A Family Doctor's Tale - POLIOMYELITIS

DOC I HAVE POLIOMYELITIS


Poliomyelitis is a very rare viral disease which is seldom seen in children unlike the 1950 or 60 where poliomyelitis is quite common resulting in deformities of the limbs.

The childhood vaccinations against poliomyelitis has resulted in significantly few cases of poliomyelitis mostly imported.

Poliomyelitis is an acute highly contagious viral illness with a wide range of severity caused by the polio virus.


It attacks the muscles and nerves throughout the body resulting in possible permanent paralysis or death.



The polio virus is an enteric virus classified into type 1, 2 and 3 according to tissue culture.

The disease is transmitted by human contact with discharges from the nose, mouth or faeces of an infected person.


From the nose and mouth, the virus proliferates in the nose and intestinal tract.


Once in the body it can spread through the blood and lymphatic system to attack the muscles and nerves.


The incubation period is 7 -14 days.

Symptoms of Poliomyelitis:


There are 3 patterns of polio infection;
1.subclinical -does not involve the central nervous system(CNS),
95% are subclinical infections which go unnoticed.

2.non-paralytic-involve the CNS but without paralysis

3.paralytic -involve the CNS with paralysis.
Bulbar Poliomyelitis affects the cranial nerves affecting paralysis of the facial movement,swallowing and larynx

Sufferers of polio have the following symptoms:

1.mild cases -
headache,
slight fever,
nausea and vomiting for up to 3 days.

2.slightly more severe cases -
moderate fever,
muscle pain,
stiff neck and back
fatigue.

3.severe cases -
high fever,
muscle pain or spasms,
muscle weakness,
stiffness of neck and body muscles,
constipation,
tremor
difficulty with swallowing.
difficulty in breathing

Symptoms post-polio( after the fever subsided):

1.progressive muscular weakness in muscles affected during the original infection.
Other muscles not to be affected during the original infection may also become weak.

2.Joint pain

3.extended periods of fatigue

4.Memory and concentration levels may be poorer.

5.Muscles may become smaller (atrophy) in some cases.

6.Difficulty with swallowing

7.Difficulty in breathing

8.Difficulty in walking

Investigations needed in Poliomyelitis:


1.CSF fluid-high leucocytes and protein


2.blood virological studies

Treatment for Poliomyelitis:

There is no cure for polio so treatment is symptomatic.
1.Bed rest

2.antibiotics are used to treat urinary tract infections.

3.Bethanechol can help reduce urine retention.

4.Analgesics are used to reduce headaches and muscle pain.

5.Assisted breathing with tracheostomy and respirator and intravenous fluids may be required in severe cases.

Poliomyelitis can be prevented by:


Vaccination against polio using oral doses or injection is recommended for all children from every month from 3rd to 5th month and a booster at 18 months of age.

Booster doses are also given at 6 years and 12 years of age.

Since immunization with polio vaccines started, the cases of poliomyelitis has declined worldwide.

Prognosis of Poliomyelitis:


Majority of patients has subclinical and non-paralytic Poliomyelitis  and recovered completely.

The remainder has paralytic Poliomyelitis.
Half has complete recovery in 4-6 weeks.

25% has mild disability.

The last 25% suffer severe permanent damage of muscles and nerves.
These patients are usually crippled with difficulty in walking and may need special aids such as wheelchairs,walking sticks etc to help them in their everyday life.

Mortality is in children is 1-3%.


Bulbar Poliomyelitis and adult patients have higher mortality.