralysis	peripheral paralysis, stable	peripheral paresis, usually disappears
the tendon reflexes	absent	Decreased or normal
Muscular atrophy	typical	Rare, some muscles
Renewal of function	Less damaged motoneurons in a year	Practically complete in 3-4 wks
CSF changes	As in serous meningitis	Not typical
Virological studies	Poliovirus	Coxackie A, ЕСНО

Treatment:

In acute period

·        Obligatory hospitalization.

·        Physical and psychical rest.

·        Analgetics (analgin 50% 0,1 ml/year of life, bromides).

·        Thermal procedures (hot wrappings, ozocerite, paraffin appliques).

·        dehydration (lasix 1-3 mg/kg, mannit, manitol 1-1.5 g/kg).

·        glucocorticoids (in severe cases) 1-3 mg/kg (by prednisolon).

·        Human immuneglobulin 0.5 m/kg 2-3 days.

In the early period of rehabilitation

·        Proserin 1 mg/year of life, galantamin, dibasol 1-5 mg per day for 20-30 days.

·        physical exercises, physiotherapy, ozocerite, paraffin appliques, diathermy, massage.

·        Vitamins (В₆, В₁₂), ATPh.

·        anabolic steroids (2-3 courses per year).

An orthopaedic correction in residual period.

Prophylaxis

·        Isolation on 21 day from the disease  beginning, hospitalization of patient.

·        Supervision after contact for 3 weeks.

·        Specific active: vaccination by an inactivated (once) than an oral (twice)polo vaccine (IPV, OPV) from a 3 mo age, with a 30 days interval, OPV revaccinatiion in 18 months, 6, 14 years.

Poliovaccine (inactivated)

  

Combined Poliovaccine (inactivated)

Oral Poliovaccine

  

Vaccination by Oral Poliovaccine

Vaccine associated poliomyelitis (diagnostic criteria)

·        Beginning of illness not early than 4 days and not later than 30 days after the reception of vaccine, for those, who contacted with vaccinated children - up to 60 days.

·        Development of languid paresis or paralyses without violation of sensitiveness with the proof (after 2 mo) remaining phenomena.

·        Absence of the disease progress.

·        Selection of identical virus with the vaccinal culture of virus (by the antigen properties), 4-times growth of specific antibodies.

References:

Main:

1.     Current therapy in pediatric infectious diseases – 2 edited by John D. Nelson, M. D. – B.C. Decker  inc. Toronto, Philadelphia, 1988, - P. 134-138, 285.

2.     Ambulatory pediatric care (edited by Robert A. Derchewitz; - 2 nd ed. – Lippincot – Raven, 1992. – P. 570-574; 255.          

3.     Principles and Practice of Pediatric Infectious Diseases. / Edited by Saran S. Long, Larry K. Pickering, Charles G. Prober, Philadelphia, Pa: Churchill Livingstone; 1997. – 1921 p.

Additional:

1.     Textbook of Pediatric Nursing.  Dorothy R. Marlow; R. N., Ed. D. –London, 1989.-661p.

2.     Pediatrics ( 2^nd edition, editor – Paul H.Dworkin, M.D.) – 1992. – 550 pp.