POLIOMYELITIS

DESCRIPTION

often called polio or infantile paralysis, is an acute, viral, infectious disease spread from person to person, primarily via the fecal-oral route

DESCRIPTION

Affects chiefly the anterior horn cells of the spinal cord and the medulla, cerebellum and midbrain

ETIOLOGIC/CAUSATIVE AGENT Poliomyelitis is caused by infection with a virus known as poliovirus (PV).

 There are three serotypes of poliovirus,: 1. PV1: most frequent cause of paralytic poliomyelitis, both epidemic and endemic : As of 2012, PV1 is highly localized to regions in Pakistan and Afghanistan in Asia, and Nigeria, Niger and Chad in Africa

ETIOLOGIC/CAUSATIVE AGENT

ETIOLOGIC/CAUSATIVE AGENT
2. PV2: the next most frequent : Wild poliovirus type 2 has probably been eradicated; it was last detected in October 1999 in Uttar Pradesh, India 3. PV3: Wild PV3 is found in parts of only two countries, Nigeria and Pakistan.

ETIOLOGIC/CAUSATIVE AGENT

Poliovirus is however strictly a human pathogen, and does not naturally infect any other species

ETIOLOGIC/CAUSATIVE AGENT

Poliovirus ( Legio Debilitants) There are three strains of poliomyelitis: Brunhilde Lansing Leon

INCUBATION PERIOD

14 days, with a range of 5-35 days, for paralytic and non-paralytic forms; 3-5 days for the minor illness

PERIOD OF COMMUNICABILITY

Most contagious in a few days before and after the onset of symptom when the virus is found in the oropharynx for about a week, and in large quantities in the small bowels, and continues to be in the feces up to 3 months

MODES OF TRANSMISSION

Virus is harbored in GIT and is transmitted through saliva, vomitus, and feces. Person-to-person spread of poliovirus via the fecal-oral route is the most important route of transmission

RISK FACTORS

Age: Infants and elderly

RISK FACTORS
Living with an infected person

RISK FACTORS
Compromised immmune system

Lack of immunization against polio

Extreme stress or strenous activity

RISK FACTORS
Travel to an area that has experienced a polio outbreak

RISK FACTORS
Poor sanitation and hygiene Poverty Tonsillectomy: a risk factor for bulbar paralysis.

TYPES
1.Subclinical/asymptomatic/silent Persons who are expose to poliomyelitis ward like the nurses and other members of the health team. But not all polio victim has small leg or both.

TYPES
2. Abortive/Nonparalytic type Starts with a mild to moderate upper respiratory infection or with symptoms of mild influenza like mild fever, malaise, head ache, sore throat, inflamed pharynx and vomiting (9095% of cases)

 Symptoms usually last 1 - 2 weeks

TYPES
3. Preparalytic/Meningitic type (Major Illness of Poliomyelitis) At least 5% are affected Second febrile stage is observed, this time with higher temperature, headache, vomiting, restlessness, anorexia, lethargy, and pain in the neck and back, arms, legs and abdomen

TYPES
It causes also muscle spasms and tenderness in the extension of the neck and back It usually lasts about a week with meningeal irritation persisting for about two weeks

TYPES
4. Paralytic Type (0.5-1%) In rare cases, poliovirus infection leads to paralytic polio, the most serious form of the disease Early manifestations are pain and some degree of stiffness followed by twitching and diminished deep tendon reflexes

TYPES
Loss of tendon reflexes, positive Kernigs signs and Brudzinskis Sign In one to two days later, weakening of muscles plus paralysis Positive Hoyne signs

PARALYTIC TYPE

Spinal Paralytic Poliomyelitis Bulbar Form of Poliomyelitis Bulbospinal Paralytic Poliomyelitis

ANATOMY AND PHYSIOLOGY

PATHOPHYSIOLOGY

PATHOGNOMONIC SIGN

NEURONAL DAMAGE flaccid paralysis weakness or paralysis reduced muscle tone

PHYSICAL EXAMINATION

PROGNOSIS

What to expect depends on the form of the disease (subclinical, nonparalytic, or paralytic) and the site affected

PROGNOSIS
If the spinal cord and brain are not involved, which is the case more than 90% of the time, complete recovery is likely.

PROGNOSIS
Brain or spinal cord involvement is a medical emergency that may result in paralysis or death (usually from respiratory difficulties).

PROGNOSIS

Disability is more common than death. Infection high in the spinal cord or in the brain increases the risk of breathing problems.

DIAGNOSTIC /LABORATORY TESTS Virus Culture The laboratory diagnosis of polio is confirmed by isolation of virus by cultures, from the stool or throat swab or cerebrospinal fluid (rare). In an infected person, the virus is most likely to be cultured in stool cultures.

DIAGNOSTIC /LABORATORY TESTS Serologic test Acute and convalescent serum sample may be tested for rise in antibody titer (antibodies to the poliovirus), but the report can be difficult to interpret as in many cases, the rise in titer may occur prior to paralysis.

DIAGNOSTIC /LABORATORY TESTS

Cerebrospinal fluid test Infection with polio virus may cause an increased number of white blood cells and a mildly elevated protein level in cerebrospinal fluid

COMPLICATIONS Aspiration pneumonia Cor pulmonale High blood pressure Kidney stones Lack of movement Lung problems

COMPLICATIONS

Myocarditis Paralytic ileus (loss of intestinal function) Permanent muscle paralysis, disability, deformity Pulmonary edema

COMPLICATIONS

Shock Urinary tract infections Late complications: skeletal and soft tissue deformity

COMPLICATIONS

Post-polio syndrome is a complication that develops in some patients, usually an average of 25 to 35 after their initial infection.

COMPLICATIONS

Weakness may get worse in muscles that were previously weakened. Weakness may also develop in muscles that previously were thought not to be affected.

TREATMENT/MANAGEMENT

Medical Surgical Pharmacological

MEDICAL MNGT
Treatment of pain with analgesics (such as acetaminophen). Antibiotics for secondary infections (none for poliovirus). Fluid Therapy Prolong rehabilitation may be necessary including braces, splint or surgery.

SURGICAL MNGT

NURSING MANAGEMENT

POSSIBLE PREVENTION & CONTROL

The best preventive measure for poliomyelitis is ensuring hygiene and encouraging good sanitation practices. But, polio prevention begins with polio vaccination.

 Polio vaccine has been developed against all 3 subtypes of the poliovirus and is very effective in producing protective antibodies that induces immunity against the poliovirus and provides protection from paralytic polio.

POSSIBLE PREVENTION & CONTROL

Two types of vaccine are available: an inactivated (killed) polio vaccine (IPV) and a live attenuated (weakened) oral polio vaccine (OPV).

POSSIBLE PREVENTION & CONTROL

POSSIBLE PREVENTION & CONTROL

DIET
Increase Protein Reduce Sugar

EXERCISE
Strengthening Exercise Cardiovascular Exercise Hydrotherapy